Tuberculosis in the community: 2. The perceptions of members of a tuberculosis health team towards a voluntary health worker programme

Dick, Judy; Schoeman, Jan H

doi:10.1016/s0962-8479(96)90106-9

Cited by 15 publications

(12 citation statements)

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“…Although not much detail is given about the community relationship of the recruits, this is more detail than that provided in other studies. Another small group of studies focuses specifically on peer health workers, or people with previous experience of a specific disease as CLHW [41,63,64]. Here, previous experience is explicitly acknowledged, yet like most studies, very little additional information is available on these recruits and on their relationship with the community.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies provide information about motivation, but do not connect this to retention or attrition [31,38,39,45,50,59,63,65,67]. With regard to attrition, the discourse in some studies suggests a particularly high relevance of remuneration [31,62,64,67].…”

Section: Synthesis Of Findingsmentioning

confidence: 99%

“…From this perspective it is striking that at least sixteen studies provide no longitudinal data or descriptive indications of sustainability [37,45,46,48,49,52,54,55,58–61,63–65]. Soares et al note that drug and gang violence driven by external factors jeopardized sustainability of the favela program [57].…”

Section: Synthesis Of Findingsmentioning

confidence: 99%

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The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review

Vries

Pool

2017

PLoS ONE

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BackgroundDespite the availability of practical knowledge and effective interventions required to reduce priority health problems in low-income countries, poor and vulnerable populations are often not reached. One possible solution to this problem is the use of Community or Lay Health Workers (CLHWs). So far, however, the development of sustainability in CLHW programs has failed and high attrition rates continue to pose a challenge. We propose that the roles and interests which support community health work should emerge directly from the way in which health is organized at community level. This review explores the evidence available to assess if increased levels of integration of community health resources in CLHW programs indeed lead to higher program effectiveness and sustainability.Methods and FindingsThis review includes peer-reviewed articles which meet three eligibility criteria: 1) specific focus on CLHWs or equivalent; 2) randomized, quasi-randomized, before/after methodology or substantial descriptive assessment; and 3) description of a community or peer intervention health program located in a low- or middle-income country. Literature searches using various article databases led to 2930 hits, of which 359 articles were classified. Of these, 32 articles were chosen for extensive review, complemented by analysis of the results of 15 other review studies. Analysis was conducted using an excel based data extraction form. Because results showed that no quantitative data was published, a descriptive synthesis was conducted. The review protocol was not proactively registered. Findings show minimal inclusion of even basic community level indicators, such as the degree to which the program is a community initiative, community input in the program or training, the background and history of CLHW recruits, and the role of the community in motivation and retention. Results show that of the 32 studies, only one includes one statistical measure of community integration. As a result of this lack of data we are unable to derive an evidence-based conclusion to our propositions. Instead, our results indicate a larger problem, namely the complete absence of indicators measuring community relationships with the programs studied. Studies pay attention only to gender and peer roles, along with limited demographic information about the recruits. The historicity of the health worker and the community s/he belongs to is absent in most studies reviewed. None of the studies discuss or test for the possibility that motivation emanates from the community. Only a few studies situate attrition and retention as an issue enabled by the community. The results were limited by a focus on low-income countries and English, peer-reviewed published articles only.ConclusionPublished, peer-reviewed studies evaluating the effectiveness and sustainability of CLHW interventions in health programs have not yet adequately tested for the potential of utilizing existing community health roles or social networks for the development of effective and sus...

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Section: Resultsmentioning

confidence: 99%

Section: Synthesis Of Findingsmentioning

confidence: 99%

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The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review

Vries

Pool

2017

PLoS ONE

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“…4 TB is a stigmatised disease and the lack of support from health workers, family and friends, as well as the length of the treatment period, all contribute to the temptation to discontinue TB therapy. 5 The context of this research was Van Wyksvlei, a sub-economic area of Wellington. Wellington is part of the Drakenstein Municipality and is mainly an agricultural area.…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of the reasons why PTB patients at clinics in the Wellington area stop their treatment

Portwig¹,

Couper

2006

South African Family Practice

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BackgroundTuberculosis (TB) remains the leading infectious cause of adult mortality, despite 60 years of effective chemotherapy. One reason for this is the problem caused by the interruption and failure of treatment, which usually are related to non-adherence. The reasons for non-adherence to TB treatment are multifaceted, ranging from the personalities of the patients to the social and economic environment. In South Africa, the most common problems have been shown to be the erratic way in which the treatment is taken, and not patients absconding from the treatment program. There is a strong suspicion that the disability grants issued to TB patients are acting as a disincentive to finish anti-tuberculosis medication. TB is a stigmatised disease and the lack of support from health workers, family and friends, as well as the length of the treatment period, all contribute to the temptation to discontinue TB therapy. This research was undertaken in Van Wyksvlei, a sub-economic area of Wellington. Wellington is part of the Drakenstein Municipality in the Western Cape, South Africa and is mainly an agricultural area. The aim of the study was to explore and describe the reasons why patients in the Wellington area do not complete their TB treatment, and then to make recommendations to improve adherence.

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“…One article was found which investigates methods of improving skills and utilisation of community health volunteers in Nepal who are primarily involved in reducing vitamin A deficiency (Curtale et al, 1995). Another article presents results of interviews with health team members in South Africa regarding their perceptions of volunteers (Dick and Schoeman, 1996). Some motivating factors are identified in community health workers for HIV in a previously reported article evaluating community care for TB in Africa (Maher et al, 1997).…”

mentioning

confidence: 99%

Best dissertation section

Thomas

2002

Journal of Management in Medicine

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Tuberculosis is the cause of a large burden of disease in less developed countries. With the development of drug resistance and the co-epidemic of HIV, tuberculosis has already started to make a comeback in wealthier countries. The WHO's solution to this global tuberculosis epidemic is the DOTS strategy, the implementation of which presents many problems. The two issues most common to the majority of locations are delay in presentation for treatment and non-completion of treatment. This review looks at the reasons for these problems in the less developed world, and addresses some solutions. The main reasons for delayed presentation are: a lack of understanding about TB; the stigma associated with the disease; the inaccessibility of treatment; and a preference for private practitioners. The main reasons for non-completion of treatment are: the stigma of the disease; a lack of information; dissatisfaction with the treatment and its delivery; and inaccessibility of treatment. Successful implementations of the DOTS strategy need to address all these issues. There is little evidence that DOT enhances treatment completion unless combined with other strategies. Community-based, patient-orientated DOTS appears to be an appropriate way of addressing many of these issues. The involvement of volunteers in community-based strategies is common, but needs more research in order for this strategy to realise its full potential.

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Tuberculosis in the community: 2. The perceptions of members of a tuberculosis health team towards a voluntary health worker programme

Cited by 15 publications

References 6 publications

The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review

The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review

A qualitative study of the reasons why PTB patients at clinics in the Wellington area stop their treatment

Best dissertation section

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