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Determinants of Community Health Worker Performance in Nutrition Education in a Multi‐tasked Setting in Rural Zimbabwe
Author(s) -
Kambarami R,
Mbuya M,
Humphrey J,
Stoltzfus R
Publication year - 2015
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.29.1_supplement.898.7
Subject(s) - psychological intervention , hygiene , nursing , medicine , environmental health , context (archaeology) , psychology , geography , archaeology , pathology
Zimbabwe, like several low‐income countries, faces health worker shortages. Community Health Workers (CHWs) bridge this gap and help deliver essential health services and nutrition interventions. However, as CHW workloads increase, their ability to provide quality services is compromised. We studied determinants of CHWs' performance delivering nutrition and hygiene education in rural Zimbabwe. In the ongoing SHINE trial, 79 CHWs deliver household‐level lessons on infant feeding and hygiene. We assessed CHW demographic and work context characteristics by questionnaire interview. Exploratory factor analyses of the Likert‐type questions produced distinct and reliable (Cronbach's alpha range: 0.68‐0.93) constructs of motivation, supervision, peer support and feedback. Performance of CHWs was assessed through direct observation by a nurse supervisor using a seven‐item checklist. Multiple logistic regression was used to test associations between CHW characteristics and performance. Female CHWs (OR 9.91; 95% CI 1.37‐71.52) and CHWs with positive perceptions of good performance feedback (OR 8.45; 95% CI 1.84‐38.79) were significantly more likely to be high performers. Amongst CHWs responsible for multiple tasks in rural Zimbabwe, female gender and positive feedback are associated with high quality delivery of behavior change education in infant feeding and hygiene. Our methods and findings illustrate ways to understand heterogeneity in CHW performance and also identify modifiable organizational factors associated with program delivery.