Please note that the following order contains 7 separate papers that are all dependent on
one another.
Each of the following 7 tasks must be completed independently with each paper meeting
defined length and having their own title page and reference page.
I’ve submitted all 7 tasks to be completed as one order so the finished papers would flow
naturally and the style and themes would be interwoven.
Hope the following helps clarify the requirements of this order.
Please note the total number of pages (40) ordered are broken down into the following
areas.
RET1 – Issues in Research Fundamentals (Tasks 1, 2, and 3)
Task 1. Topic Selection Reflection: 5 pages
Task 2: Literature Review Reflection: 5 pages
Task 3: Research Paradigms/ Research Design
• Part B: 4 pages
• Part C: 4 pages
• Part D: 4 pages
RPT1 Research Proposal (Tasks 4, 5, 6, and 7)
• Task 4: Participants & Instruments (Part A): 4 pages
• Task 5: Methodology_ Task 5 (Part B): 4 pages
• Task 6: Data Analysis_ Task 6 (Part C): 4 pages
• Task 7: Complete Research Proposal
A. Abstract (approximately 120 words in length)
B. Table of contents
C. Introduction (suggested length of 3 paragraphs)
D. Previously Evaluated Components: 4 pages
E. Conclusion, including a reflection statement about the process of creating this
research proposal (suggested length of 3 paragraphs).
RET1 – Issues in Research Fundamentals
Task 1. Topic Selection Reflection
LITERATURE REVIEW
Topic Selection – The graduate understands how to select appropriate research topics and
research paradigms.
Describe the process of selecting an appropriate research topic.
Introduction:
In the first task of the research fundamentals project you are asked to develop a research
topic and describe the problem.
After you have completed that task, reflect on the process of selecting your topic.
Task 1: 5 pages in length.
Write an essay in which you:
A. Describe the process you used to select your research topic in your problem, search, and
evaluation task.
1. Describe what motivated you to select your topic. (Interest in community health nursing:
see attached papers for reference)
2. Describe what barriers you think you might encounter with your research topic.
3. Describe how your research topic will benefit your field.
B. Include all in-text citations and references in APA format.
RET1 Task 1 Grading Criteria-Topic Selection
Reflection:
Communication Holistic: The work is extremely clear and easy to understand.
Mechanics (grammar, punctuation, spelling, etc.): The work contains no readily detectable
errors.
Style: The writing style is characterized by highly varied sentence structure, vivid
vocabulary, and accurate word choice.
A1. Selection of Topic
The candidate provides a precise description of what motivations there were to select the
research topic.
A2. Barriers
The candidate provides a precise description of barriers that may be encountered with the
research topic.
A3. Benefit to the Field
The candidate provides a precise description of how the research topic will benefit the
field.
B. Sources: The candidate provides appropriate in-text citations and/or references with no
readily detectable deviations from APA style.
Task 2. Literature Review Reflection (508.2.1-01, 02, 2.3-05)
Describe the purpose of conducting a literature review.
Discuss how conducting a literature review relates to other parts of the research plan.
Define how conducting a literature review can clarify the relationship between research and
practice.
Explain how resource availability and selection can limit the scope of a research topic.
Introduction:
After you have completed the full literature review task (RLT1 508.2.5-03-06, 08, 09), you
are prepared to write a reflection of your literature review experience.
Take a moment to think about the process of conducting a literature review, selecting
resources, and how the review will affect your next step in your research plan.
Task 2: 5 pages in length
Write an essay that reflects on your literature review process.
Address the following elements in the essay:
A. Describe the process you went through to select your research topic in your problem,
search, and evaluation RLT Task 1. (see attached documentation)
B. Discuss the purpose of conducting a literature review of your chosen research topic.
C. Discuss at least two specific examples of how the literature review affected different
components of your research proposal.
D. Explain how resource availability and selection limited the scope of your research
topic.
E. Discuss how performing a literature review affects your practice in a professional
setting.
F. Include all in-text citations and references in APA format.
RET1 Task 2 Grading Criteria Literature Review Reflection
Communication Holistic: The work is extremely clear and easy to understand.
Mechanics (grammar, punctuation, spelling, etc.): The work contains no readily detectable
errors.
Style: The writing style is characterized by highly varied sentence structure, vivid
vocabulary, and accurate word choice.
A. Process for Selecting Research Topic
The candidate provides a precise description of the process used to select the research
topic.
B. Purpose of Literature Review
The candidate provides a credible and well-supported discussion of the purpose of
conducting a literature review of the research topic.
C. Effect of Literature Review on Research Proposal
The candidate provides a logical discussion of more than 2 specific examples of how the
literature review affected different components of the research proposal.
D. Resource Availability and Selection
The candidate provides a credible and well-supported explanation of how resource
availability and selection limited the scope of the research topic.
E. Effect of Literature Review on Professional Practice
The candidate provides a credible and well-supported discussion of how performing a
literature review affects practice in a professional setting.
F. Sources: The candidate provides appropriate in-text citations and/or references with no
readily detectable deviations from APA style.
Overall Holistic
Task 3: RESEARCH PARADIGMS/ RESEARCH DESIGN
Quantitative Research Paradigms – Quantitative Research Paradigms
The graduate understands the components of quantitative research.
The graduate understands the components of qualitative research.
Action Research Paradigms – Action Research Paradigms
The graduate understands the components of action research.
Types of Variables and Data – Types of Variables and Data
The graduate understands and uses different types of variables and data that can be
collected during a research study.
Data Collection
The graduate evaluates the relative merits of instruments for measuring specific
motivation, performance, and learning style variables.
Research Proposal – The graduate completes a research proposal.
Objectives:
Outline a research scenario that would be suitable for quantitative research.
Outline a research scenario that would be suitable for qualitative research.
Outline a research scenario that would be suitable for action research.
Describe how action research benefits the field of education.
Compare and contrast action research methodology with other forms of research.
Differentiate between quantitative and
qualitative data.
Define nominal, ordinal, interval, and ratio variables.
Identify examples and non examples of measurable variables.
Recognize the purposes of specified types of data collection instruments.
Identify specific data collection instruments appropriate for qualitative data collection.
Describe a research design that will be utilized to prove a hypothesis.
Discuss the role of the researcher in a research project.
Introduction:
There are several paradigms of educational research.
Each of these paradigms will help direct your research study, including how your subjects
are selected, what your role as a researcher is, and how you collect and analyze different
types of data.
For this task you will be describing three different research scenarios—one each for a
quantitative, qualitative, and action research paradigm—that are appropriate for your
professional setting.
Task 3:
Write an original essay in which you:
A. Describe your professional setting. (Community health clinic and Progressive Care Unit
in hospital setting)
B. Describe a research scenario appropriate for a quantitative research paradigm (length 4
pages).
Within that scenario, include the following elements:
1. State an appropriate research question and/or hypothesis.
2. Define the role of the researcher.
3. Describe the target audience and the role of the participants.
4. Discuss possible variations of groupings in your quantitative research scenario.
5. Discuss methods (such as survey, test, observation) and corresponding instruments (such
as interviews or questionnaires, multiple-choice objective tests, and observation
checklists) to be used for data collection.
6. Describe the types of data to be collected that would influence your choice of data
analysis.
7. Describe types of data analysis you would use.
8. Explain how quantitative research benefits your field.
C. Describe a research scenario appropriate for a qualitative research paradigm (length 4
pages).
Within that scenario, include the following elements:
1. State an appropriate research question.
2. Define the role of the researcher.
3. Describe the target audience and the role of the participants.
4. Discuss possible variations of groupings in your qualitative research scenario.
5. Discuss approaches/methods (such as surveys, case studies, observation) and
corresponding instruments (such as interviews or questionnaires, multiple-choice objective
tests, and observation checklists) to be used for data collection.
6. Describe three types of data you would collect to allow for triangulation of data.
7. Describe types of data analysis you would use.
8. Explain how qualitative research benefits your field.
D. Describe a research scenario appropriate for an action research paradigm (length 4
pages).
Within that scenario, include the following elements:
1. State an appropriate research question and/or hypothesis.
2. Define the role of the researcher.
3. Describe the target audience and the role of the participants.
4. Discuss possible variations of groupings in your action research scenario.
5. Discuss methods (such as survey, test, case study, observation) and corresponding
instruments (such as interviews or questionnaires, multiple-choice objective tests, and
observation checklists) to be used for data collection.
6. Describe three types of data you would collect to allow for triangulation of data.
7. Describe types of data analysis you would use.
8. Explain how action research benefits your field.
E. Include all in-text citations and references in APA format.
RET1 Task 3 Grading Criteria
Communication Holistic The work is extremely clear and easy to understand.
Mechanics
(grammar, punctuation, spelling, etc.) The work contains no readily detectable errors.
Style (word choice, sentence structure, etc.) The writing style is characterized by highly
varied sentence structure, vivid vocabulary, and accurate word choice.
A. Professional Setting
The candidate provides a precise description of the professional setting.
B. Scenario for Quantitative Research
The candidate describes a plausible scenario for quantitative research.
B1. Research Question and/or Hypothesis
The candidate states an appropriate research question and/or hypothesis.
B2. Researcher’s Role
The candidate provides a precise definition of the role of the researcher.
B3. Target Audience and Participants’ Role
The candidate provides a precise description of the target audience and the role of the
participants.
B4. Groupings
The candidate provides a credible and well-supported discussion of possible variations of
groupings in the quantitative research scenario.
B5. Methods of Data Collection and Instruments Used
The candidate provides a credible and well-supported discussion of methods and
corresponding instrumentation to be used for data collection.
B6. Types of Data Collected
The candidate provides a precise description of the types of data to be collected.
B7. Types of Data Analysis Used
The candidate provides a precise description of the types of data analysis used.
B8. Field Benefits of Quantitative Research
The candidate provides a credible and well-supported explanation of how quantitative
research benefits the field.
C. Scenario for Qualitative Research
The candidate describes a plausible scenario for qualitative research.
C1. Research Question
The candidate states an appropriate research question.
C2. Researcher’s Role
The candidate provides a precise definition of the role of the researcher.
C3. Target Audience and Participants’ Role
The candidate provides a precise description of the target audience and the role of the
participants.
C4. Groupings
The candidate provides a credible and well-supported discussion of possible variations of
groupings in the qualitative research scenario.
C5. Approaches/Methods of Data Collection and Instruments Used
The candidate provides a credible and well-supported discussion of approaches/methods of
data collection, including instruments used.
C6. Types of Data Collected
The candidate provides a reasonable description of 3 types of data to be collected.
C7. Types of Data Analysis Used
The candidate provides a precise description of the types of data analysis used.
C8. Field Benefits of Qualitative Research
The candidate provides a credible and well-supported explanation of how qualitative
research benefits the field.
D. Scenario for Action Research
The candidate describes a plausible scenario for action research.
D1. Research Question and/or Hypothesis
The candidate states an appropriate research question and/or hypothesis.
D2. Researcher’s Role
The candidate provides a precise definition of the role of the researcher.
D3. Target Audience and Participants’ Role
The candidate provides a precise description of the target audience and the role of the
participants.
D4. Groupings
The candidate provides a credible and well-supported discussion of possible variations of
groupings in the quantitative research scenario.
D5. Methods of Data Collection and Instruments Used
The candidate provides a credible and well-supported discussion of methods of data
collection, including instruments used.
D6. Types of Data Collected
The candidate provides a reasonable description of 3 types of data to be collected.
D7. Types of Data Analysis Used
The candidate provides a precise description of the types of data analysis used.
D8. Field Benefits of Action Research
The candidate provides a credible and well-supported explanation of how action research
benefits the field.
E. Sources
Candidate provides appropriate in-text citations and/or references with no readily
detectable deviations from APA style.
Overall Holistic
RPT1 Research Proposal Participants & Instruments (Part A)
RESEARCH DESIGN
Research Proposal – The graduate completes a research proposal.
Describe an appropriate methodology to investigate a problem.
Introduction:
This task is the first of four tasks comprising a Research Proposal.
In this task you will use the problem definition, research questions, and literature review
created in RLT1 – Literature Review for Research to develop the participants and
instruments section of the research proposal.
Task 1: Participants and Instruments Part A
Write an essay 4 pages in length.
A. Provide the following components from task RLT1: (see attached)
Task 4:
• Description of the problem that exists in an instructional setting
B. Discuss why this research approach is an appropriate choice for your proposal.
C. State the purpose of your research proposal.
D. Describe your role and bias as the researcher in your chosen research approach.
E. Describe the sampling techniques you will use.
1. Explain why the sampling techniques you will use are appropriate to the methodology you
have chosen.
F. Describe your target audience or participants, including age and number of participants,
gender, ethnicity, economic situation (if appropriate), education level, etc.
G. State an appropriate hypothesis statement, if relevant to your research approach.
Note: A qualitative research approach will not necessarily include a qualitative hypothesis
statement.
H. Include all in-text citations and references in APA format.
Research_Proposal_Task_4_ Part A
Mechanics (grammar, punctuation, spelling, etc.) The work contains no readily detectable
errors.
Style (word choice, sentence structure, etc.) The writing style is characterized by highly
varied sentence structure, vivid vocabulary, and accurate word choice.
A. Required Information
The candidate provides the required information for evaluator reference.
B. Appropriateness of Approach
The candidate provides a credible and well-supported discussion of why this research
approach is an appropriate choice for the proposal.
C. Purpose of Research Proposal
The candidate provides an appropriate statement of the purpose of the research proposal.
D. Role and Bias of Researcher
The candidate provides a precise description of the role and bias as the researcher.
E. Sampling Techniques
The candidate provides a precise description of the sampling techniques to be used.
E1. Appropriateness of Sampling Techniques
The candidate provides a credible and well-supported discussion of why the sampling
technique is an appropriate choice for the proposal.
F. Target Audience or Participants
The candidate provides a precise description of the target audience or participants.
G. Hypothesis Statement
The candidate provides an appropriate hypothesis statement, or uses a qualitative approach
and does not need a hypothesis statement.
H. Sources
The candidate provides appropriate in-text citations and/or references with no readily
detectable deviations from APA style.
Overall Holistic
Methodology_ Task 5 (Part B)
RESEARCH DESIGN
Research Proposal – The graduate completes a research proposal.
Describe an appropriate methodology to investigate a problem.
Introduction:
This task is the second of four tasks comprising the Research Fundamentals project.
In this task you will use the problem definition, research questions, and literature review
created in RLT1 to construct the methodology section of the research proposal.
Task 5:
For parts B–E, use your chosen research approach to guide your selection of data collection
methods, instruments, data, and methodology.
Write an essay 4 pages in length in which the following information is provided:
A. Provide the following components from the first task in RPT1 (Part A):
• Description of the problem that exists in an instructional setting
• Description of the research design and approach you plan on implementing
• Rationale for research approach
• Role and bias of researcher
• Sampling techniques used
• Description of participants or target audience
• Hypothesis statement (if appropriate)
Note: A qualitative research approach will not necessarily include a qualitative hypothesis
statement.
B. Describe the data collection methods used for your research proposal.
C. Describe the instruments used for data collection.
D. Describe the data you will collect through your instruments or methods.
E. Describe your research procedure.
F. Include all in-text citations and references in APA format.
RPT2 508.3.6-07 Part B Grading Criteria
Communication Holistic The work is extremely clear and easy to understand.
Mechanics (grammar, punctuation, spelling, etc.) The work contains no readily detectable
errors.
Style (word choice, sentence structure, etc.) The writing style is characterized by highly
varied sentence structure, vivid vocabulary, and accurate word choice.
A. Required Information
The candidate provides the required information for evaluator reference.
B. Data Collection Methods
The candidate provides a precise description of the data collection methods.
C. Instruments Used
The candidate provides a precise description of the instruments used for data collection.
D. Data to be Collected
The candidate provides a precise description of the data to be collected.
E. Procedure
The candidate provides a precise description of the research procedure.
F. Sources
The candidate provides appropriate in-text citations and/or references with no readily
detectable deviations from APA style.
Overall Holistic
Data Analysis_ Task 6 (Part C)
Describe the process of data analysis used to evaluate data in the context of a specified
research paradigm.
Introduction:
This task is the third of four tasks comprising RPT1 – Research Proposal.
In this task you will describe the data analysis portion of your research proposal, which
you will develop using research questions and methodology based on the topic.
Task 6:
In a brief essay (4 pages) provide a detailed description of how you would analyze the data
you have collected for your research proposal.
The description should:
A. Provide your research methodology (for evaluator reference only).
B. Describe techniques you will use to analyze collected data, which could include any
statistical technique or a computer analysis program.
C. Provide a rationale for the analysis you have chosen.
D. Describe how you might interpret the results of the analysis to assist you in answering
your research questions.
E. Include all in-text citations and references in APA format.
RPT3 Grading Criteria for Data Analysis Task 6
Communication Holistic
The work is extremely clear and easy to understand.
Mechanics (grammar, punctuation, spelling, etc.) The work contains no readily detectable
errors.
Style (word choice, sentence structure, etc.)
The writing style is characterized by highly varied sentence structure, vivid vocabulary,
and accurate word choice.
A. Research Methodology
The candidate provides the research methodology.
B. Techniques for Analyzing Data
The candidate provides a precise description of techniques used to analyze collected data.
C. Rationale for Analysis Chosen
The candidate provides a credible and well-supported rationale for the analysis chosen.
D. Interpretation of Analysis Results
The candidate provides a precise description of how results of the analysis might be
interpreted to assist in answering the research questions.
E. Sources
The candidate provides appropriate in-text citations and/or references with no readily
detectable deviations from APA style.
Overall Holistic
Complete Research Proposal_Task 7
Design a research proposal on a specified topic.
Submit a written report of the research proposal on a specified topic.
This task is the fourth and final component of RPT1 – Research Proposal.
After you have successfully completed the participants and instruments, methodology, and
data analysis components of the project, combine all of them in this task with the
literature review task and present the information in the form of a research proposal.
Task 7:
Select a topic of interest to you and develop a research proposal to examine a researchable
question related to your topic.
This research proposal should be formatted in APA style.
In your proposal, include the following elements:
A. Abstract (approximately 120 words in length)
B. Table of contents
C. Introduction (suggested length of 3 paragraphs)
D. Previously evaluated components with headings, subheadings, formatting, and citations:
• Problem statement
• Literature review
• Hypothesis (if appropriate)
Note: A qualitative research approach will not necessarily include a qualitative hypothesis
statement.
• Research design
• Role and bias of researcher
• Sampling techniques
• Participants
• Data collection methods
• Instruments
• Research procedure
• Data analysis
E. Conclusion, including a reflection statement about the process of creating this research
proposal (suggested length of 3 paragraphs).
Possible questions to consider and address include:
• What would you do differently in building your next research proposal?
• What components were the most challenging for you to write?
• What parts of the proposal intrigued you the most?
• How do you plan on using this proposal in the future?
F. Include your data collection instrument in an appendix.
G. Include all in-text citations and references in APA format.
Grading Criteria for Task 7 Complete Research Proposal
Communication Holistic The work is extremely clear and easy to understand.
Mechanics (grammar, punctuation, spelling, etc.) The work contains no readily detectable
errors.
Style (word choice, sentence structure, etc.) The writing style is characterized by highly
varied sentence structure, vivid vocabulary, and accurate word choice.
A. Abstract
The candidate provides an abstract that precisely describes the proposal.
B. Table of Contents
The candidate provides a table of contents.
C. Introduction
The candidate provides a precise introduction to the research proposal.
D. Required Information
The candidate provides the required information with proper headings, subheadings,
formatting, and citations.
E. Conclusion
The candidate provides a credible and well-founded conclusion, including a reflection
statement.
F. Appendix
The candidate provides the data collection instrument in an appendix.
G. Sources
The candidate provides appropriate in-text citations and/or references with no readily
detectable deviations from APA style.
Overall Holistic
RLT1: Description of Health-Related Problem- the following is to be used in completion of
the following Task.
Community health workers (CHWs) are workers based in the community who assist individuals
and groups in the community access social and health services and educate them on different
issues related to health (Gopalan, Mohanty & Das, 2012).
Even though the CHWs may not replace the quality and sophisticated healthcare delivered by
highly skilled healthcare workers, they play a vital role in enhancing health care and
service access which have been associated with improved health outcomes.
In addition, the CHWs act as an effective connection between the community and the formal
healthcare system as well as a vital component in wider approach efforts that put into
consideration environmental and social health determinants (Bhutta, Lassi, Pariyo &
Huicho, 2010).
The role played by the formally trained healthcare workers, including doctors and nurses in
community and primary care, has been well-appreciated.
Nonetheless, the shortage of the formally trained staff in most countries remains the major
setback against the delivery of quality maternal and child care interventions.
Through adequate and appropriate training, CHWs can successfully perform those tasks, thus,
improving access to basic health services in the community and meeting the community’s
demand for such services (Bhutta et al., 2010).
Even though the benefits of addressing productivity are widely acknowledged, the issue
regarding the productivity of CHWs has received relatively little attention.
As many nongovernmental organizations and countries incorporate CHW strategies into
healthcare programs, there increases the necessity for guidance on how the investments on
CHW programs, in terms of quality and productivity, could be maximized (Jaskiewicz &
Tulenko, 2012).
Numerous current reviews have emphasized on examining the CHWs’ effectiveness.
However, their scope is mostly limited to particular subpopulations, study designs, or
disease conditions (Viswanathan, Kraschewski, Nishikawa, Morgan et al., 2009).
Instructional Setting
The instructional setting for the project is within the community. Community health workers
(CHWs) provide health services to members of the community, mostly in the hard to reach
areas with limited access to basic healthcare services. This is attributed to the global
shortage of skilled professional healthcare providers which hinders equitable access to
basic healthcare services by all. The CHWs do not undergo formal training but, rather, they
usually undergo short-term training on health education, promotion and the management of
certain illnesses (Bhutta et al., 2010).
Study Questions
This project is intended to investigate the quality and cost-effectiveness of the
interventions and services rendered by the CHWs, relative to those provided by the
professional and skilled healthcare providers. Structured and focused clinical questions
form the basis for this evidence based practice (Haber, 2010). PICO guidelines would be
applied to help in formulating an answerable question and obtain the major concepts that
relate to the problem under investigation. PICO is an instrument applied in evidence-based
research to aid in identifying major concepts and answerable research questions (Sean,
2008). PICO is an acronym that stands for:
• P – Problem/Population/Patient: in this case, the population under investigation
are the CHWs
• I – Intervention: the quality and cost-effectiveness of CHW health interventions
• C – Comparator/Control: professional, skilled healthcare professionals
• O – Outcome: community outcomes
The study questions are outlined below:
• What are the characteristics and roles of CHWs?
• What are the services/interventions provided by the community health workers?
• What is the outcome of CHWs on health outcomes, specifically on behavior,
knowledge, satisfaction and healthcare utilization?
• What factors influence the productivity of CHWs?
• What is known regarding the cost effectiveness of CHW programs in improving the
outcomes in health?
• Can the quality of care delivered by CHWs replace the quality of care provided by
the trained healthcare providers?
References
Bhutta, Z. A., Lassi, Z. S., Pariyo, G., & Huicho, L. (2010). Global experience of
community health workers for delivery of health related Millennium Development Goals: A
systematic review, country case studies, and recommendations for integration into national
health systems. Global Evidence of Community Health Workers, 1-377. World Health
Organization.
Gopalan, S. S., Mohanty, S. & Das, A. (2012). Assessing community health workers’
performance motivation: A mixed-methods approach on India’s Accredited Social Health
Activists (ASHA) programme. British Medical Journal, 2 (5).
Haber, J. (2010). Research questions, hypotheses, and clinical questions. In G. Wood (Ed.),
Nursing research: Methods and critical appraisal for evidence-based practice (7th ed., pp.
27-55). St. Louis, Mo.: Mosby/Elsevier.
Jaskiewicz, W. & Tulenko, K. (2012). Increasing community health worker productivity
and effectiveness: a review of the influence of the work environment. Human Resources for
Health, 10 (38), 1-9.
Sean, C. M. A., 2008. Systematic Searching of the Literature. Retrieved August 14, 2008
from: http://www.cdha.nshealth.ca/system/files/sites/…/systematic-searching-
literature.pdf.
Viswanathan, M., Kraschewski, J. L., Nishikawa, B., Morgan, L. C., Honeycutt, A. A.,
Thieda, P., Lohr, K. N., & Jonas, D. E. (2009). Outcomes of community health worker
interventions. Rockville, MD: Agency for Healthcare Research and Quality.
TASK 2
Literature Review Sources
Problem Statement
The role of CHWs in improving access to basic healthcare services in the community,
especially the marginalized communities in developing countries, is widely acknowledged
(Bhutta et al., 2011). CHWs will not replace the need for quality health care delivery
performed by highly educated and skilled health care workers. However, they could affect
access to health care and services, thus, affecting health outcomes. In addition, CHWs
could be the link that connects the community to the formal health care system and who
could provide a vital piece in the goal to establish a broader approach that incorporates
both the social and environmental factors that impact health. Nonetheless, there is a
significant dearth of information regarding the CHW program’s cost-effectiveness, and
whether those programs promote access and equity. In addition, there is inadequate
information regarding the quality of care rendered by the CHWs and, therefore, there is a
need for further studies to help in evaluating the effectiveness and quality of care
provided by the CHWs. This is in comparison to compared to services rendered by killed
healthcare professionals in the management of specific health problems, and in health
education and promotion. Further studies are also necessary to help illuminate the factors
influencing CHW intervention and sustainability (Bhutta et al., 2010). These are the issues
that this project is intended to address.
Literature Search
The literature review entails the systematic identification, location and the analysis of
publications that contain information relevant to the study’s problem under investigation.
It involves the process of reading, analyzing, evaluating, and summarizing the scholarly
sources that are relevant to the problem under investigation (Machi, 2009). The review of
literature for this project focused on peer reviewed journal articles as these provide
primary and reliable information regarding a specific topic under study. The aim of the
systematic literature review is to search for evidence regarding the typical
characteristics and roles of CHWs, and the CHW interventions, the cost and cost-
effectiveness of CHW interventions, the outcome of their interventions, external support
and the quality of the care they provide, and the characteristics in the training of CHWs.
Deciding on the Search Topic
The first step for a literature search is the formulation of a focused research question or
hypothesis. This project focuses on CHWs, a vital component in the goal to establish a
broader approach that incorporates both the social and environmental factors that impact
health.
The search topic for locating the sources of information would focus on CHWs, the CHW
programs, and the interventions of CHWs, including the quality and cost-effectiveness of
the interventions.
Article location
This literature review is based on online research articles found in online databases,
including PubMed/Medline, Cumulative Index to Nursing and Allied Heath Literature (CINAHL),
and the Cochrane Collaborations resources. In addition, manually searching the appropriate
reference lists of relevant articles was done to ensure that no relevant study would be
missed out. In searching for academic publications, the ‘Boolean search strategy’ was
adopted in searching the electronic databases. The Boolean search strategy is a tool that
is used to combine words to make statements that can be used to conduct a literature
search. It helps in narrowing down the research topic. The Boolean search strategy combines
the keywords using three operators: ‘AND’, ‘OR’, and ‘NOT’ operators (Sean, 2008). The key
search terms used for locating the literature in the databases included community health
worker (CHW), community health aid, village health volunteer, lay health worker, village
health guide, community extension worker, community based interventions, and mid-level
health worker. The search terms were not modified because they readily revealed articles
with relevant information for the questions under investigation. The searches were combined
using the Boolean search strategy, as follows:
• Community Health Worker (CHW) AND Community Based Interventions: to retrieve
articles containing both terms
• CHW OR Community Health Aid, OR Village Health Volunteer, OR Lay Health Worker, OR
Community Extension Worker, OR Mid-level Health Worker: to retrieve articles containing
either terms.
• CHW NOT Non-healthcare: to retrieve articles containing only one term.
Inclusion/exclusion criteria
The search was further limited to articles written in English only as this is a universal
language. The search was also restricted to current articles written within the duration of
five years, that is, articles from 2007 to date. This is because healthcare is dynamic and
continuously changing, and limiting the search to five years would ensure that current and
up to date information is obtained. Following retrieval, the abstracts were integrated to a
standardized form and the major determinant variables which included: the participants; the
study’s design, where controlled randomized trials were preferred; and, the interventions
delivered, specifically by the CHWs. Full articles were extracted in situations where
abstracts were not available. Because the project is aimed at investigating the quality and
effectiveness of care rendered by the CHWs in parallel to the professional health workers.
Specific emphasis was laid on extracting information related to CHWs, their roles,
training, and the quality and effectiveness of care they provide in terms of health
education, promotion, and management of specific health conditions in the community.
The keywords that yielded the most fruitful searches included community health worker,
community health aid, community extension workers, and community based interventions, with
CHW being the most favorable keyword. After interrogation of the above databases using the
above search terms, 210 potential articles were identified. Consequently, this was culled
to 97 articles after the review of abstracts and the exclusion of those that were
significantly diverged from the study’s problem. The ten most informative articles that met
the inclusion/exclusion criteria were chosen for appraisal and these will be presented in
the subsequent section.
Article Evaluation by CARS Checklist
The CARS checklist, an acronym for Credibility, Accuracy, Reasonableness and Support, is a
tool used in research to help in evaluating the sources of information the researcher
intends to use in an attempt to answer a study’s question. It helps the researcher to
separate high-quality from low quality information (Harris, 2010).
Credibility
Credibility is a measure of reliability or the authenticity of the information’s source.
Some of the indicators in the credibility of a source include the credentials of the
author(s), including the relevance of the education and training background to the
information presented in the article. One should look for the title or the degree of the
author(s) or employment position and, if the source is authored by a group or organization,
one should assess whether the body is well-known, trustworthy and respected. One should
also check for evidence of quality control, including evidence that the article or
publication was peer reviewed to ensure that the information it contains is current and
valid (Harris, 2010). The ten articles were credible because they all have authors whose
education and training is relevant to the topic of study presented in the articles.
Accuracy
Accuracy is assessed by determining whether the information in a publication is exact,
comprehensive, detailed and up to date. Information that abides by those qualities enables
the researcher to make informed judgments. Accuracy is also demonstrated by the lack of
bias in the information (Harris, 2010). The selected ten articles were accurate because
they contained current and up to date information, ranging from 2009 to 2012.
Reasonableness
Reasonableness measures the moderateness, consistency, and fairness of the information. An
article that displays fairness provides a well-reasoned and balanced argument with a
thoughtful and factual tone. Moderateness is demonstrated when information is presented in
a professional and calm manner. Consistency is displayed by the free flow of information
without any contradictions (Harris, 2010). The authors of the ten articles have provided a
balanced argument of the evidence in a professional and calm tone.
Support
Most articles contain information obtained from other information sources and, to enhance
the credibility of such information, the author should properly cite the sources of
information. Support in any article is demonstrated by the use of facts and figures to
support claims, proper citations and documentation statistics, and facts used in an article
(Harris, 2010). The authors of the ten selected articles used evidence from previous
studies to back their claims and support their arguments.
Annotated Bibliography of the Selected Articles
Journal Article 1
Corluka, A., Walker, D. G., Lewin, S., Glenton, C. & Scheel (2009). Are vaccination
programs delivered by lay health workers cost-effective? A systematic review. Human
Resources for Health, 7 (81).
The study focuses on reviewing the costs and the cost-effectiveness of vaccination program
interventions involving lay health workers (LHWs). The information in the article can be
used to influence decision-making in healthcare, especially regarding the cost
effectiveness of healthcare interventions and the availability of funds to finance the
interventions rendered by the LHWs compared to those by professional staff. The
considerations practically influence the economic evaluation of the health worker programs,
particularly, the LHW programs. This article is intended for health decision-makers and
human resource personnel. The limitation of this study is that it only reviewed three
articles that met the inclusion criteria, meaning that the information was obtained from
limited sources and, thus, not comprehensive. The reviewed articles were also heterogeneous
and did not address issues of vital importance to the topic under investigation. Hence, the
researchers were unable to draw any conclusion on the cost-effectiveness of LHWs in
promoting the uptake of vaccinations. Based on the review, the authors concluded that
conventional economic evaluation, especially on the analysis of cost effectiveness has
narrowly focused on health outcomes, particularly those regarding vaccine delivery and
promotion at the primary level of care by the LHWs.
Journal Article 2
Viswanathan, M., Kraschewski, J. L., Nishikawa, B., Morgan, L. C., Honeycutt, A. A.,
Thieda, P., Lohr, K. N., & Jonas, D. E. (2010). Outcomes and cost of community health
worker interventions: A systematic review. Medical Care, 48 (9), 792-808.
The study focuses on reviewing the cost and outcomes of CHW interventions for the
underserved. This article provides an insight into the effectiveness of the CHWs in
healthcare delivery, information which can be used by health decision makers to improving
access to care through CHW programs for underserved population. The limitation of the
article is that some of the sources used to support the claims and provide evidence that
are older than 10 years, and this reduces the accuracy and credibility of the information.
The article is intended for healthcare workers, educators and decision makers in the
community. The authors concluded that CHWs can improve the outcome for certain health
conditions in the underserved populations. This source provides evidence that the CHWs can
be used to minimize the healthcare barriers associated with limited access, especially
among the underserved population. This article is relevant to the current study.
Journal Article 3
Medhanyie, A., Spigt, M., Kifle, Y., Schaay, N., Sanders, D., Blanco, R., Geertjan, D.,
& Berhane, Y. (2012). The role of health extension workers in improving utilization of
maternal health services in rural areas in Ethiopia: A cross sectional study. BMC Health
Services Research, 12 (352).
This article focuses on investigating the role of CHWs in enhancing the utilization of
maternal health services. This study reveals that CHWs contribute significantly to enhanced
access and utilization of maternal services. This information can be used to devise
strategies to help improve CHW programs to enhance healthcare access. The limitation of
this study is that it used a small sample, which limits the representation of the general
population to the study. The study is intended for skilled medical healthcare providers who
are encouraged to devise strategies to help in supporting the efforts of healthcare
extension workers in providing safe and quality care. The authors concluded that HEWs have
improved maternal healthcare access in Ethiopia. Nonetheless, they need further training
regarding the referral of cases they are unable to handle, for instance, in assisting
births. This article is relevant to the problem under investigation.
Journal Article 4
Gopalan, S. S., Mohanty, S. & Das, A. (2012). Assessing community health workers’
performance motivation: A mixed-methods approach on India’s Accredited Social Health
Activists (ASHA) programme. British Medical Journal, 2 (5).
The study focuses on examining the CHWs’ performance motivation and the determinants on
India’s Accredited Social Health Activist Programme. Since CHWs are key personnel in
improving access to healthcare for the community and for facilitating the achievement of
the MDGs, understanding the motivation and the determinants is important, and this article
addresses that issue. This article is intended for healthcare workers and the stakeholders
in the community, who understand the factors that enhance the motivation of CHWs. The
limitation of the article is that there is an element of bias because the researchers never
sought the perspectives of the community and the supervisor on the performance of CHWs. The
authors concluded that the CHW program can largely empower and motivate the local lay women
in the community.
Journal Article 5
Jaskiewicz, W. & Tulenko, K. (2012). Increasing community health worker productivity
and effectiveness: a review of the influence of the work environment. Human Resources for
Health, 10 (38), 1-9.
This article focuses on investigating the basic considerations for a model that can be used
for enhancing the work environment and the productivity of CHWs, which could ultimately
improve the effectiveness of community-based strategies. The article is intended for
program managers and policy-makers. This article is useful for program managers, policy-
makers and other stakeholders because they can use the information to strike a balance on
the various elements that influence the working environment of CHWs, hence, increasing the
quality and effectiveness of the services rendered. This article provides current evidence
to back claims and provides a balanced approach during discussion. The authors concluded
that an enabling environment is necessary for the maximization of the productivity of CHWs.
This article contains current and relevant information for the topic of this research
study.
Journal Article 6
Kisia, J., Nelima, F., Otieno, D. O., Kiilu, K., Emmanuel, W., Sohani, S., Siekmans, K.,
Nyandigisi, A. & Akhwale, W. (2012). Factors associated with utilization of community
health workers in improving access to malaria treatment among children in Kenya. Malaria
Journal, 11 (248).
The article focuses on examining the factors associated with CHWs’ utilization in enhancing
malaria treatment access among children aged less than five years by women caregivers in
two Kenyan endemic districts. This article is useful to healthcare policy-makers. This
article is intended for policy-makers and program managers. The limitation of the article
is that the internal validity and generalization of the study could not be assured due to
the lack of a control group. This also made it hard to minimize the effects of other
confounders and to control biases. The authors concluded that utilizing CHWs in enhancing
malaria treatment access at the community is promising and that this will promote access
for the poorest households and facilitate appropriate and early treatment for vulnerable
individuals, particularly those living in remote areas.
Journal Article 7
Kalyango, J. N., Rutebemberwa, E., Alfven, T., Ssali, S., Peterson, S., & Karamagi, C.
(2012). Performance of community health workers under integrated community case management
of childhood illnesses in eastern Uganda. Malaria Journal, 11 (282).
The article focuses on comparing the CHWs’ performance in the management of malaria and
pneumonia with the performance of CHWs in the management of malaria treatment and the
factors affecting their performance in Eastern Uganda. This article is intended for the
health-policy makers and healthcare providers working in conjunction with CHWs in the
community. The limitation of the study is associated with the methodology where the
researchers used case scenarios, record reviews and knowledge tests in the register for
CHWs, yet these do not reflect their actual practice. The authors concluded that through
appropriate training that focuses on pneumonia assessment, the provision of the necessary
supplies and drugs and through proper supervision, CHWs are able to provide integrated
malaria and pneumonia treatment. This article is relevant to the current study because it
provides information regarding the effectiveness of CHWs in managing multiple illnesses.
Journal Article 8
Brown, H. S. III, Wilson, K. J., Pagán, J. A., Arcari, C. M., Martinez, M., Smith, K.,
& Reininger, B. (2012). Cost effectiveness analysis of a community health worker
interventions for low-income Hispanic adults with diabetes. Preventing Chronic Disease, 9
(E40), 1-9.
The study focuses on estimating the long-term cost effectiveness of a program on a
lifestyle modification led by the CHWs among the low-income Hispanic adults suffering from
diabetes mellitus type 2. This study is intended for healthcare policy makers and
stakeholders in the community. The article is useful because it can be used as a framework
for designing cost-effective CHW programs for managing other health illnesses in the
community. The authors found that the CHW program proved to be cost effective and concluded
that the culturally sensitive lifestyle modification programs are cost-effective in the
management of diabetes mellitus type 2. This article contains evidence based information
that is relevant and appropriate for the current problem under investigation.
Journal Article 9
Javanparast, S., Baum, F., Labonte, R., Sanders, D. Rajabis, Z. & Heidaris, G.
(2012).The experience of community health workers training in Iran: A qualitative study.
BMC
Services Research, 12 (291): 1-8.
The study focuses on analyzing the training process for CHWs in Iran and the manner by
which the various training components could influence the satisfaction and performance of
the CHWs. This article is intended for health leaders and program managers of different
countries who intend to improve training in CHW programs. This article is current and,
therefore, provides current evidence based information regarding CHW programs. The authors
concluded that even though the CHW programs vary based on context and country, the Iranian
CHW training program offers an insight for nations that intend to improve on training as a
major element in their CHW program. This article provides current evidence on information
that is relevant to topic of this research study. Nonetheless, this study failed to set out
measures that could be used to measure the effects of training on the program’s performance
and community health outcomes.
Journal Article 10
Nascimento, T., Wada, N., Guidoni, L. M., Golub, J. E., Dietze, R., & Maciel, L. N.
(2011). Cost-effectiveness of community health worker versus home-based guardians for
directly observed treatment of tuberculosis in Vitória, Espírito Santo State, Brazil.
Cadernos de Saúde Pública, 27(5), 1-12.
The study focuses on comparing the outcomes and costs associated directly as observed in
treatment supervised by guardians relative to the standard care of the Directly Observed
Therapy, Short Course (DOTS) provided by CHWs in Vitória, Espírito Santo State, Brazil. It
provides insight into the cost and effectiveness of CHW supervised DOTS and, therefore, has
useful information that can be used as a foundation for comparison in the current study.
This article seems to be intended for health policy-makers and stakeholders in the
community. The limitation of this article is that most of the sources used are more than
five years old and, hence, the evidence provided is not up to date, reducing its
credibility. Nonetheless, this article is relevant to this paper’s topic of study. The
authors concluded that the guardian-supervised DOTS are less costly and effective when
compared to conventional health facility treatment in Victoria. In addition, the guardian-
supervised DOTS seem to be a promising alternative to complement the CHW-supervised DOTS.
References
Bhutta, Z. A., Lassi, Z. S., Pariyo, G., & Huicho, L. (2010). Global experience of
community health workers for delivery of health related Millennium Development Goals: A
systematic review, country case studies, and recommendations for integration into national
health systems. Global Evidence of Community Health Workers, 1-377. World Health
Organization.
Brown, H. S. III, Wilson, K. J., Pagán, J. A., Arcari, C. M., Martinez, M., Smith, K.,
& Reininger, B. (2012). Cost effectiveness analysis of a community health worker
interventions for low-income Hispanic adults with diabetes. Preventing Chronic Disease, 9
(E40), 1-9.
Corluka, A., Walker, D. G., Lewin, S., Glenton, C. & Scheel (2009). Are vaccination
programs delivered by lay health workers cost-effective? A systematic review. Human
Resources for Health, 7 (81).
Gopalan, S. S., Mohanty, S. & Das, A. (2012). Assessing community health workers’
performance motivation: A mixed-methods approach on India’s Accredited Social Health
Activists (ASHA) programme. British Medical Journal, 2 (5).
Harris, R. (2010). The CARS checklist for information quality. VirtualSalt. Retrieved
November 21, 2012, from http://www.virtualsalt.com/evalu8it.htm
Jaskiewicz, W. & Tulenko, K. (2012). Increasing community health worker productivity
and effectiveness: a review of the influence of the work environment. Human Resources for
Health, 10 (38), 1-9.
Javanparast, S., Baum, F., Labonte, R., Sanders, D. Rajabis, Z. & Heidaris, G.
(2012).The experience of community health workers training in Iran: a qualitative study.
BMC Services Research, 12 (291): 1-8.
Kisia, J., Nelima, F., Otieno, D. O., Kiilu, K., Emmanuel, W., Sohani, S., Siekmans, K.,
Nyandigisi, A. & Akhwale, W. (2012). Factors associated with utilization of community
health workers in improving access to malaria treatment among children in Kenya. Malaria
Journal, 11 (248).
Medhanyie, A., Spigt, M., Kifle, Y., Schaay, N., Sanders, D., Blanco, R., Geertjan, D.,
& Berhane, Y. (2012). The role of health extension workers in improving utilization of
maternal health services in rural areas in Ethiopia: A cross sectional study. BMC Health
Services Research, 12 (352).
Machi, L.A., & McEvoy, B. T. (2009). The literature review: Six steps to success.
Thousand Oaks, CA: Corwin Press.
Nascimento, T., Wada, N., Guidoni, L. M., Golub, J. E., Dietze, R., & Maciel, L. N.
(2011). Cost-effectiveness of community health worker versus home-based guardians for
directly observed treatment of tuberculosis in Vitória, Espírito Santo State, Brazil.
Cadernos de Saúde Pública, 27(5), 1-12.
Sean, C. M. A., 2008. Systematic Searching of the Literature. Retrieved August 14, 2008
from: http://www.cdha.nshealth.ca/system/files/sites/…/systematic-searching-
literature.pdf.
Viswanathan, M., Kraschewski, J. L., Nishikawa, B., Morgan, L. C., Honeycutt, A. A.,
Thieda, P., Lohr, K. N., & Jonas, D. E. (2010). Outcomes and cost of community health
worker interventions: a systematic review. Medical Care, 48 (9), 792-808.
TASK 3: LITERATURE REVIEW
Professional Setting
In healthcare, human resource’s crisis is recognized as a major factor responsible for the
poor performance of the healthcare system in the delivery of evidence-based and effective
interventions for the treatment of priority health problems. The human resource crisis is
more critical in the developing nations (Brown, Wilson, Pagán, Arcari, Martinez et al.,
2012). The participation of community health workers (CHWs) in providing primary health
care interventions has been a major global experience for many decades. The universal
shortage of trained professional medical workers triggers the call to include the CHWs in
service provision at the community level. The major strategy that can be used to address
the disparities in health is by involving the community, specifically, through CHWs
(Viswanathan, Kraschewski, Nishikawa, Morgan et al., 2010). Sufficient evidence reveals
that the CHWs play a significant role in improving the population’s health especially
within the community setting where the greatest shortage of capable and motivated
healthcare professionals, such as physicians, general practitioners and nurses, is
experienced (Bhutta, Lassi, Pariyo & Huicho, 2010).
The roles and characteristics of CHWs
Community health workers (CHWs) are community-based workers charged with the mandate of
educating community members about health issues by helping the individuals and groups in
the community gain access to social and healthcare services. The World Health Organization
(WHO) expounds that CHWs should be: members of the community they serve; selected by the
community members; and, answerable to the community they are serving. The CHWs usually have
a shorter duration of training when compared to professional workers (Bhutta et al., 2010).
CHWs have increasingly been acknowledged as an integral component of the health care
workforce required to facilitate the achievement of the health-related Millennium
Development Goals (Jaskiewicz & Tulenko, 2012). Similarly, their role in enhancing
basic health service access and mobilization of community action is widely acknowledged
(Javanparast, Baum, Labonte, Sanders et al., 2012).
The CHWs form a major link through which the community can access health services,
particularly for those living in the underserved rural areas (Kisia, Nelima, Otieno, Kiilu,
Emmanuel et al., 2012). CHWs are mostly required to address various essential service needs
such as family planning, maternal and child health, malaria, HIV/AIDS, and environmental
health. Due to the human resource and financial constraints experienced in most developing
countries, CHWs are in a situation where they are expected to perform more but with limited
support in terms of supplies, equipment, and supervision (Jaskiewicz & Tulenko, 2012).
The debate about the functions each individual CHW can effectively and realistically
perform based on their approved scope of practice still rages on.
Review of the Sources
The sources used in the literature review for this project are going to be discussed in
terms of relevance, publication dates and scholarly journals. In terms of relevance, the
articles were found to be relevant to the study’s topic and questions. These articles
contain studies with evidence regarding the roles of the CHWs in delivering various
healthcare interventions to the community members, especially for those in the hard-to-
reach areas and whose access to formal healthcare services is limited. Those studies also
illuminate on the effectiveness of the CHWs in delivering health education and health
promotional services to the community and in improving access to such services.
In terms of the publication date, the reviews of literature for this project involved the
use of the most current articles that have been published between the years 2009 to 2012.
This shows that the articles used for review are less than five years old, implying that
the literature is current and up to date. Furthermore, all these articles have been
published in scholarly journals, meaning that they underwent peer review and the
information was appraised and found to be accurate, reliable and based on evidence. In
summary, the articles used for the literature review in this project are relevant to the
study’s topic, are current and up to date, and are from reliable sources, which are also
based on evidence.
Factors Influencing Human Behavior
CHWs or lay health workers (LHWs) are a cadre of ordinary people who undergo minimal
short-term training (Corluka, Walker, Lewin, Glenton & Scheel, 2009). The CHWs do not
have professional or formal health training but deliver basic health services. They are
community members selected by the community and who are then made accountable to the
community, and are usually supported by the health system. Most community members,
particularly women, are motivated with the opportunity to be a CHW, becoming empowered
personally, financially and socially. Empowering the rural women with no alternative jobs
to become CHWs is regarded as a sustainable and replicable model on community health
management. Studies have revealed that motivation is directly related to self-efficacy,
implying that through proper orientation, selection and training, it is possible to
organize lay women for community health activities (Gopalan, Mohanty & Das, 2012).
The major challenge for the current healthcare system in most nations is the necessity to
develop and strengthen human resources that can deliver essential interventions.
Consequently, this is seen as the major factor towards the increased interest in using CHWs
(Corluka et al., 2009). The involvement of the community through CHWs is seen as a major
component in addressing the disparities in health services through the improvement of
healthcare access, counseling, provision of culturally competent health education, and
through direct care delivery. CHWs have been shown to minimize health barriers associated
with health values and beliefs by inculcating healthy community behavior and enhancing the
access and utilization of healthcare services (Viswanathan et al., 2010; Gopalan et al.,
2012).
In addition, the CHWs have been widely used in vertical programs targeting the management
of childhood illnesses. The management of multiple conditions is likely to prove
challenging to the CHWs due to limited training and the increased complexity of the
multiple conditions. However, a study by Kalyango, Rutebemberwa, Alfven, Ssali and other
colleagues (2012) report that with appropriate support, supervision and training
emphasizing the assessment of complex conditions, CHWs can provide an integrated management
of some complex childhood conditions such as malaria and pneumonia.
CHWs have been widely used in the provision of care for various health issues, including
immunization services and family planning. Nonetheless, there is scanty evidence regarding
the effectiveness of their work in primary healthcare implementation. This complicates the
situation for policy makers who have to decide on how best CHWs can improve primary health
care’s effectiveness (Medhanyie, Spigt, Kifle, Schaay et al., 2012). They have also been
found to be effective in motivating lifestyle changes in individuals with chronic health
conditions such as diabetes mellitus type 2 (Brown et al., 2012). Kisia et al. (2012)
reported that well-trained and supervised CHWs can be vital in improving access to malaria
treatment at the community level, especially among the vulnerable individuals in hard-to-
reach areas. They ensure this through the reduced costs for fever treatments, improved
community interaction because they understand the situations of the family, ready
availability of community health service providers, and through frequent follow-ups.
Furthermore, very few studies have investigated the effectiveness and quality of CHW
interventions relative to those of the professional healthcare providers.
Barriers to the Success of the CHW Programs
Despite the current evidence regarding reviews on the interventions that can affect
newborn, child and maternal health and survival, the main issue concerns the availability
of a trained and skilled health workforce that can implement the interventions in the
population’s setting (Javanparast et al., 2012). The shortage and misdistribution of
skilled medical personnel is associated with poor care and commodity access by the needy
population. This parallels the realization that skilled and semi-skilled community health
workers (CHWs) can play a vital role in mobilizing the community and delivering various
health commodities. Most countries have, thus, attempted to explore alternative strategies
for reaching the varied population with cadres other than the traditional health workers.
One of the strategies identified to aid in the attainment of health related Millennium
Development Goals (MDGs) is by investing in CHWs (Bhutta et al., 2010).
The issue of concern regards how much should be expected from the CHWs before reduced
organizational support and work overload affect the quality of care and productivity of
their services and, consequently, the effectiveness of the community-based programs relying
on them (Gopalan et al., 2012). Very little is known regarding CHW productivity because
minimal attention has been focused on this aspect. Nonetheless, the benefits in addressing
these issues to do with productivity are widely acknowledged and include the reduced
workload, greater efficiency, higher quality of care, and increased job satisfaction.
Because many nongovernmental organizations and nations increasingly incorporate CHW
strategies in their programs for health, there is an increased need for guidance regarding
how the CHW program investments can be maximized on the aspect of productivity, including
its quality and effects (Jaskiewicz & Tulenko, 2012).
According to Jaskiewicz and Tulenko (2012), the productivity of CHWs is influenced by
various interrelated inputs, including motivation, capacity (skills, attitudes and
knowledge), and the availability of organizational and material support. Working conditions
are vital in creating conditions that enhance efficient and effective work, reducing
turnover and attrition, and boosting morale. This can be ensured through the creation of a
positive working environment that takes into consideration health and safety issues,
continuous supportive supervision, manageable workload, clean environment, availability of
drugs, equipment and supplies, and meets the communication and information need of the
CHWs. Workload defines the quality and level of productivity of the CHWs, wherein the
components of workload include the number of tasks, organization of the tasks, and the
catchment area.
Resource constraints, including limited transportation for CHWs, community members and
stock-outs, can hinder the trust of the community on the CHW program. The gap in
communication among the various stakeholders can lead to delays in the delivery of stocks
and supplies with associated lack of clarity regarding the CHW responsibilities. The weak
supportive system for the CHWs remains a major concern for most nations because it is
associated with the exclusion of the poor and secluded community members from accessing
basic and appropriate healthcare services (Gopalan et al., 2012). Workload significantly
determines the level of quality and productivity of the services rendered by the CHWs.
Workload is multifactorial and can be influenced by the number and tasks of the catchment
area and the organization (Jaskiewicz & Tulenko, 2012). The CHWs’ workload has
persistently been on the increase and is associated with feelings of being overburdened. If
there is a lack of proper orientation, the CHWs may experience difficulties in their
attempts to monitor the various health initiatives in the community. This may be attributed
to the low level of formal education possessed by the CHWs (Gopalan et al., 2012).
Literature reveals that, for CHW programs to be successful, there is a need for reliable
and regular supervision and support. Evidence shows that providing supportive supervision
to CHWs within the functional structures of the health team is associated with better
outcomes. On the other hand, a poor working environment with ineffective supervision and
lack of support is associated with low morale and poor productivity among the CHWs
(Jaskiewicz & Tulenko, 2012). The lack of proper training for the CHWs hinders the
acquisition of skills and knowledge necessary for the healthcare interventions. For the CHW
programs to perform effectively, emphasis on their training and supervision is necessary.
Nonetheless, the lack of interest and low use by governments, inadequate supplies and
staff, inconsistent remuneration, and the lack of involvement by the community have been
shown to negatively affect the CHW programs (Bhutta et al., 2010).
Best Practices
The CHW programs have been shown to be effective in delivering basic healthcare services to
the community because, in addition to providing such care to the community they belong to,
the CHWs are also peers in those programs. Hence, there is a greater likelihood of peer
rapport and greater trust (Brown et al., 2012). The delegation of healthcare tasks to the
CHWs within the community is regarded as a major strategy in improving access to quality
healthcare services (Javanparast et al., 2012). Brown et al. (2012) also report that the
CHWs provide a more personalized interaction to the members of the community when compared
to the traditional professional healthcare providers. This is associated with enhanced
self-efficacy and better healthcare access. They concluded that CHWs are effective in
enhancing health and quality outcomes from the societal perspective and cost-effectiveness.
Nonetheless, their study did not provide any firm argument as to whether the quality of
care rendered by CHWs could surpass that of the professional healthcare providers.
Evidence reveals that CHW interventions can potentially address substantial health
disparities and the necessity of translating more research into practice. By virtue of
their role as a link to the health care system, CHWs should play a major role in
disseminating efficacious interventions to members of the community who rarely reap the
benefits of the advances in healthcare (Nascimento, Wada, Guidoni, Golub et al., 2011). On
the other hand, evidence on CHW effectiveness relative to alternative interventions appears
mixed, with some comparison studies showing statistically significant results while others
demonstrated a lack of statistically significant differences. Some reviews propose that the
CHWs could serve as the means through which the outcomes for various underserved
populations could be improved. Nonetheless, such reviews were shown to have several
methodological limitations and, thus, for the full understanding of the CHW intervention’s
effectiveness, further studies may be necessary to bridge the gap in research (Viswanathan
et al., 2010).
Literature reveals that CHWs offer various services to the community, including safe
delivery, counseling on appropriate breastfeeding, and managing uncomplicated childhood
illnesses. These include TB, malaria, HIV/AIDS, and sexually transmitted diseases through
the provision of preventive health education. The services rendered by the CHWs have been
shown to reduce maternal and child mortality rates. The CHWs have been shown to provide a
vital link between the social service and health care systems, with their communities. In
addition, evidence reveals that such services have significantly reduced the burden of
malaria and TB in the community. The recent task delegation to CHWs is regarded as a
response to the international shortage of healthcare workers and a fundamental strategy for
improving quality health service access (Javanparast et al., 2012).
References
Bhutta, Z. A., Lassi, Z. S., Pariyo, G., & Huicho, L. (2010). Global experience of
community health workers for delivery of health related Millennium Development Goals: A
systematic review, country case studies, and recommendations for integration into national
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