Cargando…

Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya

Amidst the COVID-19 pandemic and national responses, trust (one’s belief that a system acts in one’s best interest) is important to consider. In community health systems, trust is embedded in relationships between clients, CHWs, and health system stakeholders. This mixed-methods study explores trust...

Descripción completa

Detalles Bibliográficos
Autores principales: Sripad, Pooja, Gottert, Ann, Abuya, Timothy, Casseus, Alain, Hossain, Sharif, Agarwal, Smisha, Warren, Charlotte E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021319/
https://www.ncbi.nlm.nih.gov/pubmed/36962536
http://dx.doi.org/10.1371/journal.pgph.0000595
_version_ 1784908457031237632
author Sripad, Pooja
Gottert, Ann
Abuya, Timothy
Casseus, Alain
Hossain, Sharif
Agarwal, Smisha
Warren, Charlotte E.
author_facet Sripad, Pooja
Gottert, Ann
Abuya, Timothy
Casseus, Alain
Hossain, Sharif
Agarwal, Smisha
Warren, Charlotte E.
author_sort Sripad, Pooja
collection PubMed
description Amidst the COVID-19 pandemic and national responses, trust (one’s belief that a system acts in one’s best interest) is important to consider. In community health systems, trust is embedded in relationships between clients, CHWs, and health system stakeholders. This mixed-methods study explores trust through the evolving COVID-19 crisis in Bangladesh, Haiti, and Kenya, where multi-country community health research was underway. We investigate the extent and ways trust between communities, community health workers (CHWs), and health system actors shift, including its relation to community fear and hostility, through self-reported positive and negative experiences of CHWs and policy/program stakeholders on a phone-based survey with 2,025 CHWs and 72 key informant interviews, including CHWs, in late 2020. On surveys, CHWs reported high levels of community trust (8/10 in Bangladesh and Kenya; 6/10 in Haiti) with over 60% reporting client relief in seeing their CHWs. About one-third of CHWs across countries reported experiencing instances of hostility from community members during the pandemic in the form of refused home-entry, ignored advice, or being shouted at. Multivariate analyses revealed that CHWs reporting more positive and fewer negative experiences is consistently associated with continuing routine work, doing COVID-19-related work, and greater community trust. Qualitative interviews showed that existing pre-pandemic trusting relationships withstood the early phase of COVID-19, mitigating negative community reactions toward CHWs and stigma towards COVID-positive individuals, maintaining routine health services, and sustaining appreciation for CHW-provided prevention information and emotional support. CHW-community and CHW-health system actor trust is strengthened when CHWs are well-resourced; CHW-community trust is strained by public frustration at the pandemic, associated restrictions, and sociopolitical stressors. Our study suggests that with adequate institutional support, bonds of trust can promote resilient community health systems during extended public health crises, through CHWs’ commitment to mitigating misinformation, reducing stigma, maintaining routine service provision, and promoting COVID-19 prevention.
format Online
Article
Text
id pubmed-10021319
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-100213192023-03-17 Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya Sripad, Pooja Gottert, Ann Abuya, Timothy Casseus, Alain Hossain, Sharif Agarwal, Smisha Warren, Charlotte E. PLOS Glob Public Health Research Article Amidst the COVID-19 pandemic and national responses, trust (one’s belief that a system acts in one’s best interest) is important to consider. In community health systems, trust is embedded in relationships between clients, CHWs, and health system stakeholders. This mixed-methods study explores trust through the evolving COVID-19 crisis in Bangladesh, Haiti, and Kenya, where multi-country community health research was underway. We investigate the extent and ways trust between communities, community health workers (CHWs), and health system actors shift, including its relation to community fear and hostility, through self-reported positive and negative experiences of CHWs and policy/program stakeholders on a phone-based survey with 2,025 CHWs and 72 key informant interviews, including CHWs, in late 2020. On surveys, CHWs reported high levels of community trust (8/10 in Bangladesh and Kenya; 6/10 in Haiti) with over 60% reporting client relief in seeing their CHWs. About one-third of CHWs across countries reported experiencing instances of hostility from community members during the pandemic in the form of refused home-entry, ignored advice, or being shouted at. Multivariate analyses revealed that CHWs reporting more positive and fewer negative experiences is consistently associated with continuing routine work, doing COVID-19-related work, and greater community trust. Qualitative interviews showed that existing pre-pandemic trusting relationships withstood the early phase of COVID-19, mitigating negative community reactions toward CHWs and stigma towards COVID-positive individuals, maintaining routine health services, and sustaining appreciation for CHW-provided prevention information and emotional support. CHW-community and CHW-health system actor trust is strengthened when CHWs are well-resourced; CHW-community trust is strained by public frustration at the pandemic, associated restrictions, and sociopolitical stressors. Our study suggests that with adequate institutional support, bonds of trust can promote resilient community health systems during extended public health crises, through CHWs’ commitment to mitigating misinformation, reducing stigma, maintaining routine service provision, and promoting COVID-19 prevention. Public Library of Science 2022-10-07 /pmc/articles/PMC10021319/ /pubmed/36962536 http://dx.doi.org/10.1371/journal.pgph.0000595 Text en © 2022 Sripad et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Sripad, Pooja
Gottert, Ann
Abuya, Timothy
Casseus, Alain
Hossain, Sharif
Agarwal, Smisha
Warren, Charlotte E.
Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya
title Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya
title_full Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya
title_fullStr Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya
title_full_unstemmed Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya
title_short Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya
title_sort confirming—and testing—bonds of trust: a mixed methods study exploring community health workers’ experiences during the covid-19 pandemic in bangladesh, haiti and kenya
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021319/
https://www.ncbi.nlm.nih.gov/pubmed/36962536
http://dx.doi.org/10.1371/journal.pgph.0000595
work_keys_str_mv AT sripadpooja confirmingandtestingbondsoftrustamixedmethodsstudyexploringcommunityhealthworkersexperiencesduringthecovid19pandemicinbangladeshhaitiandkenya
AT gottertann confirmingandtestingbondsoftrustamixedmethodsstudyexploringcommunityhealthworkersexperiencesduringthecovid19pandemicinbangladeshhaitiandkenya
AT abuyatimothy confirmingandtestingbondsoftrustamixedmethodsstudyexploringcommunityhealthworkersexperiencesduringthecovid19pandemicinbangladeshhaitiandkenya
AT casseusalain confirmingandtestingbondsoftrustamixedmethodsstudyexploringcommunityhealthworkersexperiencesduringthecovid19pandemicinbangladeshhaitiandkenya
AT hossainsharif confirmingandtestingbondsoftrustamixedmethodsstudyexploringcommunityhealthworkersexperiencesduringthecovid19pandemicinbangladeshhaitiandkenya
AT agarwalsmisha confirmingandtestingbondsoftrustamixedmethodsstudyexploringcommunityhealthworkersexperiencesduringthecovid19pandemicinbangladeshhaitiandkenya
AT warrencharlottee confirmingandtestingbondsoftrustamixedmethodsstudyexploringcommunityhealthworkersexperiencesduringthecovid19pandemicinbangladeshhaitiandkenya