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Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa

BACKGROUND: South Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing health workforce deficiencies. As increased access to quality service delivery hinges upon their motivation, this study explored C...

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Autores principales: Kigozi, Gladys, Heunis, Christo, Engelbrecht, Michelle
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499870/
https://www.ncbi.nlm.nih.gov/pubmed/32943026
http://dx.doi.org/10.1186/s12913-020-05612-9
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author Kigozi, Gladys
Heunis, Christo
Engelbrecht, Michelle
author_facet Kigozi, Gladys
Heunis, Christo
Engelbrecht, Michelle
author_sort Kigozi, Gladys
collection PubMed
description BACKGROUND: South Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing health workforce deficiencies. As increased access to quality service delivery hinges upon their motivation, this study explored CHWs’ motivation to deliver systematic household contact tuberculosis (TB) investigation (SHCI). METHODS: In 2017, a cross-sectional survey was conducted among CHWs in the Mangaung Metropolitan District, Free State Province. Exploratory factor analysis was performed on a 30-item scale to determine the dimensions underlying CHW motivation. Items with factor loadings of 0.4 and above were retained. Descriptive and inferential analyses were used to determine CHW motivation levels. Multiple linear regression analysis was used to investigate the determinants of CHW motivation. RESULTS: Out of 235 participants, 89.2% were female. Participants’ median age was 39 (inter-quartile range: 33–45) years. CHW motivation was defined by 16 items across three dimensions — intrinsic job satisfaction, burnout and team commitment, together explaining 56.04% of the total variance. The derived scale showed satisfactory internal consistency (Cronbach’s alpha: 0.81), with a mean motivation score of 52.26 (standard deviation [sd]: 5.86) out of 64. Statistically significant differences were observed between formal CHWs — those with at least phase 1 standardised accredited training, and informal CHWs — those without such accredited training regarding team commitment scores (17.82 [sd: 2.48] vs. 17.07 [sd: 2.82]; t((233)) = 2.157; p = 0.013). CHW age (β = 0.118, p = 0.029), location (β = 1.737, p = 0.041), length of service (β = − 0.495, p < 0.001), attendance of TB SHCI training (β = 1.809, p = 0.036), and TB SHCI competence (β = 0.706, p < 0.001), contributed statistically significantly to CHW motivation. CONCLUSION: CHW motivation to perform TB SHCI was both intrinsic and extrinsic. The high overall mean score implies that the CHWs were well-motivated to perform TB SHCI. To ensure sustained improved access to quality TB SHCI service provision, programme managers in the Free State and similar settings could potentially use the tool derived from this study to monitor and inform CHW motivation interventions. Interventions should pay close attention to the CHWs’ formalisation, competence and training.
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spelling pubmed-74998702020-09-21 Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa Kigozi, Gladys Heunis, Christo Engelbrecht, Michelle BMC Health Serv Res Research Article BACKGROUND: South Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing health workforce deficiencies. As increased access to quality service delivery hinges upon their motivation, this study explored CHWs’ motivation to deliver systematic household contact tuberculosis (TB) investigation (SHCI). METHODS: In 2017, a cross-sectional survey was conducted among CHWs in the Mangaung Metropolitan District, Free State Province. Exploratory factor analysis was performed on a 30-item scale to determine the dimensions underlying CHW motivation. Items with factor loadings of 0.4 and above were retained. Descriptive and inferential analyses were used to determine CHW motivation levels. Multiple linear regression analysis was used to investigate the determinants of CHW motivation. RESULTS: Out of 235 participants, 89.2% were female. Participants’ median age was 39 (inter-quartile range: 33–45) years. CHW motivation was defined by 16 items across three dimensions — intrinsic job satisfaction, burnout and team commitment, together explaining 56.04% of the total variance. The derived scale showed satisfactory internal consistency (Cronbach’s alpha: 0.81), with a mean motivation score of 52.26 (standard deviation [sd]: 5.86) out of 64. Statistically significant differences were observed between formal CHWs — those with at least phase 1 standardised accredited training, and informal CHWs — those without such accredited training regarding team commitment scores (17.82 [sd: 2.48] vs. 17.07 [sd: 2.82]; t((233)) = 2.157; p = 0.013). CHW age (β = 0.118, p = 0.029), location (β = 1.737, p = 0.041), length of service (β = − 0.495, p < 0.001), attendance of TB SHCI training (β = 1.809, p = 0.036), and TB SHCI competence (β = 0.706, p < 0.001), contributed statistically significantly to CHW motivation. CONCLUSION: CHW motivation to perform TB SHCI was both intrinsic and extrinsic. The high overall mean score implies that the CHWs were well-motivated to perform TB SHCI. To ensure sustained improved access to quality TB SHCI service provision, programme managers in the Free State and similar settings could potentially use the tool derived from this study to monitor and inform CHW motivation interventions. Interventions should pay close attention to the CHWs’ formalisation, competence and training. BioMed Central 2020-09-18 /pmc/articles/PMC7499870/ /pubmed/32943026 http://dx.doi.org/10.1186/s12913-020-05612-9 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Kigozi, Gladys
Heunis, Christo
Engelbrecht, Michelle
Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa
title Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa
title_full Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa
title_fullStr Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa
title_full_unstemmed Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa
title_short Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa
title_sort community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in south africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499870/
https://www.ncbi.nlm.nih.gov/pubmed/32943026
http://dx.doi.org/10.1186/s12913-020-05612-9
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