Can public sector community health workers deliver a nurturing care intervention in South Africa? The Amagugu Asakhula feasibility study

Klingberg, Sonja, van Sluijs, Esther M. F., Jong, Stephanie T. and Draper, Catherine E. (2021) Can public sector community health workers deliver a nurturing care intervention in South Africa? The Amagugu Asakhula feasibility study. Pilot and Feasibility Studies, 7. ISSN 2055-5784

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Background: Nurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3–5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability. Methods: A qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework. Results: The delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs’ scope of work. Conclusions: Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention’s effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources.

Item Type: Article
Additional Information: Funding Information: Funding from the Cambridge MRC Doctoral Training Programme, the Oppenheimer Memorial Trust in South Africa, the Research Councils UK Newton Fund to the University of Cambridge (ES/N013891/1) and from the National Research Foundation to the University of the Witwatersrand (UID:98561) is gratefully acknowledged. The funders had no role in designing the study, data collection, analysis, interpretation, or writing the manuscript.
Uncontrolled Keywords: community health workers,feasibility study,nurturing care,process evaluation,qualitative research,south africa,medicine (miscellaneous) ,/dk/atira/pure/subjectarea/asjc/2700/2701
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Health Promotion
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Depositing User: LivePure Connector
Date Deposited: 29 Jun 2023 09:32
Last Modified: 06 Jul 2023 08:32
DOI: 10.1186/s40814-021-00802-6


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