Abstract:
Given shortages of health care providers and a rise in the number of people living with both
communicable and non-communicable diseases, Community Health Workers (CHWs) are
increasingly incorporated into health care programs. We sought to explore community per-
ceptions of CHWs including perceptions of their roles in chronic disease management as
part of the Academic Model Providing Access to Healthcare Program (AMPATH) in western
Kenya. In depth interviews and focus group discussions were conducted between July
2012 and August 2013. Study participants were purposively sampled from three AMPATH
sites: Chulaimbo, Teso and Turbo, and included patients within the AMPATH program
receiving HIV, tuberculosis (TB), and hypertension (HTN) care, as well as caregivers of chil-
dren with HIV, community leaders, and health care workers. Participants were asked to
describe their perceptions of AMPATH CHWs, including identifying the various roles they
play in engagement in care for chronic diseases including HIV, TB and HTN. Data was
coded and various themes were identified. We organized the concepts and themes gener-
ated using the Andersen-Newman Framework of Health Services Utilization and consider-
ing CHWs as a potential enabling resource. A total of 207 participants including 110
individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 commu-
nity leaders; and 34 healthcare providers participated. Participants identified several roles
for CHWs including promoting primary care, encouraging testing, providing education and
facilitating engagement in care. While various facilitating aspects of CHWs were uncovered,
several barriers of CHW care were raised, including issues with training and confidentiality.
Suggested resources to help CHWs improve their services were also described. Our findings suggest that CHWs can act as catalysts and role models by empowering members
of their communities with increased knowledge and support.