Table 3 Presentation of qualitative data and emerging themes

Strengths

1- Access to education

First time experiencing taking a course on women’s health

Easy access and exposure to new information

Enhanced opportunities with regard to gender considerations

Novel insights that clarified misconceptions about women’s health

Access to information that they otherwise wouldn’t have been able to receive

2- Learning modality

New experience of receiving information through videos in a mobile classroom environment

Having pre-recorded sessions mixed with lectures was helpful to deliver information in a simple manner

Interactions with the TA were most favored

Participants appreciated the opportunity of seeing doctors conducting actual practice in the community

3- Knowledge acquisition

Increased knowledge on women’s health that helps with care for the self and for others

CHW had limited knowledge and low-level education in general. This training helped CHW learn new information on women’s health and offered, in general, new opportunities for education

Acquisition of new health knowledge following interaction with CHW (through group sharing of personal experiences, informal conversations) who were family members, friends, or acquaintances from the community

4- Health-related behaviors

Increased ability to help others in the family and in the community regarding women’s health issues by discussing common topics, giving tips, and clarifying misconceptions

More confidence to share knowledge with friends, family, and the community

Increased curiosity to learn more by navigating websites and other sources

Influence on the health practices of family members and community members in touch with CHW

Because the information was credible since it was delivered by a trusted institution, this gave more confidence in sharing the knowledge and justifying how and why this information is trusted to others

Change in health-related behavior among community members following interaction with CHW such as increase in screening, increase in referral, increase in self-management, better attention to details related to women’s health such as period, birth control, screening, etc.

5- Individual and community empowerment

Creation of a stronger sense of community through grouping CHW and community members together in the training

Important opportunities for self-development and for positive interactions with host community members

Increased the confidence and strength of CHW because they had something new to offer the community and they had a sense of purpose now

CHW played an active role in transmitting information to people in their surroundings

Community members trusted this advice since information came from a trusted and credible source

Challenges

1- Gender considerations

More gender consideration should have been made to have women be TAs as opposed to a man given the sensitive nature of the topic

2- Learning modality

Need for more engaging and interactive approaches with TAs

Videos were helpful to deliver information but were not enough to sustain attention

Need to emphasize on practical and hands-on approaches

Reduce information and focus on necessary information, increase engagement and discussions

Need to have shorter trainings so that people can still attend while take care of primary responsibilities such as work and family duties

3- Long-term retention

There is a need for participants to have easier access to the material they learned after the training to enhance long-term retention

4- Community reactions

Some members were not receptive and had negative reactions when receiving this kind of information

Some members were jealous because CHW had an opportunity to learn whereas they did not

Sometime not being taken seriously or not having credibility when discussing health matters with community members

Trust regarding the services largely depending on others. Some trusted CHW and wanted to learn, others ridiculed it

Overall trust in the advice and health information shared by the CHW and establishment of credibility when copies of the learning material and the certification by AUB and GHI were shared

5- Access to health services

There is generally lack of access to healthcare services due to several issues such as limited availability, limited ability to finance them, having to travel long distance

Lack of free health services, community members largely struggled to find services (free or cheap ones that they could afford or that had access to given geographical challenges) and they reported lack of security

Only reported free services were cancer screening in rare times throughout the year

Despite having new access to health-related information and despite suggestions for referrals to healthcare services, community members felt contradictions