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Table 5 Full evidence profile for qualitative findings of factors that influence the performance of CHVs working within urban informal settlements in low- and middle-income countries

From: Factors influencing the performance of community health volunteers working within urban informal settlements in low- and middle-income countries: a qualitative meta-synthesis review

Programme design factors

Review finding

Contributing studies

Methodological limitations

Coherence

Relevance

Adequacy

CERQual confidence

Explanation of confidence in the evidence assessment

Factors related to human resource management

Financial incentives

Financial incentives were a great motivation for CHVs and those CHVs who depended on their role for financial support are more likely to remain as CHVs and more likely to be active CHVs

Sarma (2020), Aseyo (2018), George (2017), Osindo (2016), Odhiambo (2016), Swartz (2015), Alam (2012), Boros (2011)

Moderate methodological limitations (2 studies with serious limitations (unclear recruitment strategies, no information on the researcher’s effect and data analysis not sufficiently rigorous), 6 moderate (No clear statement of the aim of the research, no adequate information on researcher’s effect, no information on non-response and no mention on ethical approval) and 2 with no/minor concerns)

No/very minor concerns about coherence

No/very minor concerns about relevance

No/very minor concerns about adequacy (10 studies that together offered moderately rich data)

Moderate

Moderate concerns regarding methodological limitations

Alam (2009), Laston (1993)

Non-financial incentives

 

Job satisfaction and self-identity

Appreciation of the work carried out by members of the community, and being recognized personally because of their home visits, proved to be motivating factors for the community health workers. The role also brought them a sense of identity and satisfaction

George (2017), Osindo (2016), Lopes (2012), Laston (1993)

2 serious methodological limitations (George: No adequate information on the recruitment strategy and the researcher’s effect and Lopes: No clear recruitment strategy, no information on the researcher’s effect, no adequate information on data analysis and threats to participants by the community not addressed, i.e. ethical concerns)

No/very minor concerns about coherence

No/very minor concerns about relevance

moderate concerns about adequacy

Moderate

Serious concerns regarding methodological limitations and moderate volume of data available

Community trust

Community trust enhanced CHW motivation while lack of it led to demotivation

Two studies with moderate methodological limitations (Osindo: no information on the researcher’s effect and Laston: No mention of ethical approval)

Factors related to human resource management

Social status, prestige and respect

Being a volunteer brought prestige, respect and recognition/acknowledgement to the CHVs thus being a source of motivation for them to continue working as CHVs

George (2017), Osindo (2016), Alam (2012), Lopes (2012), Alam (2009) Laston (1993)

Moderate methodological limitations (2 studies with serious methodological limitations—Lopes: No clear recruitment strategy, no information on the researcher’s effect, no adequate information on data analysis and threats to participants by the community not addressed and George: No clear recruitment strategy, no information researcher’s effect) and 4 studies with no/minor limitations

No/very minor concerns about coherence

No/very minor concerns about relevance

Moderate concerns about adequacy

Moderate

Moderate concerns regarding methodological limitations and data adequacy

Job opportunities

Becoming a volunteer increased opportunity of getting a paid job

Goudet (2018) Swartz (2015), Laston (1993)

Moderate methodological limitations (1 study with serious methodological limitations—Swartz (2015) No adequate information on recruitment strategy, no enough data to support findings and no clear statement of findings)

No/very minor concerns about coherence

No/very minor concerns about relevance

Serious concerns about adequacy

Moderate

Moderate concerns regarding methodological limitations and serious concerns about data adequacy

Training

Training increased knowledge and awareness levels of CHVs thus making them more credible to the community

Sarma (2020), Goudet (2018), Aseyo (2018), George (2017), Osindo (2016), Laston (1993)

Moderate methodological limitations (2 studies with serious limitations—George: No clear recruitment strategy, no information on the researcher’s effect, and Osindo: no information on the researcher’s effect and 1 study with moderate limitations—Sarma)

No/very minor concerns about coherence

No/very minor concerns about relevance

Moderate concerns about adequacy

Moderate

Moderate concerns on methodological limitations and the volume of data

Factors related to human resource management

Supplies and resources

Lack of supplies impacted negatively on community visits to health facilities hence hindering CHV performance

Sarma (2020), George (2017)

Moderate methodological limitations (2 study with serious limitations—George: No clear recruitment strategy, no information researcher’s effect and Lopes: No clear recruitment strategy, no information on the researcher’s effect, no adequate information on data analysis and threats to participants by the community not addressed—and 5 moderate limitations—3 with no adequate information on researcher’s effect, no sampling and recruitment strategies and 2 with no adequate information on researcher’s effect)

No/very minor concerns about coherence

No/very minor concerns about relevance

Moderate concerns about adequacy

Moderate

Moderate methodological limitations and serious concerns about the low volume of data

Lack of proper protective equipment by CHVs resulted in low treatment coverage

Osindo (2016), Odhiambo (2016)

Supplies and materials play not only a functional role in the execution of CHVs' duties, but also a symbolic role in CHV relationships with their communities

Aseyo (2018)

Provision of job aids help CHVs feel more confident in counselling and giving targeted messages

Sarma (2020)

“Receiving some type of an identification badge, a sari, an umbrella or a bag would be helpful in their work.”

Laston (1993)

Health system linkage

Relationship between CHVs and other healthcare workers

Attitudes of other health staff had an impact on how CHVs feel and performed. Lack of acknowledgement and recognition by the other healthcare staff caused demotivation in the profession

George (2017), Osindo (2016), Odhiambo (2016), Lopes (2012), Boros (2011), Laston (1993)

Moderate methodological limitations (2 studies with serious limitations—George: no clear recruitment strategy, no information researcher’s effect, Lopes: No clear recruitment strategy, no information on the researcher’s effect, no adequate information on data analysis and threats to participants by the community not addressed—and 4 studies with minor limitations)

No/very minor concerns about coherence

No/very minor concerns about relevance

Moderate concerns about adequacy

Moderate

Moderate concerns on methodological limitations and the volume of data

Factors related to human resource management

Family support

Relationship between CHVs and their families

Family support of the role played by a CHV is key to the CHV’s level of activity. Disapproval leads to CHV dropout

George (2017), Alam (2012), Alam (2009), Laston (1993)

Moderate methodological limitations (1 study with serious limitations—no clear recruitment strategy, no information on the researcher’s effect and 3 studies with no/very minor limitations)

No/very minor concerns about coherence

No/very minor concerns about relevance

Moderate concerns about adequacy

Moderate

Moderate concerns on methodological limitations and the volume of data

Gendered Household roles and duties: Female CHVs with no or fewer household responsibilities are more likely to remain as SS

Alam (2009), Laston (1993)

Moderate methodological limitations (1 study—Laston with minor limitation—no mention of ethical approval)

No/very minor concerns about coherence

No/very minor concerns about relevance

Serious concerns about adequacy

Low

Moderate concerns on methodological limitations and the low volume of data

Supportive supervision

Supportive supervision seen as a source of motivation for CHVs

Aseyo (2018), Karuga (2017)

Moderate methodological limitations (1 study with moderate and 1 study with serious limitations—no information on sampling, recruitment strategy, No clear research question, potential for respondent bias and no adequate rationale for using a mixed method design to address the research question and 1 study with minor concern on researcher’s effect)

No/very minor concerns about coherence

No/very minor concerns about relevance

Serious concerns about adequacy

Moderate

Moderate concerns on methodological limitations and serious concerns about the low volume of data

Odhiambo (2016)

CHV personal characteristics

Age

Age was a factor that affected interaction between the CHEWs and CHVs. A supervisor’s age in relation to the supervisees affected whether the supervisor would be able to provide adequate supervision

Karuga (2017)

Serious methodological limitations (No clear research question, there was a potential for respondent bias since the implementors of the intervention are the ones who also evaluated it and no adequate rationale for using a mixed method design to address the research question)

 

Minor concern about relevance—partial relevance (study had rural components)

Serious concerns about adequacy (1 study with thin data)

Low

Serious concerns regarding methodological limitations, minor concerns on partial relevance and serious concerns about the low volume of data

Prior experience with health condition

Prior experience of ill health or condition seen as a motivation of becoming a CHV

George (2017)

Serious methodological limitations (No clear recruitment strategy, no information researcher’s effect)

 

No/very minor concerns about relevance

Serious concerns about adequacy (1 study with very thin data)

Low

Serious concerns on methodological limitations and the low volume of data

Community contextual factors

Insecurity

Insecurity and inaccessibility of certain neighborhoods impacted negatively on CHV performance

Odhiambo (2016), Osindo (2016), Lopes (2012)

Moderate methodological limitations (1 study with serious limitations – No clear recruitment strategy, no adequate information on data analysis and researcher’s effect, and threats to participants by the community not addressed - and 2 with moderate limitations – no adequate information on researcher’s effect)

No/very minor concerns about coherence

No/very minor concerns about relevance

Serious concerns about adequacy

Moderate

Moderate Moderate concerns on methodological limitations and the low volume of data.

Gender

Women are seen as the ‘natural’ providers of care and it is assumed that this is what shapes women’s ability and their motivation to engage in CHV work.

Swartz (2015

Serious methodological limitations (No adequate information on recruitment strategy, no enough data to support findings and no clear statement of findings)

 

No/very minor concerns about relevance

Serious concerns about adequacy (1 study with thin data)

Low

Serious concerns on methodological limitations and the low volume of data.

African ethic of Ubuntu

It is natural for African people to care for another

Swartz (2015

Serious methodological limitations (No adequate information on recruitment strategy, no enough data to support findings and no clear statement of findings)

 

No/very minor concerns about relevance

Serious concerns about adequacy (1 study with thin data)

Low

Serious concerns on methodological limitations and the low volume of data.

Economic contextual factors

Demand for financial or material support

Households expected tangible support from CHVs, which some CHVs provided from their own resources out of sympathy and to increase their acceptance in the community.

Aseyo (2018), Goudet (2018), Odhiambo (2016), Osindo (2016),

Moderate methodological limitations (2 studies with moderate limitations – No adequate information on researcher’s effect and no information on sampling and recruitment strategy respectively - and 2 study with minor limitations)

No/very minor concerns about coherence

No/very minor concerns about relevance

Moderate concerns about adequacy

Moderate

Moderate concerns on methodological limitations and the volume of data.

  1. Overall CERQual rating of confidence in the finding, based on four levels of confidence in the evidence contributing to the finding:
  2. ∙ High—it is highly likely that the review finding is a reasonable representation of the phenomenon of interest
  3. ∙ Moderate—it is likely that the review finding is a reasonable representation of the phenomenon of interest
  4. ∙ Low—it is possible that the review finding is a reasonable representation of the phenomenon of interest
  5. ∙ Very low—it is not clear whether the review finding is a reasonable representation of the phenomenon of interest