Programme design factors | Review finding | Contributing studies | Methodological limitations | Coherence | Relevance | Adequacy | CERQual confidence | Explanation of confidence in the evidence assessment | |
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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. |