Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Nursing

Supervisor

Lorie Donelle

2nd Supervisor

Jodi Hall

Co-Supervisor

Abstract

Community Health Workers (CHWs) are individuals who are selected and trained to provide healthcare services in the community. To be effective, they need ongoing training opportunities to gain knowledge and skills to perform their tasks. This study used descriptive qualitative methods to explore how Animatrice de Santé Maternelle (ASM)-CHWs working in select regions of Rwanda gained and enhanced their knowledge and skills to support maternal and newborn health care. Thematic analysis was used to analyze data from 110 ASM-CHWs and ten supervisors of CHWs. The analysis yielded two main themes. 1) Formalized training among CHWs, which included the subthemes of didactic training workshops, supervision, and monthly meetings. 2) Informalized training, with subthemes of informal peer to peer mentorship, learning as an ongoing process, moving toward formalized peer to peer mentorship model with its benefits, way to move forward, and challenges of peer to peer mentorship model. Adequate training of CHWs is crucial to the success of the program. However, training of CHWs was hampered by the unavailability of funds. Thus, peer to peer formal mentorship could serve as a learning strategy to reinforce the training of CHWs.

Keywords: Community health worker, training strategies

Summary for Lay Audience

Community Health Workers (CHWs) are individuals who are selected and trained to provide healthcare services in the community. They have no prior education in the health domain. To be effective in their role, CHWs need ongoing training to develop knowledge and skills to perform their tasks. This study used descriptive qualitative methods to explore how CHWs working in Rwanda develop their knowledge and skills to support maternal and newborn health care. A thematic analysis was used to analyze data from 110 CHWs and ten supervisors of CHWs. The data analysis produced two main findings. 1) Formalized training among CHWs, which included classroom-based training workshops, supervision, and monthly meetings. 2) Informalized training, with subthemes of informal peer to peer teaching, learning as an ongoing process, formalized peer to peer teaching model with its benefits, its implementation, and barriers.

These findings will inform the development of ongoing training strategies to reinforce the knowledge and skills of CHWs within Rwanda. CHWs in this study highlighted several educational strategies essential to learning the CHW role. In particular, CHWs reported peer to peer mentorship as a strategy to support CHWs learning needs. Adequate training of CHWs is crucial to the success of the program and the enhanced health of mothers and their infants. However, training of CHWs was hampered by the unavailability of funds. Thus, peer to peer formal teaching can serve as a solution to reinforce the existing strategies to train CHWs effectively.

This thesis is organized into three chapters. The first chapter presents the background, an overview of Rwanda, the role of CHWs in Rwanda, the TSAM project in Rwanda, the significance and purpose of the study, the research question, and the declaration. Chapter two is a manuscript of the research. It is composed of background, literature review about different ways CHWs gain knowledge and skills in different countries, the methodology used in this study, the results, and discussion. Chapter three presents a summary of the implications of the research, conclusion, and future direction in this domain.

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