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Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Research

The use and potential impact of digital health tools at the community level: results from a multi-country survey of community health workers

Authors: Courtney T. Blondino, Alex Knoepflmacher, Ingrid Johnson, Cameron Fox, Lorna Friedman

Published in: BMC Public Health | Issue 1/2024

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Abstract

Background

Community health workers (CHWs) are increasingly viewed as a critical workforce to address health system strengthening and sustainable development goals. Optimizing and widening the capacity of this workforce through digital technology is currently underway, though there is skepticism regarding CHWs’ willingness and optimism to engage in digital health. We sought to understand CHWs’ perceptions on the use of digital health tools in their work.

Methods

We obtained survey data from 1,141 CHWs from 28 countries with complete study information. We conducted regression analyses to explore the relationship between CHWs’ training and perceived barriers to digital health access with current use of digital devices/tools and belief in digital impact while adjusting for demographic factors.

Results

Most of the CHWs worked in Kenya (n = 502, 44%) followed by the Philippines (n = 308, 27%), Ghana (n = 107, 9.4%), and the United States (n = 70, 6.1%). There were significant, positive associations between digital tools training and digital device/tool use (Adjusted Odds Ratio (AOR) = 2.92, 95% CI = 2.09–4.13) and belief in digital impact (AORhigh impact = 3.03, 95% CI = 2.04–4.49). CHWs were significantly less likely to use digital devices for their work if they identified cost as a perceived barrier (AORmobile service cost = 0.68, 95% CI = 0.49–0.95; AORphone/device cost = 0.66, 95% CI = 0.47–0.92). CHWs who were optimistic about digital health, were early adopters of technology in their personal lives, and found great value in their work believed digital health helped them to have greater impact. Older age and greater tenure were associated with digital device/tool use and belief in digital impact, respectively.

Conclusions

CHWs are not an obstacle to digital health adoption or use. CHWs believe that digital tools can help them have more impact in their communities regardless of perceived barriers. However, cost is a barrier to digital device/tool use; potential solutions to cost constraints of technological access will benefit from further exploration of reimbursement models. Digital health tools have the potential to increase CHW capacity and shape the future of community health work.
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Literature
2.
go back to reference Masis L, Gichaga A, Zerayacob T, Lu C, Perry HB. Community health workers at the dawn of a new era: 4. Programme financing. Health Res Policy Syst. 2021;19(3):107.CrossRefPubMedPubMedCentral Masis L, Gichaga A, Zerayacob T, Lu C, Perry HB. Community health workers at the dawn of a new era: 4. Programme financing. Health Res Policy Syst. 2021;19(3):107.CrossRefPubMedPubMedCentral
3.
go back to reference Sripad P, McClair TL, Casseus A, Hossain S, Abuya T, Gottert A. Measuring client trust in community health workers: A multi-country validation study. J Glob Health. 11:07009. Sripad P, McClair TL, Casseus A, Hossain S, Abuya T, Gottert A. Measuring client trust in community health workers: A multi-country validation study. J Glob Health. 11:07009.
6.
go back to reference Ahmed S, Chase LE, Wagnild J, Akhter N, Sturridge S, Clarke A, et al. Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice. Int J Equity Health. 2022;21(1):49.CrossRefPubMedPubMedCentral Ahmed S, Chase LE, Wagnild J, Akhter N, Sturridge S, Clarke A, et al. Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice. Int J Equity Health. 2022;21(1):49.CrossRefPubMedPubMedCentral
9.
go back to reference Mishra SR, Lygidakis C, Neupane D, Gyawali B, Uwizihiwe JP, Virani SS, et al. Combating non-communicable diseases: potentials and challenges for community health workers in a digital age, a narrative review of the literature. Health Policy Plan. 2019;34(1):55–66.CrossRefPubMed Mishra SR, Lygidakis C, Neupane D, Gyawali B, Uwizihiwe JP, Virani SS, et al. Combating non-communicable diseases: potentials and challenges for community health workers in a digital age, a narrative review of the literature. Health Policy Plan. 2019;34(1):55–66.CrossRefPubMed
10.
go back to reference Källander K, Tibenderana JK, Akpogheneta OJ, Strachan DL, Hill Z, ten Asbroek AHA, et al. Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review. J Med Internet Res. 2013;15(1):e17.CrossRefPubMedPubMedCentral Källander K, Tibenderana JK, Akpogheneta OJ, Strachan DL, Hill Z, ten Asbroek AHA, et al. Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review. J Med Internet Res. 2013;15(1):e17.CrossRefPubMedPubMedCentral
11.
go back to reference Paluyo J, Stake A, Bryson R. ’Padayon’: a new digital health model for diabetes and hypertension in rural Philippines. BMJ Innov. 2023;9(1):43–8.CrossRef Paluyo J, Stake A, Bryson R. ’Padayon’: a new digital health model for diabetes and hypertension in rural Philippines. BMJ Innov. 2023;9(1):43–8.CrossRef
12.
go back to reference Fredriksson A, Fulcher IR, Russell AL, Li T, Tsai YT, Seif SS, et al. Machine learning for maternal health: Predicting delivery location in a community health worker program in Zanzibar. Front Digit Health. 2022;4:855236.CrossRefPubMedPubMedCentral Fredriksson A, Fulcher IR, Russell AL, Li T, Tsai YT, Seif SS, et al. Machine learning for maternal health: Predicting delivery location in a community health worker program in Zanzibar. Front Digit Health. 2022;4:855236.CrossRefPubMedPubMedCentral
13.
15.
go back to reference Greuel M, Sy F, Bärnighausen T, Adam M, Vandormael A, Gates J, et al. Community health worker use of smart devices for health promotion: scoping review. JMIR MHealth UHealth. 2023;11(1):e42023.CrossRefPubMedPubMedCentral Greuel M, Sy F, Bärnighausen T, Adam M, Vandormael A, Gates J, et al. Community health worker use of smart devices for health promotion: scoping review. JMIR MHealth UHealth. 2023;11(1):e42023.CrossRefPubMedPubMedCentral
16.
go back to reference Bakibinga-Gaswaga E, Bakibinga S, Bakibinga DBM, Bakibinga P. Digital technologies in the COVID-19 responses in sub-Saharan Africa: policies, problems and promises. Pan Afr Med J. 2020;35(Suppl 2):38.PubMedPubMedCentral Bakibinga-Gaswaga E, Bakibinga S, Bakibinga DBM, Bakibinga P. Digital technologies in the COVID-19 responses in sub-Saharan Africa: policies, problems and promises. Pan Afr Med J. 2020;35(Suppl 2):38.PubMedPubMedCentral
17.
go back to reference Gadsden T, Maharani A, Sujarwoto S, Kusumo BE, Jan S, Palagyi A. Does social capital influence community health worker knowledge, attitude and practices towards COVID-19? Findings from a cross-sectional study in Malang district, Indonesia. SSM - Popul Health. 2022;1(19):101141.CrossRef Gadsden T, Maharani A, Sujarwoto S, Kusumo BE, Jan S, Palagyi A. Does social capital influence community health worker knowledge, attitude and practices towards COVID-19? Findings from a cross-sectional study in Malang district, Indonesia. SSM - Popul Health. 2022;1(19):101141.CrossRef
18.
go back to reference Hentschel E, Russell AL, Said S, Tibaijuka J, Hedt-Gauthier B, Fulcher IR. Identifying programmatic factors that increase likelihood of health facility delivery: results from a community health worker program in Zanzibar. Matern Child Health J. 2022;26(9):1840–53.CrossRefPubMed Hentschel E, Russell AL, Said S, Tibaijuka J, Hedt-Gauthier B, Fulcher IR. Identifying programmatic factors that increase likelihood of health facility delivery: results from a community health worker program in Zanzibar. Matern Child Health J. 2022;26(9):1840–53.CrossRefPubMed
19.
go back to reference Ballard M, Olsen HE, Millear A, Yang J, Whidden C, Yembrick A, et al. Continuity of community-based healthcare provision during COVID-19: a multicountry interrupted time series analysis. BMJ Open. 2022;12(5):e052407.CrossRefPubMed Ballard M, Olsen HE, Millear A, Yang J, Whidden C, Yembrick A, et al. Continuity of community-based healthcare provision during COVID-19: a multicountry interrupted time series analysis. BMJ Open. 2022;12(5):e052407.CrossRefPubMed
20.
go back to reference Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010;2010(3):CD004015.PubMedPubMedCentral Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010;2010(3):CD004015.PubMedPubMedCentral
22.
go back to reference August F, Pembe AB, Mpembeni R, Axemo P, Darj E. Effectiveness of the Home Based Life Saving Skills training by community health workers on knowledge of danger signs, birth preparedness, complication readiness and facility delivery, among women in Rural Tanzania. BMC Pregnancy Childbirth. 2016;16(1):129.CrossRefPubMedPubMedCentral August F, Pembe AB, Mpembeni R, Axemo P, Darj E. Effectiveness of the Home Based Life Saving Skills training by community health workers on knowledge of danger signs, birth preparedness, complication readiness and facility delivery, among women in Rural Tanzania. BMC Pregnancy Childbirth. 2016;16(1):129.CrossRefPubMedPubMedCentral
23.
go back to reference Kanté AM, Exavery A, Jackson EF, Kassimu T, Baynes CD, Hingora A, et al. The impact of paid community health worker deployment on child survival: the connect randomized cluster trial in rural Tanzania. BMC Health Serv Res. 2019;19(1):492.CrossRefPubMedPubMedCentral Kanté AM, Exavery A, Jackson EF, Kassimu T, Baynes CD, Hingora A, et al. The impact of paid community health worker deployment on child survival: the connect randomized cluster trial in rural Tanzania. BMC Health Serv Res. 2019;19(1):492.CrossRefPubMedPubMedCentral
25.
go back to reference Borges do Nascimento IJ, Abdulazeem HM, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, et al. The global effect of digital health technologies on health workers’ competencies and health workplace: an umbrella review of systematic reviews and lexical-based and sentence-based meta-analysis. Lancet Digit Health. 2023;5(8):e534–44. Borges do Nascimento IJ, Abdulazeem HM, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, et al. The global effect of digital health technologies on health workers’ competencies and health workplace: an umbrella review of systematic reviews and lexical-based and sentence-based meta-analysis. Lancet Digit Health. 2023;5(8):e534–44.
26.
go back to reference Rogers A, Goore LL, Wamae J, Starnes JR, Okong’o SO, Okoth V, et al. Training and experience outperform literacy and formal education as predictors of community health worker knowledge and performance, results from Rongo sub-county. Kenya Front Public Health. 2023;11:1120922.CrossRefPubMed Rogers A, Goore LL, Wamae J, Starnes JR, Okong’o SO, Okoth V, et al. Training and experience outperform literacy and formal education as predictors of community health worker knowledge and performance, results from Rongo sub-county. Kenya Front Public Health. 2023;11:1120922.CrossRefPubMed
27.
go back to reference Wanduru P, Tetui M, Tuhebwe D, Ediau M, Okuga M, Nalwadda C, et al. The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda – a mixed methods cross-sectional study. Glob Health Action. 2016;9(1):33194.CrossRefPubMed Wanduru P, Tetui M, Tuhebwe D, Ediau M, Okuga M, Nalwadda C, et al. The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda – a mixed methods cross-sectional study. Glob Health Action. 2016;9(1):33194.CrossRefPubMed
28.
go back to reference Kawakatsu Y, Sugishita T, Tsutsui J, Oruenjo K, Wakhule S, Kibosia K, et al. Individual and contextual factors associated with community health workers’ performance in Nyanza Province, Kenya: a multilevel analysis. BMC Health Serv Res. 2015;15(1):442.CrossRefPubMedPubMedCentral Kawakatsu Y, Sugishita T, Tsutsui J, Oruenjo K, Wakhule S, Kibosia K, et al. Individual and contextual factors associated with community health workers’ performance in Nyanza Province, Kenya: a multilevel analysis. BMC Health Serv Res. 2015;15(1):442.CrossRefPubMedPubMedCentral
30.
go back to reference Rowe SY, Kelly JM, Olewe MA, Kleinbaum DG, McGowan JE, McFarland DA, et al. Effect of multiple interventions on community health workers’ adherence to clinical guidelines in Siaya district, Kenya. Trans R Soc Trop Med Hyg. 2007;101(2):188–202.CrossRefPubMed Rowe SY, Kelly JM, Olewe MA, Kleinbaum DG, McGowan JE, McFarland DA, et al. Effect of multiple interventions on community health workers’ adherence to clinical guidelines in Siaya district, Kenya. Trans R Soc Trop Med Hyg. 2007;101(2):188–202.CrossRefPubMed
31.
go back to reference Kozuki N, Tesfai C, Boetzelaer AZ and E van. Can low-literate community health workers treat severe acute malnutrition? A study of simplified algorithm and tools in South Sudan. Field Exch 59. 2019;30. Kozuki N, Tesfai C, Boetzelaer AZ and E van. Can low-literate community health workers treat severe acute malnutrition? A study of simplified algorithm and tools in South Sudan. Field Exch 59. 2019;30.
32.
go back to reference Taylor CA, Lilford RJ, Wroe E, Griffiths F, Ngechu R. The predictive validity of the Living Goods selection tools for community health workers in Kenya: cohort study. BMC Health Serv Res. 2018;18(1):803.CrossRefPubMedPubMedCentral Taylor CA, Lilford RJ, Wroe E, Griffiths F, Ngechu R. The predictive validity of the Living Goods selection tools for community health workers in Kenya: cohort study. BMC Health Serv Res. 2018;18(1):803.CrossRefPubMedPubMedCentral
33.
go back to reference Bagonza J, Rutebemberwa E, Eckmanns T, Ekirapa-Kiracho E. What influences availability of medicines for the community management of childhood illnesses in central Uganda? Implications for scaling up the integrated community case management programme. BMC Public Health. 2015;15(1):1180.CrossRefPubMedPubMedCentral Bagonza J, Rutebemberwa E, Eckmanns T, Ekirapa-Kiracho E. What influences availability of medicines for the community management of childhood illnesses in central Uganda? Implications for scaling up the integrated community case management programme. BMC Public Health. 2015;15(1):1180.CrossRefPubMedPubMedCentral
34.
go back to reference Wallis L, Blessing P, Dalwai M, Shin SD. Integrating mHealth at point of care in low- and middle-income settings: the system perspective. Glob Health Action. 2017;10(sup3):1327686.CrossRefPubMedPubMedCentral Wallis L, Blessing P, Dalwai M, Shin SD. Integrating mHealth at point of care in low- and middle-income settings: the system perspective. Glob Health Action. 2017;10(sup3):1327686.CrossRefPubMedPubMedCentral
35.
go back to reference Ejigu Y, Abera N, Haileselassie W, Berhanu N, Haile BT, Nigatu F, et al. Motivation and job satisfaction of community health workers in Ethiopia: a mixed-methods approach. Hum Resour Health. 2023;21(1):35.CrossRefPubMedPubMedCentral Ejigu Y, Abera N, Haileselassie W, Berhanu N, Haile BT, Nigatu F, et al. Motivation and job satisfaction of community health workers in Ethiopia: a mixed-methods approach. Hum Resour Health. 2023;21(1):35.CrossRefPubMedPubMedCentral
36.
go back to reference Hermann K, Van Damme W, Pariyo GW, Schouten E, Assefa Y, Cirera A, et al. Community health workers for ART in sub-Saharan Africa: learning from experience – capitalizing on new opportunities. Hum Resour Health. 2009;7(1):31.CrossRefPubMedPubMedCentral Hermann K, Van Damme W, Pariyo GW, Schouten E, Assefa Y, Cirera A, et al. Community health workers for ART in sub-Saharan Africa: learning from experience – capitalizing on new opportunities. Hum Resour Health. 2009;7(1):31.CrossRefPubMedPubMedCentral
37.
go back to reference Bonenberger M, Aikins M, Akweongo P, Wyss K. The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study. Hum Resour Health. 2014;12(1):43.CrossRefPubMedPubMedCentral Bonenberger M, Aikins M, Akweongo P, Wyss K. The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study. Hum Resour Health. 2014;12(1):43.CrossRefPubMedPubMedCentral
38.
go back to reference Ballard M, Westgate C, Alban R, Choudhury N, Adamjee R, Schwarz R, et al. Compensation models for community health workers: comparison of legal frameworks across five countries. J Glob Health. 11:04010. Ballard M, Westgate C, Alban R, Choudhury N, Adamjee R, Schwarz R, et al. Compensation models for community health workers: comparison of legal frameworks across five countries. J Glob Health. 11:04010.
39.
go back to reference Smithwick J, Nance J, Covington-Kolb S, Rodriguez A, Young M. “Community health workers bring value and deserve to be valued too:” Key considerations in improving CHW career advancement opportunities. Front Public Health. 2023;8(11):1036481.CrossRef Smithwick J, Nance J, Covington-Kolb S, Rodriguez A, Young M. “Community health workers bring value and deserve to be valued too:” Key considerations in improving CHW career advancement opportunities. Front Public Health. 2023;8(11):1036481.CrossRef
40.
go back to reference Brook RD, Levy PD, Brook AJ, Opara IN. Community health workers as key allies in the global battle against hypertension: current roles and future possibilities. Circ Cardiovasc Qual Outcomes. 2023;16(3):e009900.CrossRefPubMed Brook RD, Levy PD, Brook AJ, Opara IN. Community health workers as key allies in the global battle against hypertension: current roles and future possibilities. Circ Cardiovasc Qual Outcomes. 2023;16(3):e009900.CrossRefPubMed
41.
go back to reference Scott K, Beckham SW, Gross M, Pariyo G, Rao KD, Cometto G, et al. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health. 2018;16(16):39.CrossRefPubMedPubMedCentral Scott K, Beckham SW, Gross M, Pariyo G, Rao KD, Cometto G, et al. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health. 2018;16(16):39.CrossRefPubMedPubMedCentral
43.
go back to reference Vaportzis E, Clausen MG, Gow AJ. Older adults perceptions of technology and barriers to interacting with tablet computers: a focus group study. Front Psychol. 2017;4(8):1687.CrossRef Vaportzis E, Clausen MG, Gow AJ. Older adults perceptions of technology and barriers to interacting with tablet computers: a focus group study. Front Psychol. 2017;4(8):1687.CrossRef
44.
go back to reference Schroeder T, Dodds L, Georgiou A, Gewald H, Siette J. older adults and new technology: mapping review of the factors associated with older adults’ intention to adopt digital technologies. JMIR Aging. 2023;16(6):e44564.CrossRef Schroeder T, Dodds L, Georgiou A, Gewald H, Siette J. older adults and new technology: mapping review of the factors associated with older adults’ intention to adopt digital technologies. JMIR Aging. 2023;16(6):e44564.CrossRef
45.
go back to reference Sundstrup E, Meng A, Ajslev JZN, Albertsen K, Pedersen F, Andersen LL. New technology and loss of paid employment among older workers: prospective cohort study. Int J Environ Res Public Health. 2022;19(12):7168.CrossRefPubMedPubMedCentral Sundstrup E, Meng A, Ajslev JZN, Albertsen K, Pedersen F, Andersen LL. New technology and loss of paid employment among older workers: prospective cohort study. Int J Environ Res Public Health. 2022;19(12):7168.CrossRefPubMedPubMedCentral
46.
go back to reference Patil SR, Nimmagadda S, Gopalakrishnan L, Avula R, Bajaj S, Diamond-Smith N, et al. Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India. BMJ Glob Health. 2022;6(Suppl 5):e007298.CrossRefPubMedPubMedCentral Patil SR, Nimmagadda S, Gopalakrishnan L, Avula R, Bajaj S, Diamond-Smith N, et al. Can digitally enabling community health and nutrition workers improve services delivery to pregnant women and mothers of infants? Quasi-experimental evidence from a national-scale nutrition programme in India. BMJ Glob Health. 2022;6(Suppl 5):e007298.CrossRefPubMedPubMedCentral
47.
go back to reference Schoen J, Mallett JW, Grossman-Kahn R, Brentani A, Kaselitz E, Heisler M. Perspectives and experiences of community health workers in Brazilian primary care centers using m-health tools in home visits with community members. Hum Resour Health. 2017;15(1):71.CrossRefPubMedPubMedCentral Schoen J, Mallett JW, Grossman-Kahn R, Brentani A, Kaselitz E, Heisler M. Perspectives and experiences of community health workers in Brazilian primary care centers using m-health tools in home visits with community members. Hum Resour Health. 2017;15(1):71.CrossRefPubMedPubMedCentral
48.
go back to reference Beratarrechea A, Abrahams-Gessel S, Irazola V, Gutierrez L, Moyano D, Gaziano TA. Using mHealth tools to improve access and coverage of people with public health insurance and high cardiovascular disease risk in argentina: a pragmatic cluster randomized trial. J Am Heart Assoc. 2019;8(8):e011799.CrossRefPubMedPubMedCentral Beratarrechea A, Abrahams-Gessel S, Irazola V, Gutierrez L, Moyano D, Gaziano TA. Using mHealth tools to improve access and coverage of people with public health insurance and high cardiovascular disease risk in argentina: a pragmatic cluster randomized trial. J Am Heart Assoc. 2019;8(8):e011799.CrossRefPubMedPubMedCentral
Metadata
Title
The use and potential impact of digital health tools at the community level: results from a multi-country survey of community health workers
Authors
Courtney T. Blondino
Alex Knoepflmacher
Ingrid Johnson
Cameron Fox
Lorna Friedman
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-18062-3

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