Understanding community health workers’ readiness to provide hyperlipidemia-related self-management support in rural Nepal: a biphasic mixed-methods evaluation

Abstract

Background: It is unknown whether Female Community Health Volunteers’ (FCHVs) can counsel for hyperlipidemia in rural Nepal. Methods: Using the Health Belief Model, we evaluated FCHV’s knowledge, self-efficacy, and barriers to counsel for hyperlipidemia in two phases eleven months apart among 28 FCHVs from rural mid-Western Nepal. In each phase, we conducted four Focused Group Discussions (FGDs), hyperlipidemia-related training and two similar surveys before and after the training. We used inductive and deductive codes for thematic analysis and descriptive statistics for quantitative analysis. We integrated the results for complementarity and convergence using concurrent embedded design (Qual + quan). Results: FCHVs’ mean age was 48 years and 21 out of 28 had worked for > 10 years. We found four themes in FGDs. In Phase 1, despite having interest, FCHVs had limited knowledge and confidence in counseling for hyperlipidemia. However, with sufficient training, they believed they could counsel. In Phase 2, FCHVs conveyed improved knowledge and self-efficacy. They expressed community might be concerned about their expertise, which improved in Phase 2. Quantitatively, FCHVs’ knowledge improved immediately after the initial training, which was stable in Phase 2. Inadequate training was identified less as a barrier in Phase 2, but inadequate time and incentive were identified more often, and community’s perception of FCHVs’ skills remained unchanged. Conclusion: FCHVs want to provide hyperlipidemia counseling. Despite our trainings and FCHV’s perceived self-efficacy, knowledge gap persisted. FCHVs’ workload, inadequate incentives and knowledge were important barriers. Balanced workload, regular trainings and adequate incentives are important to engage FCHVs in hyperlipidemia management.