Academic journal article Iranian Journal of Public Health

Affecting Factors on the Performance of Community Health Workers in Iran's Rural Areas: A Review Article

Academic journal article Iranian Journal of Public Health

Affecting Factors on the Performance of Community Health Workers in Iran's Rural Areas: A Review Article

Article excerpt

Introduction

The primary objective of health system is to improve the accessibility of underserved groups and to reduce rural and urban inequalities in benefiting health care outcomes (1). Hence, after the Islamic Revolution in Iran, the government increased its focus on rural areas and established primary health care system. Iran's Primary Health Care (PHC) System was developed for the provision of health services in rural centers and health houses in which CHW performs in the most basic level (2). CHW is currently the most vital health service delivery agent in Iran's health system. Significant results in the society's health status are the achievements of high effectiveness in CHW performance (3), especially improvement in the health of mothers and children and in most health indicators during the last 40 yr (2). However, in the best circumstances, if a structure designed according to the existing needs remains unchanged, it gradually loses its responsiveness to the needs in course of changing conditions (4-7). Currently, primary health care networks in rural areas are facing several challenges in meeting the population needs (8-10). Based on the findings, CHWs in Iran have faced new challenges in the trend of health care and their abilities in terms of skills and educational competencies has led to decrease in their productivity and effectiveness in response to current needs of the community which is constantly changing, consequently it has resulted in decline in the inclination the community to approach them for receiving services (2). CHW's activities in the primary years of the plan was commensurate to the needs of the community, however, today, it requires other health care plans to address non-communicable diseases, prevention and control of high-risk behavior and lifestyle improvement (11). Literature state that inappropriate training is caused by decrease in the level of motivation and self-confidence and poor performance is due to absence, low quality of performance, weakness in managerial and organizational affairs (12). Moreover, lack of occupational vision has negative effect on the performance of CHWs and had resulted in significant decline (13, 14). Literature indicate various constraints and they mainly address certain aspects of CHW challenges, hence, there is an urgent necessitate in Iran to identify and study them and provide an in-depth understanding (2).Therefore, the present study aimed to use a mixed-methods approach to investigate affecting factors on CHW performance in rural community of Iran.

Methods

The present study was conducted during 20142015 with a mixed method in three phases of literature review, Delphi technique and rich picture for showing the relationships between factors (Fig. 1).

Phase 1: literature Review

Aiming to extract affecting factors on the performance of CHW in three steps a list of the factors was developed.

I. Extraction of Previous Studies

The relevant studies were extracted including scientific articles, books, published and unpublished reports and etc. Articles were collected with Narrative method by two independent research groups. The keywords included Persian words and their English equivalents of Behvarz, Health Worker and lay health workers, auxiliary health workers, community health worker in Google Scholar, Iranian Scientific Information Database (SID), Magiran, PubMed, and web of knowledge in data banks in the first six months of 2014.

II Qualitative Content Analysis

Each article was reviewed independently by two researchers and in order to perform a more comprehensive data extraction, all qualitative themes and data which were relevant to the research objective were extracted. Subsequently, discussion and agreement of the researchers about the extracted themes of an article led to formation of primary themes. Finally, the primary themes of all articles were integrated with each other in one document.

I. …

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