abstract: 'Background: Community health workers (CHWs) are increasingly being used

  in low-income countries to address human resources shortages, yet there

  remain few effective, evidence-based strategies for addressing the

  enduring programmatic constraints of worker motivation, retention and

  performance. This paper describes how two interventions were designed by

  the Innovations at Scale for Community Access and Lasting Effects

  (inSCALE) project to address these constraints in Uganda and Mozambique

  drawing on behavioural theory and formative research results.

  Methods: A review of the work motivation and CHW motivation

  literature-incorporating influences on retention and performance-was

  conducted on articles sourced through electronic web searches. Formative

  research with a focus on the barriers and facilitators to CHW

  motivation, retention and performance was conducted with community

  health workers and key stakeholders in Uganda and Mozambique. An

  analytical induction approach to the thematic analysis of transcripts

  from 98 in-depth interviews and 26 focus group discussions was adopted

  across the country settings.

  Results: From the theoretical review, it was determined that the

  interventions should promote CHWs as members of a collective by

  highlighting a sense of shared experience, focus on alignment between

  worker and programme goals, and emphasise the actions that lead to good

  performance. The Social Identity Approach was selected as the theory

  most likely to lead to the development of effective, scalable and

  sustainable interventions by addressing the identified gap in the

  literature of the influence of CHW working context. The formative

  research indicated that CHWs value feedback and feeling connected to the

  health system and their community, are motivated by status and community

  standing, and want to be provided with the necessary tools to perform.

  Two interventions based on these results were developed: a

  participatory, local community approach and an information communication

  technology (ICT) approach.

  Conclusions: Drawing on contextual data and theory that is sensitive to

  context can potentially lead to the development of appropriate and

  effective interventions when aiming to improve the motivation, retention

  and performance of CHWs in Uganda and Mozambique and other comparable

  settings. Evaluation of the developed interventions is crucial to assess

  this potential.'
affiliation: 'Strachan, DL (Corresponding Author), UCL Inst Global Hlth, 30 Guilford
  St, London WC1N 1EH, England.

  Strachan, Daniel Llywelyn; Hill, Zelee, UCL Inst Global Hlth, London WC1N 1EH, England.

  Kallander, Karin, Malaria Consortium, London EC2A 4LT, England.

  Kallander, Karin, Karolinska Inst, Stockholm, Sweden.

  Nakirunda, Maureen, Malaria Consortium Uganda, Kampala, Uganda.

  Ndima, Sozinho; Muiambo, Abel, Malaria Consortium Mozamb, Coop, Maputo, Mozambique.'
article-number: '25'
author: 'Strachan, Daniel Llywelyn and Kallander, Karin and Nakirunda, Maureen and
  Ndima, Sozinho and Muiambo, Abel and Hill, Zelee and inSCALE Study Grp, '
author-email: d.strachan@ucl.ac.uk
author_list:
- family: Strachan
  given: Daniel Llywelyn
- family: Kallander
  given: Karin
- family: Nakirunda
  given: Maureen
- family: Ndima
  given: Sozinho
- family: Muiambo
  given: Abel
- family: Hill
  given: Zelee
- family: inSCALE Study Grp
  given: ''
da: '2023-09-28'
doi: 10.1186/s12960-015-0020-8
eissn: 1478-4491
files: []
journal: HUMAN RESOURCES FOR HEALTH
keywords: 'Community health workers; Motivation; Retention; Performance; Social

  Identity Approach; Human resources for health; Uganda; Mozambique'
keywords-plus: SOCIAL IDENTITY; PUBLIC-HEALTH; CARE; IDENTIFICATION; PERCEPTIONS;
  POOR
language: English
month: APR 30
number-of-cited-references: '52'
orcid-numbers: 'Strachan, Daniel/0000-0001-6143-1742

  Soremekun, Seyi/0000-0002-5531-0220

  Kallander, Karin/0000-0002-5778-5780

  Ndima, Sozinho/0000-0003-4650-379X

  Kirkwood, Betty/0000-0001-5274-6072'
papis_id: e277d5275e03469628452309488420f4
ref: Strachan2015usingtheory
times-cited: '46'
title: Using theory and formative research to design interventions to improve community
  health worker motivation, retention and performance in Mozambique and Uganda
type: article
unique-id: WOS:000354173900001
usage-count-last-180-days: '0'
usage-count-since-2013: '20'
volume: '13'
web-of-science-categories: Health Policy \& Services; Industrial Relations \& Labor
year: '2015'