Acceptability and feasibility of home-based hypertension and physical activity screening by community health workers in an under-resourced community in South Africa

Mark Stoutenberg; Simone H Crouch; Lia K McNulty; Andrea Kolkenbeck-Ruh; Georgia Torres; Philippe J L Gradidge; Andy Ly; Lisa J Ware

doi:10.1007/s10389-023-01873-w

Acceptability and feasibility of home-based hypertension and physical activity screening by community health workers in an under-resourced community in South Africa

Z Gesundh Wiss. 2023 Mar 23:1-12. doi: 10.1007/s10389-023-01873-w. Online ahead of print.

Authors

Mark Stoutenberg^{1

2}, Simone H Crouch³, Lia K McNulty¹, Andrea Kolkenbeck-Ruh^{3

4}, Georgia Torres², Philippe J L Gradidge², Andy Ly¹, Lisa J Ware^{3

5}

Affiliations

¹ Department of Kinesiology, College of Public Health, Temple University, 237 Pearson Hall, 1800 North Broad, Philadelphia, Pennsylvania 19122 USA.
² Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St. Andrews Road, Parktown, Gauteng, 2193 South Africa.
³ SA MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Corner College and Clinic Road, Chris Hani Baragwanath Academic Hospital, Soweto, 1864 South Africa.
⁴ Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Johannesburg, 2193 South Africa.
⁵ DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Wits Education Campus, 27 St. Andrews Road, Parktown, Gauteng, 2193 South Africa.

Abstract

Background: Low-middle-income countries (LMICs) face increasing burdens from non-communicable disease (NCDs) requiring primary care task shifting to community health workers (CHWs). This study explored community members' perceptions of NCD-focused, CHW-led home visits in a historically disadvantaged township of South Africa.

Methods: Trained CHWs visited community member homes, performing blood pressure and physical activity (PA) screenings, followed by brief counselling and a satisfaction survey. Semi-structured interviews were conducted within 3 days of the visit to learn about their experiences.

Results: CHWs visited 173 households, with 153 adult community members consenting to participate (88.4%). Participants reported that it was easy to understand CHW-delivered information (97%), their questions were answered well (100%), and they would request home service again (93%). Twenty-eight follow-up interviews revealed four main themes: 1) acceptance of CHW visits, 2) openness to counselling, 3) satisfaction with screening and a basic understanding of the results, and 4) receptiveness to the PA advice.

Conclusion: Community members viewed CHW-led home visits as an acceptable and feasible method for providing NCD-focused healthcare services in an under-resourced community. Expanding primary care reach through CHWs offers more accessible and individualized care, reducing barriers for individuals in under-resourced communities to access support for NCD risk reduction.

Keywords: Community health worker; Home visit; Hypertension; Non-communicable disease; South Africa.