Female community health volunteers' experience in navigating social context while providing basic diabetes services in western Nepal: Social capital and beyond from systems thinking
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The rising global burden of non-communicable diseases (NCDs) has swiftly increased the mobilization of community health workers (CHWs) for prevention and management, largely in resource-poor settings. However, global literature is scarce on CHWs` real-life experiences on how they navigate the complex social context while delivering the home-based management of NCDs. This study is set in the context of Nepalese CHWs, referred to as female community health volunteers (FCHVs) who were enrolled in the basic type 2 diabetes (T2D) service provision. Drawing on the interdisciplinary synthesis of the Chronic Care Model and Social Capital theory, through the phenomenological approach, our study presents the sociological phenomena of FCHVs' lived experiences regarding their involvement in T2D intervention in Pokhara Metropolitan City of western Nepal. The empirical materials involved two focus group discussions with 14 and in-depth interviews with 9 FCHVs who were involved in providing basic T2D services. Our study revealed that the elements of social capital, including 1) expanding Social Network; 2) gaining and maintaining Social Trust; and 3) generating Norms of Reciprocity among community people were the major challenges that FCHVs had to face in T2D intervention. In addition, power dynamics challenged FCHVs interplaying with social capital elements. Once the social capital was strengthened, it was not always in favor of FCHVs' pleasant experiences. Increased social capital was embedded with their self-motivation but put them in dilemmas and risked their social relationship creating feedback loops with each of these elements. Despite the hurdles, strengthening the social capital by their timeless efforts and the strong support systems from their families, non-government organizations, and self-motivation helped them to overcome the complexity of the social context they encountered. Our findings can give valuable insights to understand the role of social context while designing and implementing CHW health interventions, especially in resource-poor settings. However, research with larger samples, including the perspectives of service recipients and health workers is needed to yield robust results.
Originalsprog | Engelsk |
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Artikelnummer | e0002632 |
Tidsskrift | PLOS Global Public Health |
Vol/bind | 3 |
Udgave nummer | 11 |
DOI | |
Status | E-pub ahead of print - 2024 |
Bibliografisk note
Copyright: © 2023 Dahal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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