Table 3 Acceptability of a community CVD programme among CHWs and community members based on the Theoretical Framework of Acceptability (TFA) framework
TFA construct / theme | Sub-theme | Summary codes | |
|---|---|---|---|
CHW | Community | ||
Ethicality | Programme fits community value system | • Belief in seeking healthcare from facilities. • Interest in remaining healthy. • No contradiction with religious or political views. | • Similar approaches have been employed • No contradiction with religious, political or cultural views. • Intervention elements such as education and counseling are acceptable |
Affective attitude | Willingness to engage in intervention | • Participation in similar community based programmes. • Community health services delivery is our role. • Appointed and trusted by the community members. • High perceived disease burden • High need for CVD services • Opportunity to widen scope of work. | • High perceived CVD burden. • Interest in screening and treatment services. • Opportunity to know CVD status. • Difficult to access care at health facilities. |
Conditions for intervention participation | • Well trained to carry out assigned tasks. • Obtain all costs related to intervention delivery. • Regular refresher trainings. • Honesty in terms of services. | • Well trained and motivated CHWs • Early information about planned events. • Continuous involvement in project activities. • Honesty in terms of services. | |
Appropriateness of intervention delivery strategies (group gatherings and house to house visits) | Group gatherings • Has high reach to community members. • Varrying confidence in conducting group sensitizations. House to house visits • Flexible timing. • Quality time with community members. • Reach the underserved. | • Appropriate with high reach among community members. House to house visits • Reach the underserved. | |
Intervention coherence | Understanding of intervention | • Training in CVD prevention and control. • CHWs educating community members. • Assess lifestyle risk factors and provide advice. • Encourage screening for risk factors. • Offer treatment to community members. | • CVD prevention programme. • Promotion of healthy lifestyles. • CHWs trained to sensitise community. • Community members mobilising others. |
Burden | Reaching communities | • Transportation, big areas of coverage, meals and equipment • Being exemplary • Carrying heavy screening equipment. |  |
Mobilising communities | • High interest of in financial gains • Resistant groups like youths • Uncooperative community members • Uncommon lifestyle choices • Fatigue due to repetitive information. • Unavailability at homes | • Low and inconsistent turn up • Unavailability at homes • Unwillingness to change • Unreceptivity to CHWs • Other duties and responsibilities | |
Community health work related challenges | • Inadequate training for proposed roles. • Transport and weather challenges. • Low motivation and incentives. • Inadequate tools and materials. | • Negative community attitudes towards CHWs. • CHWs not being exemplary. | |
Health system barriers | • Unprepared health workers. • Lack of required equipment and drugs. • Poor relationship with health workers. • Low belief in health system. | • Lack of transport to distant health facilities. • Lack of medicines at health facilities. • Lack of screening equipment. • Absence of health workers at facilities. • Low belief in health system. | |
Opportunity costs | Reduced time for other activities | • Reduced time for attending to farmlands, domestic work, socializing and travelling away. | • Reduced time for income generating activities and tending to farms. |
Benefits to communities | • Access to treatment. • Healthy members contributing to their communities. • Savings due to prevention of CVDs. • Knowing CVD status. | • Obtaining treatment and screening for CVDs. • Knowing CVD status early. • Healthy community members. • Knowledge on CVDs and risk factors. | |
Benefits to CHWs | • Information to keep healthy and better manage CVDs. • Community members acknowledging CHW expertise. • Fame and earning community trust. |  | |
Self-efficacy | Confidence to deliver intervention or change behaviour | • Previous experience in community programmes. • Anticipated adequate training. • Positive and eager community for information. | • Increased and empowerment to contribute to behavior change • Information sharing among community members. |
Perceived effectiveness | Intervention is effective | • Timely and consistent information key to reduce unhealthy behaviours • CHWs serving as examples | |
Measures to increase effectiveness | • Utilise community resources (community, religious and cultural leaders and community radio / loudspeakers) • Increase functionality of the health system • Involve external persons in intervention delivery • Provide information education and communication materials such as leaflets in the local language. | ||