Improving the health literacy of Lay Community Health Workers (LCHWs) in Southern Africa to improve the health of women and children

该研究项目的最终目的是提高南部非洲农村社区卫生工作者的健康素养，使妇女能够对自己和子女的健康做出更好的选择。非专业社区卫生工作者（LCHW）通过在南部非洲农村家庭提供健康咨询和护理来补充初级保健诊所。LCHW提供产前和产后护理，一般健康咨询，并支持艾滋病毒等慢性病的管理。然而，由于他们的基本、不足和差的培训，以及缺乏对促进和保持良好健康的信息的理解和使用，即所谓的卫生知识普及，他们的作用目前受到限制。南部非洲农村黑人妇女的保健知识非常贫乏，因此，妇女在对自己和子女的健康作出选择时往往缺乏信息。这反过来又增加了南部非洲已经负担过重的初级保健服务的压力，造成不良的保健结果，特别是营养不良和体重不足的儿童。卫生知识和赋权对于使妇女能够作出知情决定以改善自身及其子女的健康至关重要，例如与避孕和婴儿喂养及营养有关的决定。我们的目标是南部非洲农村黑人妇女及其子女，因为这一人群的卫生知识水平很低。我们正在与南部非洲的培训提供商Sizabantu合作，为四个社区的LCHW制定、实施和评估培训干预措施。为了开发培训干预措施，我们首先需要在开始教育计划之前确定变革的促进者和障碍。这是因为提高这一人群的卫生知识水平特别具有挑战性，因为卫生信息可能与妇女先前的信念（包括耻辱和神话）相冲突，使其不太可能被改编。因此，培训干预需要考虑的不仅仅是教育内容，以帮助LCHW将妇女的信仰公之于众，并提供一个安全的环境，使妇女能够掌握知识和技能，理解和理解她们的选择。一旦在南非的四个社区制定了培训干预措施并对其有效性进行了评估，将向莱索托和莫桑比克的社区推广。该教育方案将包括为LCHW提供性健康和生殖健康、产前健康和幼儿健康与发展方面的培训。一旦LCHW参加了教育培训方案，他们将在每周的家庭访问中利用新获得的知识和技能提高非洲黑人妇女的健康知识。干预措施的最终结果是使非洲黑人妇女能够作出必要的积极决定，以改善其自身及其子女的健康。这项研究最有可能产生的积极健康决定的类型包括采取（更有效的）避孕方法，以减少性传播疾病和提高母乳喂养率。

This research project ultimately aims to improve the health literacy of Lay Community Health Workers (LCHWs) in rural Southern Africa to enable women to make better choices about their own and their children's health. Lay Community Health Workers (LCHWs) complement primary healthcare clinics by providing health advice and care in family homes in rural Southern Africa. LCHWs provide antenatal and postnatal care, general health advice and also support management of chronic conditions such as HIV. However, their role is currently limited by their basic, insufficient and poor training and a lack of understanding and use of information to promote and maintain good health, known as health literacy. Health Literacy is very poor among rural black Southern African women and therefore, choices that women make about their own and their children's health are often poorly informed. In turn, this contributes to increased pressure on already overburdened primary health services in Southern Africa and poor health outcomes, in particular malnutrition and underweight children. Health Literacy and empowerment are essential to enable women to make informed decisions to improve their own and their children's health, for example relating to contraception and infant feeding and nutrition. We are targeting rural black Southern African women and their children as health literacy is poor amongst this population. We are working with Sizabantu, a training provider in Southern Africa, to develop, implement and evaluate a training intervention for LCHWs in four communities. In order to develop the training intervention, we first need to identify the facilitators and barriers to change before starting an educational programme. This is because improving health literacy in this population is particularly challenging, since health information may conflict with women's prior beliefs (including stigma and myths) making it less likely to be adapted. Therefore, the training intervention needs to consider more than educational content in order to help LCHWs draw women's beliefs out into the open and provide a safe environment in which women can be equipped with the knowledge and skills to understand and make sense of their options. Once the training intervention has been developed and evaluated for effectiveness in four communities in South Africa, it will be rolled out to communities in Lesotho and Mozambique. The educational programme will include training for LCHWs on sexual and reproductive health, antenatal health and early childhood health and development. Once LCHWs have taken part in the educational training programme they will then use their newly-acquired knowledge and skills to improve the health literacy of black African women during weekly household visits. The ultimate outcome of the intervention is for black African women to be able to make the necessary positive decisions to improve their own and their children's health. The type of positive health decisions that are most likely to arise as a result of this study include uptake of (more effective) contraception methods to reduce sexually transmitted diseases and increased breast feeding rates.