Peer-reviewed article
Can public sector community health workers deliver a nurturing care intervention in South Africa? The Amagugu Asakhula feasibility study
Sonja Klingberg, Esther M. F. van Sluijs, Stephanie T. Jong, Catherine Elizabeth Draper ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001Amagugu Asakhula is a nurturing care intervention designed to promote healthy eating and movement behaviours in preschool children (3-5 years) in South Africa. Researchers tested whether community health workers (CHWs) linked to public health facilities could deliver the intervention in Soweto. Although caregivers and CHWs liked the intervention and thought it was appropriate for CHWs to deliver, the study found it was not feasible due to workplace challenges such as delayed salary payments affecting CHW motivation and performance.
Key points
- The intervention was well-received and considered a good fit with CHWs' scope of work by both CHWs and caregivers
- Contextual barriers including late salary payments negatively influenced CHW performance and willingness to deliver the intervention
- CHWs expressed dissatisfaction with general working conditions and were reluctant to take on new tasks
- Delivery through public sector CHWs was not found to be feasible in this South African setting
- Delivery through CHWs linked to community-based organisations may be more appropriate for future testing
Limitations
The study was a small feasibility assessment (14 CHWs, 23 caregivers) over 6 weeks in one location (Soweto), so results may not generalise to other contexts or settings. The study did not measure child outcomes, so it cannot tell us whether the intervention would actually improve children's dietary and movement behaviours if delivery barriers were resolved.
Abstract
BACKGROUND: Nurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3-5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability. METHODS: A qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework. RESULTS: The delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs' scope of work. CONCLUSIONS: Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention's effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Amagugu Asakhula nurturing care intervention delivered by community health workers linked to a public sector primary health care facility, involving 6 weeks of sessions with caregivers
- Population
- 14 community health workers and 23 caregivers of preschool-age children (3-5 years) in Soweto, South Africa
Key finding
Delivery through public sector CHWs was not feasible due to contextual challenges such as late salary payments