Field Dynamics Faced by Community Health Workers During a Public Health Crisis: A Qualitative Study of Motivations and Challenges
Keywords:
community health workers, challenges, motivation, emergency, public health
Abstract
The global shortage of healthcare professionals has intensified efforts to train more Community Health Workers (CHWs) to meet health and developmental needs. Amidst a global health crisis, such as the COVID-19 pandemic tragedy that occurred several years ago, CHWs have played a crucial role in controlling community-based outbreaks, thereby strengthening the public health emergency response while facing numerous challenges. This study explores the motivations and challenges CHWs face in managing health crises. Employing a descriptive phenomenological approach, this study conducted semi-structured in-depth interviews with 13 CHWs in Makassar City, selected through purposive sampling. Data were analyzed using thematic analysis via the Colaizzi method. Thematic analysis revealed three main themes and seven sub-themes, encapsulating factors of social needs and expanded health perspectives as motivational elements alongside challenges such as the prevailing negative paradigm regarding the health crisis. CHWs are instrumental in spearheading community-based activities to manage health crises. CHW training programs, facilitated by community nurses, can significantly improve their performance and impact within the community.
References
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2. Spowart S, Masys AJ. Global Health and Pandemics—Beyond Direct Effects of COVID 19 Outbreak. In: Advanced Sciences and Technologies for Security Applications [Internet]. 2021. p. 47–70. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85107298965&doi=10.1007%2F978-3-030-71998-2_4&partnerID=40&md5=b11e9d1570c66e727e2ad4fa5d372fe3
3. IHME. Worldwide shortage of health workers threatens effective health coverage [Internet]. Institute for Health Metrics and Evaluation (IHME). 2022. Available from: https://www.healthdata.org/news-release/worldwide-shortage-health-workers-threatens-effective-health-coverage
4. WHO. Health workforce [Internet]. World Health Organization. 2022. Available from: https://www.who.int/health-topics/health-workforce#tab=tab_1
5. UNAIDS. 2 million African community health workers Harnessing the demographic dividend, ending AIDS and ensuring sustainable health for all in Africa [Internet]. 2017. Available from: https://www.unaids.org/sites/default/files/media_asset/African2mCHW_en.pdf
6. Najafizada SAM, Labonté R, Bourgeault IL. Community health workers of Afghanistan: A qualitative study of a national program. Confl Health. 2014;8(1).
7. Tantrakarnapa K, Bhopdhornangkul B. Challenging the spread of COVID-19 in Thailand. One Heal [Internet]. 2020;11(April):100173. Available from: https://doi.org/10.1016/j.onehlt.2020.100173
8. Khongsai L, Anal TSSC, A.S R, Kh TS, Shah MK, Pandey D. Combating the Spread of COVID-19 Through Community Participation. Glob Soc Welf. 2021;8(2):127–32.
9. Gilmore B, Ndejjo R, Tchetchia A, De Claro V, Mago E, Diallo AA, et al. Community engagement for COVID-19 prevention and control: A rapid evidence synthesis. BMJ Glob Heal. 2020;5(10):1–11.
10. Narkvichien M. Thailand’s 1 million village health volunteers - “unsung heroes” - are helping guard communities nationwide from COVID-19 [Internet]. World Health Organization. 2020. Available from: https://www.who.int/thailand/news/feature-stories/detail/thailands-1-million-village-health-volunteers-unsung-heroes-are-helping-guard-communities-nationwide-from-covid-19
11. APHA. Community Health Workers [Internet]. American Public Health Association. 2020 [cited 2022 Feb 2]. Available from: https://www.apha.org/apha-communities/member-sections/community-health-workers
12. Al Siyabi H, Al Mukhaini S, Kanaan M, Al Hatmi S, Al Anqoudi Z, Al Kalbani A, et al. Community Participation Approaches for Effective National COVID-19 Pandemic Preparedness and Response: An Experience From Oman. Front Public Heal. 2021;8(January):1–8.
13. Ministry of Health of the Republic of Indonesia. MINISTER OF HEALTH REPUBLIC OF INDONESIA DECREE NUMBER HK 01.07/MENKES/413/2020 REGARDING GUIDELINES FOR PREVENTION AND CONTROL OF CORONAVIRUS DISEASE 2019 (COVID-19) [Internet]. Jakarta; 2020. Available from: https://covid19.go.id/storage/app/media/Regulasi/KMK No. HK.01.07-MENKES-413-2020 ttg Pedoman Pencegahan dan Pengendalian COVID-19.pdf
14. Berliana DH, Sahar J, Rahmadiyah DC. Contribution of Community Health Workers during the COVID-19 Pandemic. J Telenursing. 2022;4(1):354–64.
15. Afiyanti Y, Rachmawati IN. Qualitative Research Methodology in Nursing Research. Jakarta: Rajawali Pers; 2014.
16. Cresswell J. Qualitative, quantitative, and mixed methods approaches. Research design. 2013.
17. Streubert HJ, Carpenter DR. Qualitative Research In Nursing: Advancing The Humanistic Imperative. Fifth. New York: Lippincott Williams & Wilkins; 2011.
18. Colaizzi PF. Reflection and Research in Psychology: A Phenomenological Study of Learning. Cornell University: Kendall/Hunt Publishing Company; 1973.
19. Guba EG, Lincoln TS. Competing paradigms in qualitative research. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (pp. 105-117). Thousand Oaks, CA Sage. 1994;105–17.
20. Aruma DEO, Hanachor DME. Abraham Maslow’s Hierarchy of Needs and Assessment of Needs in Community Development. Int J Dev Econ Sustain. 2017;5(7):15–27.
21. Sands L. What are motivation theories? [Internet]. 2020 [cited 2021 Jun 4]. Available from: https://www.breathehr.com/en-gb/blog/topic/employee-engagement/what-are-motivation-theories
22. Mohajer N, Singh D. Factors enabling community health workers and volunteers to overcome socio-cultural barriers to behaviour change: Meta-synthesis using the concept of social capital. Hum Resour Health. 2018;16(1):1–9.
23. Maes K. “Volunteers Are Not Paid Because They Are Priceless”: Community Health Worker Capacities and Values in an AIDS Treatment Intervention in Urban Ethiopia. Med Anthropol Q. 2015;29(1):97–115.
24. Cash E, Toney-Butler TJ. Social Relations [Internet]. Kentucky, United States: StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436023/#!po=83.3333
25. Goodwin R, Hou WK, Sun S, Ezra MB-. Quarantine, distress and interpersonal relationships during COVID-19. Gen Psychiatry. 2020;(0):0–4.
26. Mheidly N, Fares MY, Zalzale H, Fares J. Effect of Face Masks on Interpersonal Communication During the COVID-19 Pandemic. Front Public Heal. 2020;8(December):1–6.
27. Marroquín B, Vine V, Morgan R. Mental health during the COVID-19 pandemic: Effects of stay-at-home policies, social distancing behavior, and social resources. Psychiatry Res [Internet]. 2020;293(May):113419. Available from: https://doi.org/10.1016/j.psychres.2020.113419
28. Baridwan S, Setiawan A, Permatasari H. Public Health Measures As an Effort To Prevent and Control Covid-19 in the Community: a Literature Review. J Kesehat. 2020;13(2):121.
29. Carroll N, Sadowski A, Laila A, Hruska V, Nixon M, Ma DWL, et al. The impact of covid-19 on health behavior, stress, financial and food security among middle to high income canadian families with young children. Nutrients. 2020;12(8):1–14.
30. Profita AC. Several Factors Related to the Activeness of Posyandu Cadres in Pengadegan Village, Banyumas Regency. J Adm Kesehat Indones. 2018;6(2):68.
Published
2025-04-19
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Syamsir SB, Setiawan A, Permatasari H, Supriyatno H, Yudanagara BBH, Nrul Huda. Field Dynamics Faced by Community Health Workers During a Public Health Crisis: A Qualitative Study of Motivations and Challenges . woh [Internet]. 2025Apr.19 [cited 2025Apr.24];8(2):106-15. Available from: http://103.133.36.92/index.php/woh/article/view/2391
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Copyright (c) 2025 Syamikar Baridwan Syamsir, Agus Setiawan, Henny Permatasari, Heru Supriyatno, Bani Bacan Hacantya Yudanagara
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