ArticleBMC health services research2015
'Deep down in their heart, they wish they could be given some incentives': a qualitative study on the changing roles and relations of care among home-based caregivers in Zambia.
Article in BMC health services research, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it, 45 citations in OpenAlex.
- Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis.Family medicine and community health · 2021Pooled it
- What does the literature tell us about health workers' experiences of task-shifting projects in sub-Saharan Africa? A systematic, qualitative review.Journal of clinical nursing · 2016Pooled it
- Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: a qualitative study.BMC pregnancy and childbirth · 2021Trial
- Motivation and satisfaction among community health workers administering rapid diagnostic tests for malaria in Western Kenya.Journal of global health · 2018Trial
- The role of community health workers in improving HIV treatment outcomes in children: lessons learned from the ZENITH trial in Zimbabwe.Health policy and planning · 2018Trial
- Trial
- Retention and attrition of community health volunteers in rural Malawi; a mixed-methods study.BMC public health · 2026Article
- Altruism or Exploitation? Rethinking the Ethics of Unpaid Lay Community Health Workers in Sub- Saharan Africa. The Case of Zambia.Journal of bioethical inquiry · 2026Article
- Prevalence and risk of burnout among HIV service providers in South Africa and Zambia: findings from the HPTN 071 (PopART) trial.Human resources for health · 2024Article
- To what extent did implementing a community-embedded intervention align with the goals and roles of stakeholders in adolescent sexual and reproductive health?Reproductive health · 2024Article
- Exploring a career pathway for home support workers in Ireland: a systematic scoping review of the international evidence.Frontiers in health services · 2024Article
- "I decided to participate….because I saw it as benefiting our community and families": a qualitative study of lay providers' experiences with delivering an evidence-based mental health intervention for families in Uganda.International journal of mental health systems · 2023Article
- Conceptualization, detection, and management of psychological distress and mental health conditions among people with tuberculosis in Zambia: a qualitative study with stakeholders' and TB health workers.International journal of mental health systems · 2022Article
- Roles, Barriers, and Recommendations for Community Health Workers Providing Community-Based HIV Care in Sub-Saharan Africa: A Review.AIDS patient care and STDs · 2022Review
- Home-Based Care, the Missing Link in Caring of Patients Living with HIV/AIDS and Their Family Members: A Narrative Review.International journal of community based nursing and midwifery · 2020Review
- What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India.BMJ global health · 2019Article
- Bench, bed and beyond: Communication and responsibility in decentralised tuberculosis care.Health SA = SA Gesondheid · 2019Article
- Does supportive supervision enhance community health worker motivation? A mixed-methods study in four African countries.Health policy and planning · 2018Article
- "I will not stop visiting!" a qualitative study of community health workers' reluctance to withdraw household support following the end of a community-based intervention in Zimbabwe.BMC health services research · 2018Article
- "They do not see us as one of them": a qualitative exploration of mentor mothers' working relationships with healthcare workers in rural North-Central Nigeria.Human resources for health · 2018Article
Corrections and comments
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Authors and funding
5 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAcross Sub-Saharan Africa, the roll-out of antiretroviral treatment (ART) has contributed to shifting HIV care towards the management of a chronic health condition. While the balance of professional and lay tasks in HIV caregiving has been significantly altered due to changing skills requirements and task-shifting initiatives, little attention has been given to the effects of these changes on health workers' motivation and existing care relations.
methodsThis paper draws on a cross-sectional, qualitative study that explored changes in home-based care (HBC) in the light of widespread ART rollout in the Lusaka and Kabwe districts of Zambia. Methods included observation of HBC daily activities, key informant interviews with programme staff from three local HBC organisations (n = 17) and ART clinic staff (n = 8), as well as in-depth interviews with home-based caregivers (n = 48) and HBC clients (n = 31).
resultsSince the roll-out of ART, home-based caregivers spend less time on hands-on physical care and support in the household, and are increasingly involved in specialised tasks supporting their clients' access and adherence to ART. Despite their pride in gaining technical care skills, caregivers lament their lack of formal recognition through training, remuneration or mobility within the health system. Care relations within homes have also been altered as caregivers' newly acquired functions of monitoring their clients while on ART are met with some ambivalence. Caregivers are under pressure to meet clients and their families' demands, although they are no longer able to provide material support formerly associated with donor funding for HBC.
conclusionsAs their responsibilities and working environments are rapidly evolving, caregivers' motivations are changing. It is essential to identify and address the growing tensions between an idealized rhetoric of altruistic volunteerism in home-based care, and the realities of lay worker deployment in HIV care interventions that not only shift tasks, but transform social and professional relations in ways that may profoundly influence caregivers' motivation and quality of care.
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