Rebecca Shin-Yee Wong, Sathiya Maran, Bey Hing Goh
Current guidelines, challenges and future recommendations for regulation of stem cell research and therapy: a commentary
Cytotherapy
lay health workers lhws perform functions related healthcare delivery receive level training formal professional paraprofessional certificate tertiary education degree provide care range issues including maternal child health lhw programmes effective need better understanding factors influence success sustainability review addresses issues synthesis qualitative evidence carried alongside cochrane review effectiveness lhws maternal child healththe overall aim review explore factors affecting implementation lhw programmes maternal child healthwe searched medline ovidsp searched 21 december 2011 medline ovid inprocess nonindexed citations ovidsp searched 21 december 2011 cinahl ebsco searched 21 december 2011 british nursing index archive ovidsp searched 13 may 2011 searched reference lists included studies contacted experts field included studies carried alongside trials lhw effectiveness reviewstudies used qualitative methods data collection analysis focused experiences attitudes stakeholders regarding lhw programmes maternal child health primary community healthcare settingwe identified barriers facilitators lhw programme implementation using framework thematic synthesis approach two review authors independently assessed study quality using standard tool assessed certainty review findings using cerqual approach approach developed alongside related qualitative syntheses integrated findings outcome measures included review lhw programme effectiveness logic model finally identified hypotheses subgroup analyses future updates review effectivenesswe included 53 studies primarily describing experiences lhws programme recipients health workers lhws high income countries mainly offered promotion counselling support low middle income countries lhws offered similar services sometimes also distributed supplements contraceptives products diagnosed treated children common childhood diseases lhws trained manage uncomplicated labour refer women pregnancy labour complicationsmany findings based studies multiple settings methodological limitations findings assessed moderate certainty findings based one two studies methodological limitations assessed low certaintybarriers facilitators mainly tied programme acceptability appropriateness credibility health system constraints programme recipients generally positive programmes appreciating lhws skills similarities saw lhws however recipients concerned confidentiality receiving home visits others saw lhw services relevant sufficient particularly lhws offered promotional services lhws recipients emphasised importance trust respect kindness empathy however lhws sometimes found difficult manage emotional relationships boundaries recipients lhws feared blame care successful others felt demotivated services appreciated support health systems community leaders could give lhws credibility least health systems community leaders authority respect active support family members also importanthealth professionals often appreciated lhws contributions reducing workload communication skills commitment however health professionals thought lhws added workload feared loss authoritylhws motivated factors including altruism social recognition knowledge gain career development unsalaried lhws wanted regular payment others concerned payment might threaten social status lead recipients question motives salaried lhws dissatisfied pay levels others frustrated payment differed across regions institutions lhws stated opportunities voice complaints lhws described insufficient poor quality irrelevant inflexible training programmes calling training counselling communication topics outside current role including common health problems domestic problems lhws supervisors complained supervisors lack skills time transportation lhws appreciated opportunity share experiences fellow lhwsin studies lhws traditional birth attendants received additional training health professionals concerned lhws overconfident ability manage danger signs lhws recipients pointed problems including womens reluctance referred bad experiences health professionals fear caesarean sections lack transport cost lhws reluctant refer women poor cooperation health professionalswe organised findings outcome measures included review lhw programme effectiveness logic model proposed six chains events specific programme components lead specific intermediate longterm outcomes specific moderators positively negatively affect process suggest future updates lhw effectiveness review could explore whether presence components influences programme successrather seen lesser trained health worker lhws may represent different sometimes preferred type health worker close relationship lhws recipients programme strength however programme planners must consider achieve benefits closeness minimizing potential drawbacks important facilitators may include development services recipients perceive relevant regular visible support health system community appropriate training supervision incentives