Health Communication for Sustainable Health Attitudes and Behaviour Change. A Study of Community Health Promoters in Uasin Gishu County

Résumé

Globally healthcare workforce deficit continues to be a serious challenge in healthcare service delivery. Community healthcare promoters have been incorporated to bridge this gap in urban and rural marginalized communities. While their contribution has been applauded, health related behaviour change among these communities remains relatively low. This study aims at investigating the contribution of CHVs in enhancing health literacy for individual and communal health development. The study objectives were to identify the communities’ perceptions on CHVs contribution towards understanding and management of non-communicable diseases, to establish CHVs application of health information and communication strategies/skills in health promotion, to establish the content of health messages shared with communities/individuals about non-communicable diseases and to identify the challenges experienced by CHVs in promoting healthcare literacy. The study was guided by integrated behavioral model, health belief model and theory of interpersonal behavior. The study adopted a qualitative research approach guided by interpretivist epistemology and social constructivist ontology. A case study design was used to facilitate in-depth exploration of communication experiences and behavioural outcomes within community settings. The target population comprised 560 participants, including Community Health Promoters, Community Health Assistants (CHAs), household members, and patients affected by NCDs. A sample of 60 participants was selected through purposive, stratified random, and convenience sampling techniques. Data were collected using semi-structured interviews, focus group discussions, and document analysis. Thematic and content analysis techniques were used to analyse the data. The findings revealed that CHPs were widely perceived as trusted health literacy brokers who bridged the gap between formal healthcare systems and local communities. Through culturally adaptive and dialogic communication approaches, CHPs improved understanding of NCDs, medication adherence, dietary practices, physical activity, and preventive health behaviours. Home visits, participatory discussions, experiential demonstrations, local language interpretation, and digital health referrals emerged as key communication strategies supporting sustainable behaviour change. Participants reported increased clinic attendance, improved self-management skills, enhanced treatment adherence, and stronger community support networks. However, several barriers constrained the effectiveness and sustainability of CHP interventions, including low literacy levels, inadequate communication materials, inconsistent supervision, insufficient training, limited digital access, and lack of financial and structural support for CHPs. The study concludes that CHP-mediated health communication plays a significant role in strengthening health literacy and promoting sustainable health attitudes and behavioural transformation in communities affected by NCDs. The study recommends strengthening CHP training, integrating digital communication tools, developing literacy-sensitive educational materials, improving supervision and logistical support, and formally integrating CHPs into county health systems through structured remuneration and career progression frameworks.