Effectiveness of Training and Supportive Supervision in Improving Community Health Workers’ Knowledge, Self-Efficacy, and Capacity for Hypertension and Diabetes Screening and Referral in Rural Kenya: A Mixed- Methods Quasi-Experimental Study
Year: 2026
Type: preprint
Abstract: Background Community health workers (CHWs) are central to community-based screening and referral for hypertension and diabetes in Kenya, yet their capacity is often limited with minimal long-term support. We assessed whether training, with or without supportive supervision, improves CHW knowledge, self-efficacy, and capacity for these tasks in rural Siaya County. Methods We conducted a mixed-methods, controlled before-and-after quasi-experimental study with three arms: training plus six months of supportive supervision (n = 11), training only (n = 11), and routine practice (n = 16). Thirty-eight CHWs were assessed. Knowledge and self-efficacy were measured at baseline and endline, and intervention effects estimated using linear regression. We analysed four focus group discussions thematically. Results Participants' mean age was 48 years, and 87% were female. Knowledge improved across all arms. Low diabetes knowledge was eliminated in the full-intervention arm. Compared with control, the full intervention showed non-significant positive trends in diabetes knowledge (coefficient 2.32; 95% CI − 0.12 to 4.75; p = 0.062) and hypertension knowledge (2.23; −0.29 to 4.74; p = 0.083). Training only significantly improved hypertension knowledge (3.23; 0.71 to 5.74; p = 0.012). The largest effects were on self-efficacy, in both the full-intervention arm (33.06; 17.81 to 48.31; p < 0.001) and the training-only arm (34.06; 18.81 to 49.31; p < 0.001). High self-confidence rose from 18.2% to 100% with full intervention and from 9.1% to 81.8% with training only. At endline, the arms differed significantly in confidence for capillary glucose screening (p = 0.010), risk-assessment tools (p = 0.006), referral counseling (p = 0.006), and advising on NCD risk factors (p = 0.001). Six themes emerged from the focus groups. Qualitative findings indicated that training improved knowledge and confidence, while supportive supervision facilitated application of skills in community settings. Key implementation barriers included poor connectivity, workload, limited supplies, and transport constraints. Conclusions Training substantially improved CHW self-efficacy and practice-related competence, with more modest, condition-specific knowledge gains. Training with support supervision helps translate learning into practice. Larger, longer studies are needed to confirm these preliminary effects and test their impact on screening and referral outcomes.
Source: Research Square
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225774944