Abstract
INTRODUCTION: Community Health Workers (CHWs) play an important role in delivering primary health care (PHC) services in rural and remote areas. Community perceptions regarding CHWs impact the acceptance, satisfaction and utilisation of health care services. This subsequently affects overall health outcomes and equity within the system. However, the various factors influencing these perceptions are still dispersed across different studies. OBJECTIVE: To identify and synthesise the factors influencing community members' perceptions of PHC services delivered by community health workers in rural areas. DESIGN: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines, a Systematic Review was conducted. METHOD: A thorough search across seven databases for English-language peer-reviewed publications from 1990 to 2024 yielded 4996 records. Following screening of titles and abstracts, we reviewed 231 full texts and ultimately included 30 articles for in-depth appraisal. RESULTS: Articles from 15 countries identified three interconnected thematic clusters affecting community perception: (1) structural and service delivery cluster, including CHW accessibility, service availability and healthcare quality; (2) trust cluster, such as trust, competency and confidentiality and (3) identity and sociocultural cluster, including CHWs' gender and CHWs from the same community. CONCLUSION: Incorporating identified factors into the training curriculum for CHWs, their capacity to meet community expectations and build trust can be enhanced. These insights can be used to align services with community needs. This systematic review identified important factors for improving CHWs' delivery of PHC services in rural areas that ensure these services are sustainable and responsive to community needs.