Abstract
Working with community health workers is a vital strategy to improve health at a community level in low- and middle-income countries. Our study assessed the acceptability of a community health worker-led health literacy intervention on lifestyle modification among hypertensive and diabetes patients in the City of Harare, Zimbabwe. The intervention consisted of face-to-face individual educational sessions and support visits, delivered by trained community health workers at either the patient's home or the primary care clinic. We embedded this qualitative study within a cluster randomized trial, which assessed the intervention's effectiveness. Data were gathered through in-depth interviews with 3 community health nurses and 25 patients as well as 3 focus group discussions with CHWs. We analyzed the data manually using the deductive analysis method based on a coding framework structured according to the Theoretical Framework for Acceptability. Participants expressed optimism and anxiety regarding the intervention. All community nurses and CHWs believed that the intervention was effective in improving adherence to recommended lifestyle modifications and overall health outcomes among the patients. Patients felt that the intervention was ethically sound. All community health workers and community nurses reported a clear understanding of the intervention's goals and methods. Some patients felt that some aspects of the intervention needed to be improved. There was a consensus that the benefits associated with the intervention outweighed the costs. Some patients reported that they were not confident in participating in the intervention because some of the recommended lifestyle modifications were beyond their control. Whilst there were positive sentiments regarding the intervention's potential to empower patients and improve health outcomes, challenges related to patients' perceived burdens must be addressed. Future iterations of the intervention should focus on enhancing support for CHWs and ensuring that patients' preferences are catered for.