# Enhancing awareness and uptake of home-based care services during the coronavirus disease 2019 pandemic in Zambia

## TL;DR

This study explores how home-based care for COVID-19 was accepted in Zambia and identifies factors influencing its uptake.

## Contribution

The study provides new evidence on factors affecting home-based care acceptance in a low-resource setting.

## Key findings

- Awareness of home-based care and perceived effectiveness strongly increased its acceptance.
- Socioeconomic factors like income and employment status influenced uptake of home-based care.
- Formal employment was associated with lower odds of accepting home-based care.

## Abstract

The COVID-19 pandemic placed pressure on health systems, exposing workforce shortages and prompting innovative strategies to manage patients with mild to moderate symptoms. Home-based care emerged as a practical approach to reduce facility burden while maintaining quality care.

To assess the implementation and acceptability of the COVID-19 home management model in Zambia.

The study was conducted in 11 purposively selected districts with high levels of home-based management.

A comparative cross-sectional study was conducted. Data were collected in June 2023 and September 2023 from 566 individuals with confirmed COVID-19 eligible for home management, sampled systematically from health facility line lists. Descriptive statistics summarised participant characteristics, and multivariable logistic regression identified factors associated with accepting home-based care.

Sixty per cent participants were female, with a median age of 28 years. Awareness of the home management model (adjusted odds ratio [AOR] = 5.11; 95% confidence interval [CI]: 2.61–10.0), income between 600 and 1000 kwacha (AOR = 2.64; 95% CI: 1.10–6.85), and perceiving the model as effective (AOR = 7.88; 95% CI: 3.56–18.3) increased odds of acceptance, while formal employment reduced it (AOR = 0.38; 95% CI: 0.18–0.78).

Home-based care is a strategy for easing health system pressure. Strengthening awareness and addressing socio-economic barriers could increase uptake in Zambia.

This study contributes new evidence on the determinants of home-based care uptake within a low-resource context. The study provides actionable insights for policymakers and programme implementers seeking to strengthen community-based models of care.