# Factors Influencing Community Members' Perception of Primary Health Care Services Delivered by Community Health Workers in Rural Areas: A Systematic Review

## TL;DR

This paper reviews factors that influence how rural communities perceive health care services provided by local health workers, aiming to improve service delivery and trust.

## Contribution

The study systematically identifies and categorizes factors affecting community perceptions of health workers in rural areas.

## Key findings

- Three thematic clusters influence perceptions: structural/service delivery, trust, and identity/sociocultural factors.
- Key factors include CHW accessibility, trust, service availability, and CHW gender.
- Training CHWs based on these factors can improve service acceptance and sustainability.

## Abstract

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.

To identify and synthesise the factors influencing community members' perceptions of PHC services delivered by community health workers in rural areas.

Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) 2020 guidelines, a Systematic Review was conducted.

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.

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.

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.

Community perspectives are important in evaluating health care, and the community is more likely to utilise healthcare services if they perceive them as acceptable.Perspectives of Community Health Workers regarding challenges and barriers faced in their role of delivering primary health care services.There are individual studies on community perceptions and factors affecting community perception regarding primary health care service delivery, but evidence in the form of a systematic review is lacking.

Community perspectives are important in evaluating health care, and the community is more likely to utilise healthcare services if they perceive them as acceptable.

Perspectives of Community Health Workers regarding challenges and barriers faced in their role of delivering primary health care services.

There are individual studies on community perceptions and factors affecting community perception regarding primary health care service delivery, but evidence in the form of a systematic review is lacking.

This paper provides an overview of the factors influencing community members' perceptions of primary health care services delivered by community health workers (CHW) in rural areas.This review presents the community's viewpoint on the culturally responsive healthcare services, focusing on the quality and effectiveness of these services.Healthcare providers can leverage the identified factors to align their services with community needs.Most important factors are accessibility to CHWs, trust in CHWs, the availability of services convenient to community members and the gender of CHWs.

This paper provides an overview of the factors influencing community members' perceptions of primary health care services delivered by community health workers (CHW) in rural areas.

This review presents the community's viewpoint on the culturally responsive healthcare services, focusing on the quality and effectiveness of these services.

Healthcare providers can leverage the identified factors to align their services with community needs.

Most important factors are accessibility to CHWs, trust in CHWs, the availability of services convenient to community members and the gender of CHWs.