"I Am Now Five Steps Ahead": How Co-design Platforms Sustain Kenyan Community Health Volunteer Engagement

The aim of this study is to examine how humancentered design (HCD) as a platform for co-production might function to explain community health volunteer (CHV) motivation in self-directed and self-funded community health activities. Sustaining engagement has been difficult for CHVs who lack monetary incentives, expense reimbursement, and are rarely given opportunity to give their own voice to local health priorities.

Qualitative study utilized focus group discussions 12 months post intervention and included both an inductive and deductive level of analysis.

Three community health units (CHU) representing Kenya's diversity were selected with the local Ministry of Health including peri-urban slum, rural agrarian, and a unit where informal day labor and rented housing was the norm.

The participants were selected according to Kenya's community health strategy norms and had previously had the standard basic community health training.

A 3-day training rooted in HCD utilized multiple quality improvement tools (asset mapping, root cause analysis, key drivers) in order to help CHVs uncover unarticulated community needs and assumptions and encourage behavior change. Action plans with Plan-Do-Study-Act cycles were tracked longitudinally.

Key themes were self-interest, common goal, gratitude/indebtedness. Additional thematic analysis identified altruism as supporting sustained engagement.

This study supports HCD as a platform for sustained CHV engagement. It builds the evidence for self-interest, common goal, and gratitude/indebtedness as sustaining factors. These factors are also seen in process-based theories that operationalize and measure trust building reciprocity cycles that mirror the iterative P-D-S-A cycles seen in HCD.