Functional components of a community of practice to improve community health worker performance: A qualitative study

Background: Communities of Practice (CoPs) are a low-cost strategy for health workers to share and create knowledge through social interactions to improve the delivery of high-quality care. However, there remain critical gaps in understanding the behavioral mechanisms through which CoPs can facilitate community health worker9s (CHWs) performance. Therefore, we carried out a qualitative study of a CoP to identify the behavior change techniques (BCTs) and intervention functions that improved CHWs9 performance. Methods: We organized CHWs from two tuberculosis (TB) clinics in Kampala, Uganda into a CoP from February to August 2018. We conducted interviews with CoP members to understand their perceptions of how the CoP influenced delivery of TB contact investigation. Using an abductive approach, we first applied inductive codes characterizing CHWs9 perceptions of how the CoP activities affected their delivery of contact investigation. We then systematically mapped these codes into their functional categories using the BCT Taxonomy and Behavior Change Wheel framework. We triangulated all interview findings with detailed field notes. Results: All eight members of the CoP agreed to participate in the interviews. CHWs identified five CoP activities as improving the quality of their work: (1) individual review of feedback reports, (2) collaborative improvement meetings, (3) real-time communications among members, (4) didactic education sessions, and (5) clinic-wide staff meetings. These activities represented nine different BCTs and five distinct intervention functions. Taken together, CoP meetings enabled members to foster social support, problem solving, and knowledge sharing. The CoP enabled CHWs to identify barriers they face in the field and develop solutions. The CoP was motivating, strengthened their social and professional identities within and outside of the group, and improved their self-efficacy. Conclusions: We identified several behavioral mechanisms through which CoPs may improve CHW performance. Future studies should evaluate the importance of these mechanisms in mediating the effects of CoPs on program effectiveness.