Comparing capacity-building approaches for community health worker knowledge in Indonesia: a cross-sectional comparative study

Community Health Workers (CHWs) play a vital role in Universal Health Coverage (UHC) and Primary Health Care (PHC). Acknowledged by WHO, they significantly contribute to healthcare accessibility and positive health outcomes. Although competence is established as a vital driver of healthcare quality, there is a lack of comparative research on which specific capacity-building approaches work best for Indonesian CHWs. This study aims to assess and compare the effective approaches being used to enhance CHW knowledge. This study employed a cross-sectional comparative study across three groups with differing exposure to interventions. A total of 192 respondents of CHWs from three groups of CHW with different training methods (A, B, and C), were compared by their knowledge. Group A received pre-service training, refreshment training, periodic online classes, and supervision from external health workers by a non-government organisation; Group B received intensive training for integrated primary health services by the government (MoH), and Group C received neither training (control group). The measurement of CHWs’ knowledge used a written test consisting of five competencies in multiple-choice questions (MCQs). The Welch ANOVA test was used to compare mean knowledge scores among the three groups. Multivariable linear regression was then performed to account for potential confounding by participant characteristics (age, education, work experience, and location). Mean knowledge scores differed significantly across the three training groups in the unadjusted analysis (Welch’s ANOVA, p = 0.0016). However, after adjustment for age, education, work experience, and location, the training group was no longer independently associated with knowledge score (joint Wald test, p = 0.239). Work experience, education, age, and location remained significant predictors of knowledge. Unadjusted analyses showed significant differences in MCQ scores across groups, with Group A scoring higher than Groups B and C. However, after adjusting for education, age, experience, and region, these differences were no longer statistically significant, indicating that the training interventions were not independently associated with knowledge outcomes. Sociodemographic characteristics emerged as the stronger determinants, CHWs with higher education attainment, greater work experience, younger age, and urban residence consistently achieved higher scores. These findings suggest that standardized training programmes alone are insufficient to raise knowledge uniformly across a heterogeneous CHW workforce. Tailored training and support is therefore essential especially for older CHWs and those with lower educational backgrounds, who face greater barriers to absorbing and retaining intervention content. Addressing these structural disparities will be critical to ensuring equitable and consistent knowledge competency across all CHWs. 0011R.1/III/LPPM-PM.10.05/01/2024 Date: January 25, 2024.