Qualitative analysis of the acceptability of community health workers for malaria prevention and management in Burkina Faso

Background In Burkina Faso, few studies focused on the factors that influence the satisfaction of populations benefiting from health interventions and that may lead to low acceptability of these interventions and even affecting their effectiveness. The aim of this study was to collect data and to analyse the conditions that promote the integration/acceptability of community health workers (CHWs) in order to improve access to malaria prevention and care for the most vulnerable populations in Burkina Faso. Methods The study used a qualitative approach. Data were collected through focus groups centred on the experiences of local populations in November 2022, before the introduction of CHWs in six villages by the REACT 2 initiative in the Diébougou health district of Burkina Faso in 2021. The focus groups included all future beneficiaries of the CHW-based programme (12–13 volunteer participants per group). Data were analysed using two complementary approaches: a lexical approach (lexicometric analysis) and a thematic approach (content analysis). Results Six factors that may influence the CHWs’ social acceptability were identified: the participants’ level of knowledge on malaria, use of traditional medicine, geographical and financial accessibility to modern medicine, participants’ perceptions of the intervention, and CHWs’ sociodemographic and professional profiles. Participants identified multiple benefits, showed strong interest in the initiative, and considered all activities acceptable. The CHWs’ permanent presence in the village and their belonging to the village were positive elements. Local beliefs about malaria and the continued use of traditional medicine could negatively influence the CHWs’ acceptability. Moreover, participants expected CHWs to be qualified and to reflect a set of social values: availability, willingness, honesty, responsibility, attentiveness, and respect. Conclusions To ensure the effectiveness and sustainability of health programmes relying on CHWs’ activities, health authorities and policymakers must give greater consideration to the population perceptions, expectations and needs when allocating CHWs for the implementation of such programmes. Trial registration The REACT 2 project was a step-wedged cluster randomized controlled trial (ClinicalTrials.gov: (NCT05535465).