Walking in the heat: a qualitative study of heat stress in community health workers and promoters in Kenya

Abstract Climate change is reshaping working environments worldwide, with extreme heat posing significant risks to workers’ health, productivity, and safety. In Kenya, community healthcare workers (CHWs) and community health promoters (CHPs) play a crucial role in delivering approximately 50% of healthcare services, 80% of which require time outside, moving from one location to another. However, there is a lack of insight into how they experience heat and manage its effects in their daily work environment. This exploratory qualitative study used shared walks to understand CHWs’ and CHPs’ experiences of heat during their routine community field and household visits.We conducted 28 shared walks with CHWs and CHPs in Mombasa and Tana River counties, purposefully selecting participants based on age range and experience. Data were analysed using reflexive thematic analysis (RTA). We identified three overarching themes: Navigating challenging environments , which describes how CHWs and CHPs worked in extreme weather and faced additional environmental risks; feeling pressurised to conform , which highlights workplace and community pressures, and overcoming challenges , which explores how CHWs and CHPs adapted to working in difficult conditions. The demanding nature of work that CHWs and CHPs perform shapes their risk of heat stress. We emphasise the importance of addressing context-specific sensitivities, such as the intersection of environmental exposures and structural challenges like inadequate transportation and low wages, to design interventions that enhance resilience among CHWs and CHPs.