Confirmation of Candidature - Melaku Yenit

Ethiopia is a low-income country in the Global South, experiencing demographic, nutritional, and epidemiological transitions favouring the rise in non-communicable disease (NCD). Community health workers (CHWs) promote and manage NCD at the community level. However, there is limited information on the effectiveness of CHW's role in NCD health promotion. This PhD project aims to bridge this gap by enhancing the capacity of CHWs to effectively promote healthy lifestyles. Therefore, this PhD-by-publication aims to assess NCD knowledge, attitude, and behaviour and their relationship with perceived self-efficacy and risk perception of CHWs (Study 1). The PhD project will also identify the enablers and barriers to promoting healthy lifestyles (Study 2). Guided by the evidence from studies 1 and 2, we will co-design an intervention to equip CHWs with knowledge and self-efficacy needed to promote healthy lifestyles and pilot the intervention to determine its feasibility, acceptability and efficacy (Study 3). 

Methods
Study 1 used the data from a previous related project in Ethiopia. The purpose of Study 1 was to assess Ethiopian CHWs' NCD knowledge, attitude, and lifestyle behaviour, and their association with perceived NCD risk perception and self-efficacy in promoting NCD health. A cross-sectional study was conducted using the WHO stepwise survey. Study 1 revealed that Ethiopian CHWs needed more knowledge and a favourable attitude towards NCD health promotion. The study also showed insufficient physical activity and poor dietary habits among CHWs. 

Study 2 will use a qualitative study to explore the barriers and facilitators of promoting healthy lifestyles. The study will use Focus Group Discussions (FGDs) with CHWs and key informant interviews (KIIs) with Health Service Managers (CHWs program coordinator and CHW supervisors). All FGDs and individual interviews will be audio-recorded, transcribed, and imported into the NVivo 12 for analysis and coding. The thematic analysis method will be used to develop codes, categories and themes.

Study 3 is developing an intervention to equip CHWs to promote healthy lifestyles and piloting the intervention to determine its feasibility, acceptability and efficacy. The development of an intervention will follow various steps, from understanding the problem to designing an intervention and critical review and consensus process. The intervention development and evaluation will be guided by the Medical Research Council (MRC) framework for developing and evaluating complex interventions. 

This thesis will bring evidence of CHWs' knowledge, attitude, and lifestyle behaviour to NCD health promotion. The proposed intervention will solve the problem of promoting healthy lifestyles in CHWs so that they can serve the community with the necessary knowledge and behaviour. The findings will also inform policy and practice in developing effective interventions to promote healthy lifestyles in low-resource settings.

For more information, please email the Graduate Research School or phone 0746 311088.