TABLE 1.
Characteristics of included studies (16 studies from 18 full texts).
| Study# | Reference | Programme / intervention | Setting (incl. data collection date) | Aim of study (as reported in the papers) | Participants | Methods |
|---|---|---|---|---|---|---|
| Home visits | ||||||
| 1 | 37 | Philani Mobile Video Intervention for Exclusive breastfeeding (MOVIE) study. 13 short (2 min – 5 min) teaching videos administered by mentor mothers during their regular perinatal home visits. | Khayelitsha, Cape Town; Western Cape 2019–20 | Establish the effectiveness of the Philani MOVIE intervention and characterise, using a nested, qualitative performance evaluation, the acceptability and desirability of the intervention, as well as the mechanisms of action. | Mentor mothers (n = 26; 15 from the video intervention group and 11 from the control group) | In-depth interviews |
| 2 | 38 | Ububele Mother-Baby Home Visiting project. Lay home visitors trained (54 h) in a psychoanalytic and attachment-informed infant mental health theory that promotes a relational model of infant development. They provide an intervention (home visits over 14 weeks) that supports high risk mother–infant relationships in the same locality. | Alexandra, Johannesburg; Gauteng data collection date unclear | Explore convergences and divergences between current research-based, relational IMH models and ‘community’ knowledge held by a group of South African lay home visitors. | 4 lay home visitors who were trained to conduct home visits | Semi-structured interviews subsequent to lay home visitors training and after 9 months working |
| 3 | 39 | Philani Health and Nutrition Project + tablets with teaching videos. Tablets with teaching videos (about HIV, alcohol, nutrition and breastfeeding) developed to support the health promotion efforts of mentor mothers who form part of the Philani Health and Nutrition Project in Khayelitsha. Each LHW visits approximately four community members each day with a total caseload of 50–80 families. | Khayelitsha, Cape Town; Western Cape Nov15–May16 | Explore the acceptability and feasibility of using tablets with teaching videos (about HIV, alcohol, nutrition and breastfeeding) to support the health promotion efforts of Mentor Mothers who form part of the Philani Health and Nutrition Project in Khayelitsha. | 24 Mentor mothers | Focus group discussions (FGDs) |
| 4 | 40 | Promise EBF study. Infant feeding peer counsellors. Local women employed to provide community peer counselling on infant feeding to mothers; one antenatal support visit, followed by postnatal support visits in weeks 1, 4, 7 and 10. | Rietvlei and Umlazi (KwaZulu-Natal [KZN]), Paarl (Western Cape); conducted 2006 | Explore the experience of three LHW supervisors who were responsible for supporting infant feeding peer counsellors. | 3 supervisors, each had between 10 and 12 peer counsellors. | Semi-structured interviews |
| 5 | 41 | KZN DoH LHW MCH programme. LHWs employed by the South African DoH in KZN- received 2-week training to develop the skills to provide care and support to pregnant women, mothers, newborns and children in the community | Primary health care clinics in five rural districts in KZN; data collection date unclear | Explore the acceptability of LHWs conducting household visits to mothers and infants during pregnancy and after delivery, from the perspective of community members, professional nurses and LHWs themselves. | 65 caregivers (mother, father or grandmother of a child aged under 5 years); 37 professional nurses; 41 LHWs | 19 FGDs with caregivers, LHWs, Professional nurses |
| 6 | 42 | Mentor Mothers Zithulele (MMZ). Mentor Mothers (MMs) undertake door-to-door visits in the local community to provide mothers regular check-ups together with support on health, nutrition and childcare, based on the Philani Mentor Mother model. | Zithulele village, remote rural district in Eastern Cape; data collection date unclear | Explore participants’ experience of the impact of peer mentoring on the rural communities they serve. | HIV-positive women participating in MMZ (n = 14) and women receiving standard PMTCT care without any intervention (n = 11); Mentor mothers (n = 8) | Semi-structured interviews with HIV-positive women participating in MMZ and a focus group discussion with the Mentor mothers delivering the intervention |
| 7 | 43 | Eastern Cape Supervision Study which assessed whether an enhanced supervision package delivered to government employed LHWs in the rural Eastern Cape, South Africa improved maternal and child outcomes when compared to routine supervision as delivered within the primary health care system. Although LHWs serve their communities at large, ECSS focussed specifically on pregnant women, mothers, and young children. The enhanced supervision package comprised additional training, resources and both administrative and supportive supervision, based on the Philani Mentor Mother model. | O.R. Tambo District, rural Eastern Cape; June and July 2021 | Explore the status of supervision in the government-implemented LHW programme and experiences of the enhanced supervision package delivered as part of the ECSS | Mid-level supervisors involved in eight rural clinics enrolled in both the intervention and control arms of the RCT titled ECSS. Participants from three levels of clinic and non-governmental organisations: nine government-employed LHW supervisors or clinic personnel, two RCT programme managers and two RCT LHW supervisors. | Semi-structured qualitative interviews (N = 14) analysed thematically |
| 8 | 44 | Same intervention as43 | O.R. Tambo District, rural Eastern Cape; June and July 2021 | Explore experiences of the enhanced supervision package delivered as part of the ECSS 3 months’ post-last follow-up in the trial | Eight LHWs from each arm of the RCT, and two supervisors from the intervention arm (total n = 18). | Semi-structured qualitative interviews (N = 18) analysed thematically |
| 9 | 45,46 | Enable Mentor Mothers Programme, a ‘social franchise’ of the Philani Mentor Mother model, a home-based prevention programme implemented by the Philani Maternal, Child Health, and Nutrition Project. In Philani’s model, MMs or ‘positive peer deviants’ are trained to serve as paraprofessional community health workers for home visiting among pregnant women and their families. Specifically, MMs conduct house-to-house visits on foot, enrolling pregnant women as well as undernourished children as clients. Pregnant clients are followed up throughout pregnancy as well as afterwards for up to 6 years. The programme’s key focus areas include maternal and infant wellbeing, child nutrition, immunisation, HIV/AIDS prevention and treatment, and access to social and health services. MMs also identify and visit undernourished children and clients with chronic conditions requiring home-based care. Each LHW visits approximately four community members each day with a total caseload of 50–80 families. | Nyandeni, rural part of Eastern Cape Province; Conducted February-March 2018 | Explore LHW fidelity (content and structure of delivery) of the home-based maternal and child health intervention. | Clients of the programme and LHWs | Audio recordings of LHW home visits (n = 84). Themes across transcripts analysed through the newly developed Home Visit Communication Skills Inventory (HCSI) |
| 10 | 47,48 | Same intervention as in45 | Nyandeni, rural part of Eastern Cape Province; conducted February–March 2018 | Explore clients’ views and experiences of the Enable Mentor Mother programme and their engagements with LHWs | Pregnant or recently delivered clients (n = 26) of the Enable Mentor Mother programme | Individual interviews (n = 26) analysed thematically |
| 11 | 49 | Same intervention as in45 | Nyandeni, rural part of Eastern Cape Province; conducted February–March 2018 | Explore LHWs or MMs views and experiences of the Enable Mentor Mother programme | Mentor Mothers (n = 10) | Individual interviews (n = 10) analysed thematically |
| 12 | 50 | Same intervention as43 | O.R. Tambo District, in rural Eastern Cape province | Understand the LHWs’ experiences of becoming and working as LHWs in the government-implemented LHW programme prior to initiating the ECSS | LHWs enrolled in the intervention arm of the ECSS | Semi-structured qualitative interviews (n = 9) and focus groups (n = 2) analysed thematically |
| 13 | 51 | Family MUAC Project, anchored in the Side-by-Side campaign. Facilitating a 1-day training for all LHWs in each of the sites to refresh LHWs skills in nutrition counselling, MUAC measurement and LHW’s implementation of the family MUAC in the household. Identification and lists of all households served by participating LHWs where there were children aged between 6-months and 5 years + Planning of Nutrition Health Days to raise awareness of the importance of nutrition and growth monitoring and introduction of the MUAC measurements to the community (1-day community mobilisation in each community). | 3 districts in Gauteng – urban (Tshwane, Johannesburg, Ekurhuleni) and two districts in KZN – rural (Zululand, Umzinyathi) | Explore stakeholders, and participants’ experiences of MUAC intervention | Community task teams, participating LHWs and mothers/caregivers | Focus group discussions (n = 21) |
| 14 | 52 | Same intervention as in40 | Rietvlei and Umlazi (KwaZulu-Natal), Paarl (Western Cape); conducted 2006 | Explores mothers’ experiences of infant feeding after receiving peer counselling promoting exclusive breast or formula feeding. | Mothers (n = 17) | Semi-structured interviews |
| 15 | 53 | School-readiness intervention, part of NDoH community-based PHC outreach in crèches and day-cares. Aims to provide parents with the skills to contribute to their children’s educational and intellectual development. Includes initial assessments of the children’s readiness for school, followed by home visits to the specific children’s parents. Home visits conducted by nursing students registered for a 1-year Advanced Diploma in CHN, University of the Free State. | Heidedal, Bloemfontein, Free State intervention implemented between 2010–12 | Understand the experiences of parents regarding the school-readiness intervention for preschool children facilitated by nursing students. | Parents (n = 24) | 3 focus group discussions |
| 16 | 54 | KZN DoH MCH programme. LHWs allocated a number of households that they serve and are expected to visit regularly (3–5 households per day). During household visits they perform a variety of functions, incl. treatment support and home-based care, as well as MCH activities (visiting all mothers during pregnancy and in the postnatal period to provide education and support in several key areas including antenatal care attendance, planning for delivery of the baby, postnatal care and support for infant feeding). | Five communities in three districts in KZN; conducted 2014–15 | Explore the performance of LHWs providing maternal and child health services at household level and the quality of the LHW-mother interaction. | 15 LHWs and 30 mothers/pregnant women | LHW household visits to mothers were observed and field notes taken, followed by in-depth interviews with mothers and LHWs. |
MOVIE, Mobile Video Intervention for Exclusive breastfeeding; CHN, Community Health Nursing; EBF, exclusive breastfeeding; ECSS, Eastern Cape Supervision Study; FGD, focus group discussion; IMH, infant mental health; KZN, KwaZulu-Natal; LHW, lay health worker; MCH, maternal and child health; MM, mentor mothers; MMZ, mentor mothers Zithulele; MUAC, mid-upper arm circumference; DoH, Department of Health; NDoH, National Department of Health; HCSI, Home Visit Communication Skills Inventory; RCT, randomised controlled trial; HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; PHC, primary health care; PMTCT, prevention of mother-to-child transmission.