"They do not see us as one of them": a qualitative exploration of mentor mothers' working relationships with healthcare workers in rural North-Central Nigeria

• Published in: Human resources for health Vol. 16; no. 1; p. 47
• Main Authors: Sam-Agudu, Nadia A, Odiachi, Angela, Bathnna, Miriam J, Ekwueme, Chinazom N, Nwanne, Gift, Iwu, Emilia N, Cornelius, Llewellyn J
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.09.2018; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV Agents - therapeutic use; Community health aides; Disease transmission; Evaluation Studies as Topic; Expert mother; Female; Focus Groups; Health aspects; Health care; Health facilities; Health Personnel - psychology; HIV; HIV carriers; HIV Infections - drug therapy; Human immunodeficiency virus; Human resources; Humans; Infectious Disease Transmission, Vertical - prevention & control; Interprofessional Relations; Medical personnel; Medical tests; Mentor mother; Mentors - psychology; Methods; Middle Aged; Mothers; Mothers - psychology; Nigeria; Nurses; Peer counseling; Peer relations; Peer support; Peer tutoring; Physicians; PMTCT; Pregnancy; Prospective Studies; Public health; Qualitative research; Rural Population - statistics & numerical data; Social aspects; Social support; Task shifting; Womens health; Workers; Working conditions; Nigeria; New York; South Africa; Human resources for health; Task shifting; Expert mother; PMTCT; HIV; Mentor mother; Peer support; Nigeria
• ISSN: 1478-4491; 1478-4491
• DOI: 10.1186/s12960-018-0313-9

In HIV programs, mentor mothers (MMs) are women living with HIV who provide peer support for other women to navigate HIV care, especially in the prevention of mother-to-child transmission of HIV (PMTCT). Nigeria has significant PMTCT program gaps, and in this resource-constrained setting, lay health workers such as MMs serve as task shifting resources for formal healthcare workers and facility-community liaisons for their clients. However, challenging work conditions including tenuous working relationships with healthcare workers can reduce MMs' impact on PMTCT outcomes. This study explores the experiences and opinions of MMs with respect to their work conditions and relationships with healthcare workers. This study was nested in the prospective two-arm Mother Mentor (MoMent) study, which evaluated structured peer support in PMTCT. Thirty-six out of the 38 MMs who were ever engaged in the MoMent study were interviewed in seven focus group discussions, which focused on MM workload and stipends, scope of work, and relationships with healthcare workers. English and English-translated Hausa-language transcripts were manually analyzed by theme and content in a grounded theory approach. Both intervention and control-arm MMs reported positive and negative relationships with healthcare workers, modulated by individual healthcare worker and structural factors. Issues with facility-level scope of work, workplace hierarchy, exclusivism and stigma/discrimination from healthcare workers were discussed. MMs identified clarification, formalization, and health system integration of their roles and services as potential mitigations to tenuous relationships with healthcare workers and challenging working conditions. MMs function in multiple roles, as task shifting resources, lay community health workers, and peer counselors. MMs need a more formalized, well-defined niche that is fully integrated into the health system and is responsive to their needs. Additionally, the definition and formalization of MM roles have to take healthcare worker orientation, sensitization, and acceptability into consideration. Clinicaltrials.gov number NCT01936753 , registered September 3, 2013.