Self-esteem in the training and performance of village health workers

Abstract

As the poor countries of the world seek to assure that health care is available to their citizens, there is high interest in indigenous workers providing health care services to their own communities. The Jamkhed Comprehensive Rural Health Project in Western India has achieved outstanding results based upon the functioning of local people serving as village health workers.;This descriptive study, with cross-sectional and longitudinal components, measures changes in self-esteem levels at various points in the careers of village health workers at the Jamkhed Project and a program operated by the government. Factors which influence self-esteem are described and the relationship between self-esteem and performance is assessed.;The Jamkhed Index of Self-Esteem, or JISE, was developed for this study to determine self-esteem levels. The JISE was administered to eight comparison groups on two occasions eight months apart. It was determined that self-esteem levels of Jamkhed trainees rose during an initial training regimen, declined slightly immediately following the initial training and then increased with greater experience. There was a small increase in self-esteem of similar health workers in the government program.;An assessment was made of factors which influence self-esteem through interviews with individual village health workers. It was determined that positive messages from three sources about their worth were critical to the increase in health worker's self-esteem: the staff, their peer group, and the villagers served by their work.;The relationship of self-esteem to performance was measured by a correlation of JISE scores to scores on a Knowledge, Attitude and Practice Scale, or KAP Scale, which was administered to village women served by the health workers. The scores on the KAP scale indicated the effectiveness of the village health worker in health education. A positive relationship between self-esteem and performance was found with the Jamkhed village health workers.