Voices from the rural frontline: deconstructing communication barriers, strategies, and training needs of indonesian community health workers

Abstract

Abstract Background Community health workers (CHWs) serve as a critical bridge between rural populations and formal health systems in low- and middle-income countries. While their role in promoting behavior change is well-documented, the bottom-up perspectives of CHWs regarding the communication training they receive are rarely explored. This study aimed to examine CHWs’ real-world communication practices (barriers and strategies) and how these ground their perceived training needs. Methods A descriptive qualitative design was employed to capture the lived experiences of frontline health communicators. Data were collected through in-depth focus group discussions with 18 CHWs in Parakanmanggu Village, Pangandaran, Indonesia. The verbatim transcripts were analyzed using thematic analysis. Results The analysis revealed three interrelated themes that dictate communication effectiveness in rural settings. First, Communication Barriers, which encompassed knowledge deficits, experiential limitations, and interactional hurdles. Second, Communication Strategies, where CHWs independently utilized practical exercises, message personalization, and feedback mechanisms to overcome barriers. Third, Communicative Needs and Expectations, driven by their desire for comprehensive informational support and continuous engagement, rather than isolated training sessions. Conclusions Being proficient communicators requires more than generic, top-down instruction. The findings underscore the critical need for culturally tailored, interactive communication curricula that address the specific experiential and interactional barriers faced by rural CHWs. By aligning training with their actual field strategies and expectations, health systems can significantly enhance public reception of health interventions.