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Effect of Community Health Worker Home Visits on Post-Discharge Follow-Up among Patients in Rural Nigeria

Abstract

Post-discharge follow-up is an important component of continuity of care because patients may require continued monitoring, medication management, rehabilitation, wound care, health education, and timely referral after leaving the hospital. Patients living in rural communities in Nigeria may face significant barriers to post-discharge follow-up, including long distances to healthcare facilities, transportation difficulties, financial constraints, limited healthcare availability, poor communication, and inadequate follow-up systems. Community health workers can help address some of these barriers by conducting home visits to recently discharged patients within their communities. During home visits, community health workers may assess patients' health status, reinforce discharge instructions, monitor medication use, provide health education, identify warning signs, support adherence to follow-up appointments, and facilitate referrals when necessary. Effective implementation of community health worker home visits may therefore strengthen continuity of care and improve post-discharge follow-up among patients in rural Nigeria. Against this background, this study investigates the effect of community health worker home visits on post-discharge follow-up among patients in rural Nigeria. The study will be anchored on the Continuity of Care Theory, the Social Ecological Model, and the Donabedian Model of Healthcare Quality. Continuity of Care Theory emphasizes coordinated and consistent healthcare interactions across different stages of a patient's illness and recovery, including the transition from hospital care to community-based follow-up. The Social Ecological Model explains how individual, family, community, healthcare-system, and broader environmental factors may influence patients' access to and utilization of post-discharge healthcare services. The Donabedian Model explains healthcare quality through structure, process, and outcome, with community health worker home visits representing an important care-delivery process and post-discharge follow-up serving as a measurable outcome. Collectively, these theoretical perspectives provide a suitable framework for explaining how community health worker home visits may influence post-discharge follow-up among patients in rural Nigeria. The study will adopt a quantitative quasi-experimental research design. The study population will comprise adult patients discharged from selected hospitals and residing in rural communities in Nigeria, as well as community health workers involved in post-discharge follow-up activities. A multistage sampling technique will be used to select states, local government areas, rural communities, healthcare facilities, community health workers, and eligible discharged patients. Community health worker home visits will be assessed using indicators such as number and frequency of home visits, timing of the first visit after discharge, adherence to home-visit schedules, assessment of patients' health conditions, medication-use monitoring, wound or symptom assessment where appropriate, health education, reinforcement of discharge instructions, appointment reminders, identification of danger signs, referral arrangements, documentation of visits, communication with healthcare facilities, and follow-up supervision of community health workers. Post-discharge follow-up will be assessed using indicators such as attendance at scheduled follow-up appointments, adherence to recommended clinical reviews, medication adherence, completion of post-discharge investigations, compliance with treatment instructions, timely reporting of complications, completion of referrals, continuity of prescribed care, and appropriate healthcare utilization after discharge. Data will be collected using structured questionnaires, community health worker home-visit records, hospital discharge records, follow-up registers, clinic attendance registers, patient medical records, referral records, and home-visit assessment tools. Descriptive statistics will be used to summarize patients' demographic and clinical characteristics, home-visit exposure, and post-discharge follow-up patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of community health worker home visits on post-discharge follow-up. Where a quasi-experimental design is adopted, follow-up outcomes among patients receiving scheduled home visits may be compared with outcomes among patients receiving routine post-discharge care. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community health worker home visits have a significant positive effect on post-discharge follow-up among patients in rural Nigeria. Patients who receive structured home visits are expected to demonstrate higher rates of attendance at scheduled follow-up appointments, better adherence to treatment instructions, improved medication use, and more timely reporting of post-discharge health problems than patients who receive routine discharge care without home visits. Home-based monitoring may allow community health workers to identify emerging complications early and facilitate timely referral to healthcare facilities. Health education and reinforcement of discharge instructions may also improve patients' understanding of their care requirements and encourage continued engagement with healthcare services. However, inadequate numbers of community health workers, transportation difficulties, poor road infrastructure, limited supervision, insufficient training, weak referral systems, and resource constraints may limit the effectiveness of home-visit programmes. The study therefore expects well-organized, adequately supervised, and adequately resourced community health worker home visits to contribute significantly to improved post-discharge follow-up among patients in rural Nigeria. The study is expected to contribute to the literature on community health worker home visits, post-discharge follow-up, continuity of care, transitional care, community-based healthcare, rural healthcare services, patient follow-up, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, local government health authorities, hospitals, primary healthcare centres, community health workers, healthcare administrators, development partners, and policymakers regarding strategies for strengthening post-discharge care in rural communities. The study will also provide evidence-based recommendations for integrating community health worker home visits into discharge and transitional-care programmes, improving community health worker training and supervision, strengthening referral and communication systems between hospitals and primary healthcare facilities, providing adequate transportation and logistical support, improving follow-up documentation, and expanding community-based post-discharge services across rural Nigeria.

Keywords: Community health worker home visits, post-discharge follow-up, continuity of care, transitional care, community-based healthcare, rural healthcare, patient follow-up, primary healthcare, discharge care, Nigeria, public health.