OBJECTIVES The aim of this study is to examine how humancentered design (HCD) as a platform for co-production might function to explain community health volunteer (CHV) motivation in self-directed and self-funded community health activities. Sustaining engagement has been difficult for CHVs who lack monetary incentives, expense reimbursement, and are rarely given opportunity to give their own voice to local health priorities. DESIGN Qualitative study utilized focus group discussions 12 months post intervention and included both an inductive and deductive level of analysis. SETTING Three community health units (CHU) representing Kenya's diversity were selected with the local Ministry of Health including peri-urban slum, rural agrarian, and a unit where informal day labor and rented housing was the norm. PARTICIPANTS The participants were selected according to Kenya's community health strategy norms and had previously had the standard basic community health training. INTERVENTION A 3-day training rooted in HCD utilized multiple quality improvement tools (asset mapping, root cause analysis, key drivers) in order to help CHVs uncover unarticulated community needs and assumptions and encourage behavior change. Action plans with Plan-Do-Study-Act cycles were tracked longitudinally. RESULTS Key themes were self-interest, common goal, gratitude/indebtedness. Additional thematic analysis identified altruism as supporting sustained engagement. CONCLUSIONS This study supports HCD as a platform for sustained CHV engagement. It builds the evidence for self-interest, common goal, and gratitude/indebtedness as sustaining factors. These factors are also seen in process-based theories that operationalize and measure trust building reciprocity cycles that mirror the iterative P-D-S-A cycles seen in HCD.

中文翻译：

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“我现在领先五步”：共同设计平台如何维持肯尼亚社区健康志愿者的参与。

目的 本研究的目的是探讨以人为本的设计（HCD）作为合作生产平台如何解释社区健康志愿者（CHV）在自我指导和自筹资金的社区健康活动中的动机。对于缺乏金钱激励、费用报销，并且很少有机会就当地卫生优先事项发表自己意见的 CHV 来说，持续参与是很困难的。设计 定性研究利用干预后 12 个月的焦点小组讨论，包括归纳和演绎层面的分析。设置 当地卫生部选择了三个代表肯尼亚多样性的社区卫生单位（CHU），其中包括城郊贫民窟、农村农业单位，以及一个以非正规日工和出租房屋为常态的单位。参与者 参与者是根据肯尼亚社区卫生战略规范选择的，并且之前接受过标准的基础社区卫生培训。干预 植根于 HCD 的为期 3 天的培训利用了多种质量改进工具（资产映射、根本原因分析、关键驱动因素），以帮助 CHV 发现未明确表达的社区需求和假设，并鼓励行为改变。纵向跟踪计划-实施-研究-行动循环的行动计划。结果 关键主题是自身利益、共同目标、感恩/负债。其他主题分析确定利他主义支持持续参与。结论 本研究支持 HCD 作为持续 CHV 参与的平台。它为自身利益、共同目标和感恩/负债作为维持因素提供了证据。这些因素也出现在基于流程的理论中，这些理论可操作和衡量建立信任的互惠周期，这些周期反映了 HCD 中的迭代 PDSA 周期。