Capturing the most significant change after a work-training program for community health workers

This paper examines the changes community health workers experienced after following a nine-month work-training program and the enabling/disabling factors leading to these changes. Using the Most Significant Change technique, stories from community health workers were collected through individual interviews (N = 9), after which other community health works discussed these stories in a focus group (N = 7). Results showed that Most Significant Changes were: increased knowledge, social skills and attitudes, career discovery and facilitated employability, expanded social networks and support systems, and gained social recognition. Mentoring, peer learning and peer support, and experience-based learning were indispensable in realizing those changes. Participants selected stories as significant when they were recognizable, inspirable, or admirable. Finally, our experience suggests that the Most Significant Change technique mostly identifies positive changes, which has the potential to move programs forward. In future evaluation research using the Most Significant Change, we suggest not only a horizontal (with peers) but also vertical story selection process (with coordinators) to have a deeper understanding of different perspectives and their reasoning behind selecting stories.