ABSTRACT:
Malaria remains a significant public health challenge in endemic regions, including Nepal, despite ongoing efforts to reduce its burden. Female Community Health Volunteers (FCHVs) play a significant role in active malaria surveillance by enabling early detection, reporting, and response to public health threats. There is still a gap in research and knowledge about the different factors influencing the effectiveness of FCHVs in malaria surveillance. This study investigated the performance and factors influencing performance in active malaria case surveillance among FCHVs in Nepal by integrating constructs from the Theory of self-determination (SDT). The influence of the main constructs on performance behavior (autonomy as motivation, leadership, competencies as self-efficacy) is related to socio-environmental factors such as social support and socio-economic factors of the studied participants. A quantitative cross-sectional study analyzed factors determining FCHVs performance in active malaria surveillance. Primary data from 1204 FCHVs in eight high-endemic districts were collected via structured interviews using KoBo Toolbox. Descriptive statistics (SPSS 26.0) and structural equation modeling (AMOS 29.0) were used for analysis. The questionnaire was pre-tested for reliability. The results found that half (52.7%) of FCHVs had a high level of performance in active malaria case surveillance. The result of the SEM analysis indicated that approximately 40% of the variance in performance behaviors could be accounted for by a linear combination of the variables perceived autonomy motivation, political leadership, self-efficacy, community support, years of experience as a malaria volunteer, and occupation. While considering self-efficacy to performance, the results showed that 18% of the variance in self-efficacy could be accounted for by the linear combination of the variables perceived autonomy motivation, community support, supportive supervision, and years of experience. Self-efficacy had a modest but significant impact on overall performance that emphasis on implications for the development of self-efficacy strategies to motivate FCHVs in sustainable performance management.