Nature-informed mental health training and self-care for community health workers in South Africa: Khanya Ekhaya
1
Mental Health, Alcohol, Substance Use and Tobacco Research Unit, SAMRC, Parow, South Africa
2
Center for Substance Use, Addiction & Health Research, University of Maryland, Maryland, United States
3
Global Mental Health and Addiction Program, University of Maryland, Maryland, United States
4
Department of Behavioral and Community Health, University of Maryland, Maryland, United States
5
EnAble Institute, Curtin University, Perth, Australia
Popul. Med. 2026;8(Supplement Supplement 1):A2630
ABSTRACT
BACKGROUND:
High levels of burnout exist among healthcare providers, particularly those working in under-resourced settings with high caseloads, limited support, and little or no supervision. More work is needed to identify sustainable approaches for supporting healthcare worker well-being in these contexts.
METHODS:
In this study, our team explored how nature-based approaches could support mental health and well-being among community health workers (CHWs) in under-resourced communities of Cape Town. Building off formative qualitative research with patients, CHWs, and other stakeholders (N=30), we conducted two workshops with CHWs (N=12). Workshops focused on how CHWs could improve mental health and wellbeing among their patients and themselves. Workshops were facilitated by two trained team members and followed a semi-structured guide. As part of the workshops, CHWs also engaged in experiential mindfulness and nature-based exercises at our field site that is co-located with a nature reserve. Workshop transcripts were coded using thematic analysis with a hybrid deductive-inductive approach, with workshop facilitators developing an initial codebook and two team members conducting rapid coding.
RESULTS:
Results highlighted: (1) how CHWs perceive and define nature, including its restorative properties and how to access “nearby” nature; (2) high levels of burnout and challenging caseloads, and the ways in which nature-based activities may support CHW well-being and work with clients; (3) barriers and facilitators of nature-based approaches, including how to address safety in communities and perceptions of lack of green space, and recommendations for locations and examples of nature-based activities seen as therapeutic for both CHWs and their clients (e.g., gardening); (4) experiential feedback and observations of CHWs following nature-based activities and experiences of restoration and improved well-being; and (5) reciprocity—caring for the environment following participation.
CONCLUSIONS:
Findings have implications for how supervision and burnout reduction programming can leverage the natural world and be delivered sustainably in under-resourced contexts.
High levels of burnout exist among healthcare providers, particularly those working in under-resourced settings with high caseloads, limited support, and little or no supervision. More work is needed to identify sustainable approaches for supporting healthcare worker well-being in these contexts.
METHODS:
In this study, our team explored how nature-based approaches could support mental health and well-being among community health workers (CHWs) in under-resourced communities of Cape Town. Building off formative qualitative research with patients, CHWs, and other stakeholders (N=30), we conducted two workshops with CHWs (N=12). Workshops focused on how CHWs could improve mental health and wellbeing among their patients and themselves. Workshops were facilitated by two trained team members and followed a semi-structured guide. As part of the workshops, CHWs also engaged in experiential mindfulness and nature-based exercises at our field site that is co-located with a nature reserve. Workshop transcripts were coded using thematic analysis with a hybrid deductive-inductive approach, with workshop facilitators developing an initial codebook and two team members conducting rapid coding.
RESULTS:
Results highlighted: (1) how CHWs perceive and define nature, including its restorative properties and how to access “nearby” nature; (2) high levels of burnout and challenging caseloads, and the ways in which nature-based activities may support CHW well-being and work with clients; (3) barriers and facilitators of nature-based approaches, including how to address safety in communities and perceptions of lack of green space, and recommendations for locations and examples of nature-based activities seen as therapeutic for both CHWs and their clients (e.g., gardening); (4) experiential feedback and observations of CHWs following nature-based activities and experiences of restoration and improved well-being; and (5) reciprocity—caring for the environment following participation.
CONCLUSIONS:
Findings have implications for how supervision and burnout reduction programming can leverage the natural world and be delivered sustainably in under-resourced contexts.
| eISSN: | 2654-1459 |
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