Barriers and Enablers to Community Health Workers’ Support for Nurturing Care Beyond Health and Nutrition

Background <br/>Nurturing care—including early learning, responsive caregiving, and safety and security—is vital for children’s development. Community health workers (CHWs) are well-positioned to extend support beyond health and nutrition, yet their role in delivering these aspects of nurturing care remains underexplored. This review synthesizes global evidence on barriers and enablers influencing CHWs’ ability to provide such support. <br/><br/>Methods <br/>We conducted a scoping review guided by Arksey and O’Malley’s framework and PRISMA-ScR standards. Five databases (MEDLINE, Embase, CINAHL, Web of Science, APA PsycINFO) and grey literature were searched up to April 2025, using a Population–Concept–Context strategy. Inclusion criteria focused on studies addressing CHWs’ involvement in delivering non-health aspects of nurturing care. Data were extracted on barriers and enablers and synthesized thematically using the Nurturing Care Framework and socio-ecological model. <br/><br/>Findings <br/>From 29,997 records, 113 studies (99 peer-reviewed, 14 grey literature) from 48 countries were included. Reported barriers included heavy workloads, limited time, inadequate training, weak supervision, resource shortages, and sociocultural norms limiting caregiver engagement. Enablers included capacity building through skills-based training, integration of nurturing care into routine maternal and child health services, supportive supervision, community trust in CHWs, and availability of simple tools and counselling aids. At system level, policy support, multisectoral collaboration, and digital technologies acted as important enablers, though less frequently reported. <br/><br/>Conclusions <br/>CHWs can play a transformative role in extending nurturing care beyond health and nutrition. Addressing structural barriers and strengthening enabling environments, through training, supervision, policy backing, and cross-sectoral linkages, are essential to sustain and scale their contributions. Without such systemic support, efforts risk remaining fragmented and short-lived.