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Vedanthan R, Lee DJ, Kamano JH, Herasme OI, Kiptoo P, Tulienge D, Kimaiyo S, Balasubramanian H, Fuster V. Hypertension management in rural western Kenya: a needs-based health workforce estimation model. HUMAN RESOURCES FOR HEALTH 2019; 17:57. [PMID: 31311561 PMCID: PMC6636021 DOI: 10.1186/s12960-019-0389-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Elevated blood pressure is the leading risk for mortality in the world. Task redistribution has been shown to be efficacious for hypertension management in low- and middle-income countries. However, the workforce requirements for such a task redistribution strategy are largely unknown. Therefore, we developed a needs-based workforce estimation model for hypertension management in western Kenya, using need and capacity as inputs. METHODS Key informant interviews, focus group discussions, a Delphi exercise, and time-motion studies were conducted among administrative leadership, clinicians, patients, community leaders, and experts in hypertension management. These results were triangulated to generate the best estimates for the inputs into the health workforce model. The local hypertension clinical protocol was used to derive a schedule of encounters with different levels of clinician and health facility staff. A Microsoft Excel-based spreadsheet was developed to enter the inputs and generate the full-time equivalent workforce requirement estimates over 3 years. RESULTS Two different scenarios were modeled: (1) "ramp-up" (increasing growth of patients each year) and (2) "steady state" (constant rate of patient enrollment each month). The ramp-up scenario estimated cumulative enrollment of 7000 patients by year 3, and an average clinical encounter time of 8.9 min, yielding nurse full-time equivalent requirements of 4.8, 13.5, and 30.2 in years 1, 2, and 3, respectively. In contrast, the steady-state scenario assumed a constant monthly enrollment of 100 patients and yielded nurse full-time equivalent requirements of 5.8, 10.5, and 14.3 over the same time period. CONCLUSIONS A needs-based workforce estimation model yielded health worker full-time equivalent estimates required for hypertension management in western Kenya. The model is able to provide workforce projections that are useful for program planning, human resource allocation, and policy formulation. This approach can serve as a benchmark for chronic disease management programs in low-resource settings worldwide.
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Affiliation(s)
- Rajesh Vedanthan
- New York University School of Medicine, 180 Madison Avenue, 8th Floor, New York, NY 10016 USA
| | - Danielle J. Lee
- Temple University School of Medicine, 3500 N Broad St, Philadelphia, PA 19140 USA
| | - Jemima H. Kamano
- Department of Medicine, School of Medicine, Moi University College of Health Sciences, Nandi Rd, Eldoret, Kenya
| | - Omarys I. Herasme
- Icahn School of Medicine at Weill Cornell, 1 Gustave L. Levy Pl, New York, NY 10029 USA
- Weill Cornell Medicine, 413 East 69th Street, New York, NY 10021 USA
| | - Peninah Kiptoo
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Deborah Tulienge
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Sylvester Kimaiyo
- Department of Medicine, School of Medicine, Moi University College of Health Sciences, Nandi Rd, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | | | - Valentin Fuster
- Icahn School of Medicine at Weill Cornell, 1 Gustave L. Levy Pl, New York, NY 10029 USA
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Chandraratne N, Yamaguchi M, Indrawansa S, Gunawardena N, Kuwahara K, Islam Z, Kawasaki Y, Mizoue T, Samarasinghe D. The effect of youths as change agents on cardiovascular disease risk factors among adult neighbours: a cluster randomised controlled trial in Sri Lanka. BMC Public Health 2019; 19:893. [PMID: 31286931 PMCID: PMC6613264 DOI: 10.1186/s12889-019-7142-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 06/10/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Mobilising non-professional health workers has been successful in improving community health, but the effectiveness of an education program targeting youths in a community-based approach remains unclear. The objective of this study was to investigate the effect of an intervention with youth on cardiovascular disease risk factors of community adults. METHODS A 12-month cluster randomised trial was conducted in a semi-urban area of Colombo in Sri Lanka. Facilitators trained youth club members aged 15-29 years to assess cardiovascular disease risk factors and take actions in the community to address relevant issues. The control group received no intervention. Body weight and blood pressure as primary outcomes and lifestyle of adults as secondary outcomes were measured pre- and post-intervention. Multilevel linear and logistic regressions were used to assess the effects of the intervention on changes in continuous and binary outcomes, respectively, from baseline to endpoint. RESULTS Of 512 participants at baseline, 483 completed the final assessment after the intervention. Regarding primary outcomes, the intervention group showed a significantly greater decrease in body weight after intervention than the control group. The mean (95% confidence interval) difference of body weight change for intervention versus control group was - 2.83 kg (- 3.31, - 2.35). There was no statistically significant difference in blood pressure between the two groups. Turning to the secondary outcomes, in diet, the intervention group had a higher probability of consuming at least one serving/day of fruits (p = 0.02) and a lower probability of consuming snacks twice/day or more (p < 0.001) than the control group. CONCLUSIONS An intervention employing youths as change agents was effective in lowering body weight among community adults in Sri Lanka. TRIAL REGISTRATION Trial registration number: SLCTR/2017/002 , Name of registry: Sri Lanka Clinical Trials Registry, Date of registration: 19th January 2017, Date of enrolment of the first participant to the trial: 1st February 2017.
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Affiliation(s)
- Nadeeka Chandraratne
- Ministry of Health, Nutrition and Indigenous Medicine, Suwasiripaya, No. 385, Rev. Baddegama Wimalawansa Thero Mawatha, Colombo 10, Sri Lanka
| | - Miwa Yamaguchi
- Department of Epidemiology and Prevention, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjyuku, Tokyo, 162-8655, Japan
| | - Susantha Indrawansa
- The Foundation for Health Promotion, No.21/1 Kahawita Road, Attidiya, Dehiwala, Western Province, 10350, Sri Lanka
| | - Nalika Gunawardena
- World Health Organisation Country Office for Sri Lanka, 5 Anderson Road, Colombo, Sri Lanka
| | - Keisuke Kuwahara
- Department of Epidemiology and Prevention, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjyuku, Tokyo, 162-8655, Japan.,Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Zobida Islam
- Department of Epidemiology and Prevention, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjyuku, Tokyo, 162-8655, Japan
| | - Yohei Kawasaki
- Ministry of Health, Nutrition and Indigenous Medicine, Suwasiripaya, No. 385, Rev. Baddegama Wimalawansa Thero Mawatha, Colombo 10, Sri Lanka.,Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjyuku, Tokyo, 162-8655, Japan.
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Bustamante ND, Golden CD, Randrianasolo JF, Parmar P. A qualitative evaluation of health care in the Maroantsetra region of Madagascar. Int Health 2019; 11:185-192. [PMID: 30265340 DOI: 10.1093/inthealth/ihy070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/10/2018] [Accepted: 09/18/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Individuals in rural communities in Madagascar must frequently travel long distances, over difficult terrain, to obtain basic care. The quality of care is often inconsistent and inadequate. METHODS An exploratory mixed-methods study was conducted in select coastal communities in the Maroantsetra region of Madagascar to generate a more robust understanding of community and health care provider perceptions and how patients decide to seek health care, including the decision to use traditional medicine vs allopathic medicine. A total of 69 free-listing exercises and 21 facility assessments were conducted in eight communities. RESULTS Symptoms most commonly reported as reasons to seek health care included headaches, fever and cough. Decisions to access allopathic health care facilities depended on the intersection of geographic and financial access to health care facilities, perceived severity of the illness and the availability and confidence in traditional plant-based medications. Traveling salespeople, staff at local stores and pharmacy workers very often lacked formal training. CONCLUSIONS The decision to use allopathic medicine was determined by the perception of disease severity and when vulnerable populations, such as children and the elderly, were involved. Results provide insight into patterns, motivations and obstacles to health care utilization and decision making in the Maroantsetra region of Madagascar.
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Affiliation(s)
- Nirma D Bustamante
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Christopher D Golden
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Madagascar Health and Environmental Research, Maroantsetra, Madagascar
| | | | - Parveen Parmar
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA, USA
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Basiri M, Karimy M, Shahnazi H. Effect of Educational Intervention on Communication Skills and Self-Efficacy of Primary Healthcare Workers (Behvarz). JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2019. [DOI: 10.29252/jech.6.2.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Musinguzi G, Wanyenze RK, Ndejjo R, Ssinabulya I, van Marwijk H, Ddumba I, Bastiaens H, Nuwaha F. An implementation science study to enhance cardiovascular disease prevention in Mukono and Buikwe districts in Uganda: a stepped-wedge design. BMC Health Serv Res 2019; 19:253. [PMID: 31023311 PMCID: PMC6482572 DOI: 10.1186/s12913-019-4095-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Uganda is experiencing a shift in major causes of death with cases of stroke, heart attack, and heart failure reportedly on the rise. In a study in Mukono and Buikwe in Uganda, more than one in four adults were reportedly hypertensive. Moreover, very few (36.5%) reported to have ever had a blood pressure measurement. The rising burden of CVD is compounded by a lack of integrated primary health care for early detection and treatment of people with increased risk. Many people have less access to effective and equitable health care services which respond to their needs. Capacity gaps in human resources, equipment, and drug supply, and laboratory capabilities are evident. Prevention of risk factors for CVD and provision of effective and affordable treatment to those who require it prevent disability and death and improve quality of life. The aim of this study is to improve health profiles for people with intermediate and high risk factors for CVD at the community and health facility levels. The implementation process and effectiveness of interventions will be evaluated. METHODS The overall study is a type 2-hybrid stepped-wedge (SW) design. The design employs mixed methods evaluations with incremental execution and adaptation. Sequential crossover take place from control to intervention until all are exposed. The study will take place in Mukono and Buikwe districts in Uganda, home to more than 1,000,000 people at the community and primary healthcare facility levels. The study evaluation will be guided by; 1) RE-AIM an evaluation framework and 2) the CFIR a determinant framework. The primary outcomes are implementation - acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability. DISCUSSION The study is envisioned to provide important insight into barriers and facilitators of scaling up CVD prevention in a low income context. This project is registered at the ISRCTN Registry with number ISRCTN15848572. The trial was first registered on 03/01/2019.
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Affiliation(s)
- Geofrey Musinguzi
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Harm van Marwijk
- Department of Primary and Interdisciplinary Care, Briton and Sussex University Medical School, Sussex, UK
| | - Isaac Ddumba
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Health, Mukono, District, Uganda
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Vedanthan R, Ray M, Fuster V, Magenheim E. Hypertension Treatment Rates and Health Care Worker Density. Hypertension 2019; 73:594-601. [PMID: 30612489 PMCID: PMC6374168 DOI: 10.1161/hypertensionaha.118.11995] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/13/2018] [Indexed: 11/16/2022]
Abstract
Elevated blood pressure is the leading cause of death worldwide; however, treatment and control rates for hypertension are low. Here, we analyze the relationship between physician and nurse density and hypertension treatment rates worldwide. Data on hypertension treatment rates were collected from the STEPwise approach to Surveillance country reports, individual studies resulting from a PubMed search for articles published between 1990 and 2010, and manual search of the reference lists of extracted studies. Data on health care worker density were obtained from the Global Atlas of the Health Workforce. We controlled for a variety of variables related to population characteristics and access to health care, data obtained from the World Bank, World Development Indicators, United Nations, and World Health Organization. We used clustering of SEs at the country level. Full data were available for 154 hypertension treatment rate values representing 68 countries between 1990 and 2010. Hypertension treatment rate ranged from 3.4% to 82.5%, with higher treatment rates associated with higher income classification. Physician and nurse/midwife generally increased with income classification. Total healthcare worker density was significantly associated with hypertension treatment rate in the unadjusted model ( P<0.001); however, only nurse density remained significant in the fully adjusted model ( P=0.050). These analyses suggest that nurse density, not physician density, explains most of the relationship with hypertension treatment rate and remains significant even after adjusting for other independent variables. These results have important implications for health policy, health system design, and program implementation.
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Affiliation(s)
| | - Mondira Ray
- University of Pittsburgh School of Medicine, Pennsylvania, USA
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Meiqari L, Nguyen TPL, Essink D, Zweekhorst M, Wright P, Scheele F. Access to hypertension care and services in primary health-care settings in Vietnam: a systematic narrative review of existing literature. Glob Health Action 2019; 12:1610253. [PMID: 31120345 PMCID: PMC6534204 DOI: 10.1080/16549716.2019.1610253] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 04/15/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Health care in Vietnam is challenged by a high burden of hypertension (HTN). Since 2000, several interventions were implemented to manage HTN; it is not clear what is the status of patient access to HTN care. Objective: This article aims to perform a systematic narrative review of the available evidence on access to HTN care and services in primary health-care settings in Vietnam. Methods: Search engines were used to identify relevant records of scientific and grey literature. Data from selected articles were analysed using standardised spreadsheets and MaxQDA and following a framework synthesis methodology. Results: There has been increasing interest in research and policy concerning the burden of HTN in Vietnam, covering many aspects of access to treatment at the primary health-care level. Vietnam's National HTN Programme is managed as a vertical programme and its services integrated into the network of primary health-care facilities across the public sector in selected provinces. The Programme financed population-wide screening campaigns for the early detection of HTN among people above 40 years of age. There was no information on the acceptability of HTN health services, especially regarding the interaction between patients and health professionals. In general, articles reported good availability of medication, but problems in accessing them included: fragmentation and lack of consistency in prescribing medication between different levels and short timespans for dispensing medication at primary health-care facilities. There was limited information related to the cost and economic impact of HTN treatment. Treatment adherence among hypertensive patients based on four studies did not exceed 70%. Conclusions: Although the Vietnamese health-care system has taken steps to accommodate some of the needs of HTN patients, it is crucial to scale-up interventions that allow for regular, systematic, and integrated care, especially at the lowest levels of care.
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Affiliation(s)
- Lana Meiqari
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thi-Phuong-Lan Nguyen
- Department of Social Medicine, Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Dirk Essink
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Zweekhorst
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pamela Wright
- Guelph International Health Consulting, Amsterdam, The Netherlands
| | - Fedde Scheele
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Introducing post-discharge malaria chemoprevention (PMC) for management of severe anemia in Malawian children: a qualitative study of community health workers' perceptions and motivation. BMC Health Serv Res 2018; 18:984. [PMID: 30567567 PMCID: PMC6299958 DOI: 10.1186/s12913-018-3791-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background Severe malarial anaemia is one of the leading causes of paediatric hospital admissions in Malawi. Post-discharge malaria chemoprevention (PMC) is the intermittent administration of full treatment courses of antimalarial to children recovering from severe anaemia and findings suggest that this intervention significantly reduces readmissions and deaths in these children. Community delivery of health interventions utilizing community health workers (CHWs) has been successful in some programmes and not very positive in others. In Malawi, there is an on-going cluster randomised trial that aims to find the optimum strategy for delivery of dihydroartemesinin-piperaquine (DHP) for PMC in children with severe anaemia. Our qualitative study aimed to explore the feasibility of utilizing CHWs also known as health surveillance assistants (HSAs) to remind caregivers to administer PMC medication in the existing Malawian health system. Methods Between December 2016 and March 2018, 20 individual in-depth-interviews (IDIs) and 2 focus group discussions (FGDs) were conducted with 39 HSAs who had the responsibility of conducting home visits to remind caregivers of children who were prescribed PMC medication in the trial. All interviews were conducted in the local language, transcribed verbatim, and translated into English. The transcripts were uploaded to NVIVO 11 and analysed using the thematic framework analysis method. Results Although intrinsic motivation was reportedly high, adherence to the required number of home visits was very poor with only 10 HSAs reporting full adherence. Positive factors for adherence were the knowledge and perception of the effectiveness of PMC and the recognition from the community as well as health system. Poor training, lack of supervision, high workload, as well as technical and structural difficulties; were reported barriers to adherence by the HSAs. Conclusions Post-discharge malaria chemoprevention with DHP is perceived as a positive approach to manage children recovering from severe anaemia by HSAs in Malawi. However, adherence to home visit reminders was very poor and the involvement of HSAs in a scale up of this intervention may pose a challenge in the existing Malawian health system. Trial registration ClinicalTrials.gov identifier NCT02721420. The trial was registered on 26 March 2016. Electronic supplementary material The online version of this article (10.1186/s12913-018-3791-5) contains supplementary material, which is available to authorized users.
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Abdel-All M, Thrift AG, Riddell M, Thankappan KRT, Mini GK, Chow CK, Maulik PK, Mahal A, Guggilla R, Kalyanram K, Kartik K, Suresh O, Evans RG, Oldenburg B, Thomas N, Joshi R. Evaluation of a training program of hypertension for accredited social health activists (ASHA) in rural India. BMC Health Serv Res 2018; 18:320. [PMID: 29720161 PMCID: PMC5932780 DOI: 10.1186/s12913-018-3140-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension is a major risk factor for cardiovascular disease, a leading cause of premature death and disability in India. Since access to health services is poor in rural India and Accredited Social Health Activists (ASHAs) are available throughout India for maternal and child health, a potential solution for improving hypertension control is by utilising this available workforce. We aimed to develop and implement a training package for ASHAs to identify and control hypertension in the community, and evaluate the effectiveness of the training program using the Kirkpatrick Evaluation Model. METHODS The training program was part of a cluster randomised feasibility trial of a 3-month intervention to improve hypertension outcomes in South India. Training materials incorporated details on managing hypertension, goal setting, facilitating group meetings, and how to measure blood pressure and weight. The 15 ASHAs attended a five-day training workshop that was delivered using interactive instructional strategies. ASHAs then led community-based education support groups for 3 months. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results using tests on knowledge at baseline, post-training and post-intervention, observation of performance during meetings and post-intervention interviews. RESULTS The ASHAs' knowledge of hypertension improved from a mean score of 64% at baseline to 76% post-training and 84% after the 3-month intervention. Research officers, who observed the community meetings, reported that ASHAs delivered the self-management content effectively without additional assistance. The ASHAs reported that the training materials were easy to understand and useful in educating community members. CONCLUSION ASHAs can be trained to lead community-based group educational discussions and support individuals for the management of high blood pressure. TRIAL REGISTRATION The feasibility trial is registered with the Clinical Trials Registry - India (CTRI) CTRI/2016/02/006678 (25/02/2016).
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Affiliation(s)
- Marwa Abdel-All
- The George Institute for Global Health, et Sydney, PO Box M 201, Missenden Road, Camperdown, New South Wales, 2050, Australia. .,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
| | - Amanda Gay Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Michaela Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | | | - Gomathyamma Krishnakurup Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Clara K Chow
- The George Institute for Global Health, et Sydney, PO Box M 201, Missenden Road, Camperdown, New South Wales, 2050, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Western Sydney Local Health District, Westmead Hospital, Westmead, Australia
| | - Pallab Kumar Maulik
- The George Institute for Global Health, New Delhi, India.,The George Institute for Global Health, Oxford University, Oxford, UK
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rama Guggilla
- The George Institute for Global Health, New Delhi, India
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Rishi Valley, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Rishi Valley, Andhra Pradesh, India
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Rishi Valley Rural Health Centre, Rishi Valley, Andhra Pradesh, India
| | - Roger George Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rohina Joshi
- The George Institute for Global Health, et Sydney, PO Box M 201, Missenden Road, Camperdown, New South Wales, 2050, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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O’Donovan J, O’Donovan C, Kuhn I, Sachs SE, Winters N. Ongoing training of community health workers in low-income andmiddle-income countries: a systematic scoping review of the literature. BMJ Open 2018; 8:e021467. [PMID: 29705769 PMCID: PMC5931295 DOI: 10.1136/bmjopen-2017-021467] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/06/2018] [Accepted: 04/10/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Understanding the current landscape of ongoing training for community health workers (CHWs) in low-income and middle-income countries (LMICs) is important both for organisations responsible for their training, as well as researchers and policy makers. This scoping review explores this under-researched area by mapping the current delivery implementation and evaluation of ongoing training provision for CHWs in LMICs. DESIGN Systematic scoping review. DATA SOURCES MEDLINE, Embase, AMED, Global Health, Web of Science, Scopus, ASSIA, LILACS, BEI and ERIC. STUDY SELECTION Original studies focusing on the provision of ongoing training for CHWs working in a country defined as low income and middle income according to World Bank Group 2012 classification of economies. RESULTS The scoping review found 35 original studies that met the inclusion criteria. Ongoing training activities for CHWs were described as supervision (n=19), inservice or refresher training (n=13) or a mixture of both (n=3). Although the majority of studies emphasised the importance of providing ongoing training, several studies reported no impact of ongoing training on performance indicators. The majority of ongoing training was delivered inperson; however, four studies reported the use of mobile technologies to support training delivery. The outcomes from ongoing training activities were measured and reported in different ways, including changes in behaviour, attitudes and practice measured in a quantitative manner (n=16), knowledge and skills (n=6), qualitative assessments (n=5) or a mixed methods approach combining one of the aforementioned modalities (n=8). CONCLUSIONS This scoping review highlights the diverse range of ongoing training for CHWs in LMICs. Given the expansion of CHW programmes globally, more attention should be given to the design, delivery, monitoring and sustainability of ongoing training from a health systems strengthening perspective.
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Affiliation(s)
| | | | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Niall Winters
- Department of Education, University of Oxford, Oxford, UK
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