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Gudlavalleti AG, Babu GR, Kamalakannan S, Murthy GVS, Schaper NC, van Schayck OCP. Training of Community Health Workers in Diabetes Lead to Improved Outcomes for Diabetes Screening and Management in Low- and Middle-Income Countries: Protocol for a Systematic Review. JMIR Res Protoc 2024; 13:e57313. [PMID: 39167436 PMCID: PMC11375384 DOI: 10.2196/57313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/01/2024] [Accepted: 06/05/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Diabetes is a growing concern worldwide, particularly in low- and middle-income countries (LMICs). Type 2 diabetes mellitus constitutes a significant proportion of cases and is associated with debilitating microvascular complications. Type 2 diabetes mellitus is steadily increasing among the LMICs where many barriers to health care exist. Thus, task shifting to community health workers (CHWs) has been proposed as a solution to improve diabetes management in these settings. However, CHWs often lack the necessary training to manage diabetes effectively. Thus, a systematic review is required to present evidence of the highest degree for this intervention. OBJECTIVE This study aims to establish the protocols for a systemic review. METHODS Using the Participants Intervention Comparator Outcome Time Study Design (PICOTS) framework, this study outlines a systematic review aiming to evaluate the impact of training programs for CHWs in diabetes management in LMICs. Quantitative studies focusing on CHWs, diabetes training, focusing on diabetes management outcomes like hemoglobin A1c levels and fasting blood glucose levels, between January 2000 and December 2023 and found on databases such as PubMed, Ovid MEDLINE, Evidence Based Medicine Reviews, BASE, Google Scholar, and Web of Science will be included. We will include randomized controlled trials but will also include observational studies if we find less than 5 randomized controlled trials. An author committee consisting of 3 reviewers will be formed, where 2 reviewers will conduct the review independently while the third will resolve all disputes. The Cochrane Methods Risk of Bias Tool 2 will be used for assessing the risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation approach for the meta-analysis and narrative synthesis analysis will be used. The results will be presented in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram. RESULTS The review will begin in May 2024 and conclude in 3 months. CONCLUSIONS The review will synthesize existing evidence and provide insights into the effectiveness of such programs, informing future research and practice in diabetes care in LMICs. TRIAL REGISTRATION PROSPERO CRD42022341717; https://tinyurl.com/jva2hpdr. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/57313.
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Affiliation(s)
- Anirudh Gaurang Gudlavalleti
- Pragyaan Sustainable Health Outcomes Foundation, Hyderabad, India
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Sureshkumar Kamalakannan
- Department of social work, education and community wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - G V S Murthy
- Pragyaan Sustainable Health Outcomes Foundation, Hyderabad, India
| | - Nicolaas C Schaper
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Gudlavalleti AG, Babu GR, Agiwal V, Murthy GVS, Schaper NC, van Schayck OCP. Undesirable Levels of Practice Behaviours and Associated Knowledge amongst Community Health Workers in Rural South India Responsible for Type 2 Diabetes Screening and Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:562. [PMID: 38791775 PMCID: PMC11121515 DOI: 10.3390/ijerph21050562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Type 2 diabetes (T2DM) poses an enormous global health care challenge, especially among rural communities. Healthcare in these areas can be inadequate and inaccessible due to socio-demographic barriers. To overcome this situation, many low- and middle-income countries are resorting to task shifting, using community health workers (CHWs) for diabetes management. However, its successful implementation depends on the practice behaviours and knowledge of these workers. OBJECTIVE This cross-sectional study aimed to evaluate the proficiency of CHWs involved in diabetes screening and management in rural South India by identifying the existing practice behaviours and knowledge gaps. METHODS Employing a customised questionnaire, developed through inputs from experts and government officials, we assessed practice behaviours and the corresponding knowledge base of 275 CHWs. Analytical methodologies consisted of descriptive statistics, logistic regression, and mosaic plots for comprehensive data interpretation. RESULTS The study showcased significant deficiencies in both practice behaviours (97%) and knowledge (95%) with current mean levels ranging from 48 to 50%, respectively, among the participants. The identified areas of insufficiency were broadly representative of the core competencies required for effective diabetes management, encompassing diabetes diagnosis and referral, HbA1c testing, diabetes diet, diabetes type and self-management, microvascular complications and their screening, peripheral neuropathy management, and diabetes risk assessment. In several areas, correct practice behaviour was reported by a relatively large number of CHWs despite incorrect answers to the related knowledge questions such as referral to the health centres, self-management, and calculation of diabetes risk assessment. CONCLUSION This study highlights widespread deficiencies (97% CHWs) in diabetes management practices and knowledge (95% CHWs). To overcome these deficiencies, a thorough needs assessments is vital for effective CHW training. Training of CHWs should not only identify prior knowledge and/or behaviour but also their interrelationship to help create a robust and flexible set of practice behaviours.
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Affiliation(s)
- Anirudh G. Gudlavalleti
- Pragyaan Sustainable Health Outcomes Foundation, World Trade Centre, Nanakramguda, Hyderabad 500032, Telangana, India;
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (N.C.S.); (O.C.P.v.S.)
| | - Giridhara R. Babu
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Varun Agiwal
- Indian Institute of Public Health Hyderabad, Rajendranagar, Hyderabad 500030, Telangana, India;
| | - G. V. S. Murthy
- Pragyaan Sustainable Health Outcomes Foundation, World Trade Centre, Nanakramguda, Hyderabad 500032, Telangana, India;
| | - Nicolaas C. Schaper
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (N.C.S.); (O.C.P.v.S.)
| | - Onno C. P. van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (N.C.S.); (O.C.P.v.S.)
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Pardoel ZE, Reijneveld SA, Lensink R, Postma MJ, Trang NTT, Walton P, Swe KH, Pamungkasari EP, Koot JAR, Landsman JA. Culturally adapted training for community volunteers to improve their knowledge, attitude and practice regarding non-communicable diseases in Vietnam. BMC Public Health 2024; 24:364. [PMID: 38310223 PMCID: PMC10837994 DOI: 10.1186/s12889-024-17938-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/31/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND The burden of non-communicable diseases is becoming unmanageable by primary healthcare facilities in low- and middle-income countries. Community-based approaches are promising for supporting healthcare facilities. In Vietnam, community health volunteers are trained in providing health promotion and screening in a culturally adapted training. This study aims to assess the change in knowledge, attitude and practice regarding NCD prevention and management after a culturally adapted training, and the potential mechanisms leading to this change. METHODS The Knowledge Attitude and Practice survey was assessed before and after an initial training, and before and after a refresher training (n = 37). We used a focus group discussion with community health volunteers (n = 8) to map potential mechanisms of the training and applying learned knowledge in practice. Data were collected in the districts Le Chan and An Duong of Hai Phong, Vietnam, in November 2021 and May 2022. RESULTS We found that knowledge increased after training (mean = 5.54, 95%-confidence interval = 4.35 to 6.74), whereas attitude and practice did not improve. Next, knowledge decreased over time (m=-12.27;-14.40 to -10.11) and did not fully recover after a refresher training (m=-1.78;-3.22 to -0.35). As potential mechanisms for change, we identified the use of varying learning methods, enough breaks, efficient coordination of time located for theory and practice, handout materials, large group size and difficulty in applying a digital application for screening results. CONCLUSION Culturally adapted trainings can improve knowledge among community health volunteers which is important for the support of primary healthcare in low- and middle-income countries. Using a digital screening application can be a barrier for the improvement of knowledge, attitude and practice and we suggest using an intergenerational or age-friendly approach, with the supervision of primary healthcare professionals. Future research on behavioral change should include additional components such as self-efficacy and interrelationships between individuals.
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Affiliation(s)
- Zinzi E Pardoel
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, Groningen, 9700 RB, The Netherlands.
| | - Sijmen A Reijneveld
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, Groningen, 9700 RB, The Netherlands
| | - Robert Lensink
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, Groningen, 9700 RB, The Netherlands
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Faculty of Medicine, Department of Pharmacology and Therapy, Universitas Airlangga, Surabaya, Indonesia
- Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | | | | | | | | | - Jaap A R Koot
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, Groningen, 9700 RB, The Netherlands
| | - Jeanet A Landsman
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, Groningen, 9700 RB, The Netherlands
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Okop K, Delobelle P, Lambert EV, Getachew H, Howe R, Kedir K, Niyibizi JB, Bavuma C, Kasenda S, Crampin AC, King AC, Puoane T, Levitt NS. Implementing and Evaluating Community Health Worker-Led Cardiovascular Disease Risk Screening Intervention in Sub-Saharan Africa Communities: A Participatory Implementation Research Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010298. [PMID: 36612620 PMCID: PMC9819933 DOI: 10.3390/ijerph20010298] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 05/27/2023]
Abstract
The increasing burden of non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD) in low- and middle-income countries (LMICs) poses a considerable threat to public health. Community-driven CVD risk screening, referral and follow-up of those at high CVDs risk is essential to supporting early identification, treatment and secondary prevention of cardiovascular events such as stroke and myocardial infarction. This protocol describes a multi-country study that aims to implement and evaluate a community health worker (CHW)-led CVD risk screening programme to enhance referral linkages within the local primary care systems in sub-Saharan Africa (SSA), using a participatory implementation science approach. The study builds upon a prior community-driven multicentre study conducted by the Collaboration for Evidence-based Health Care and Public Health in Africa (CEBHA+). This is a participatory implementation research. The study will leverage on the CVD risk citizen science pilot studies conducted in the four selected CEBHA+ project countries (viz. Ethiopia, Rwanda, Malawi, and South Africa). Through planned engagements with communities and health system stakeholders, CHWs and lay health worker volunteers will be recruited and trained to screen and identify persons that are at high risk of CVD, provide referral services, and follow-up at designated community health clinics. In each country, we will use a multi-stage random sampling to select and then screen 1000 study participants aged 35-70 years from two communities (one rural and one urban). Screening will be done using a simple validated non-laboratory-based CVD risk assessment mobile application. The RE-AIM model will be used in evaluating the project implementation outcomes, including reach, fidelity, adoption and perceived effectiveness. Developing the capacities of CHWs and lay health worker volunteers in SSA to support population-based, non-invasive population-based CVD risk prevention has the potential to impact on early identification, treatment and secondary prevention of CVDs in often under-resourced communities. Using a participatory research approach to implementing mobile phone-based CHW-led CVD risk screening, referral and follow-up in SSA will provide the evidence needed to determine the effectiveness of CVD risk screening and the potential for scaling up in the wider region.
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Affiliation(s)
- Kufre Okop
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town 7700, South Africa
- Centre for Social Science Research, University of Cape Town, Cape Town 7700, South Africa
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town 7700, South Africa
- Department of Public Health, Vrije Universiteit Brussel, 1090 Brussel, Belgium
| | - Estelle Victoria Lambert
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
| | | | - Rawleigh Howe
- Armauer Hansen Research Institute (AHRI), Addis Ababa P.O. Box 1005, Ethiopia
| | - Kiya Kedir
- Armauer Hansen Research Institute (AHRI), Addis Ababa P.O. Box 1005, Ethiopia
| | | | - Charlotte Bavuma
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali 4285, Rwanda
| | - Stephen Kasenda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe P.O. Box 46, Malawi
| | - Amelia C. Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe P.O. Box 46, Malawi
| | - Abby C. King
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town 7535, South Africa
| | - Naomi S. Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town 7700, South Africa
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Fowokan A, Afungchwi GM, Renner L, Freccero P, Gupta S, Denburg A. Evaluation of a Health Care Worker Training Intervention to Improve the Early Diagnosis and Referral of Childhood Cancers in Ghana: A Qualitative Descriptive Study. JCO Glob Oncol 2022; 8:e2200151. [PMID: 36103639 PMCID: PMC9812462 DOI: 10.1200/go.22.00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE This study sought to (1) evaluate the perceived effectiveness of an early childhood cancer warning signs and symptoms (EWSS) training intervention on health care worker (HCW) knowledge, attitudes, and clinical practice; (2) evaluate the ease of implementation of training received, including potential barriers and facilitators; and (3) provide insights into program improvements for future iterations of the intervention. METHOD Using a qualitative descriptive study design, we conducted in-depth, semistructured interviews with 23 purposively sampled Ghanaian HCW recipients of the EWSS training intervention. We undertook iterative thematic analysis of data concurrently with interviews and used a modified version of the theoretical framework of acceptability to guide the evaluation of the training intervention. RESULTS We identified six themes-affective attitude, burden, intervention coherence, perceived effectiveness, self-efficacy, and quality improvement-that structure participant perceptions of the effectiveness of the EWSS training. Participants generally had a positive attitude to the training intervention, found the content relatively easy to understand, and communicated the positive impacts of the training on their day-to-day practice. However, they also identified patient- and system-level challenges to the real-world implementation of intervention components, including patients' cultural and religious beliefs about illnesses, patients' financial constraints, and inadequately funded health systems. CONCLUSION Our findings suggest that although an HCW-focused training intervention has the potential to improve timely diagnosis and referral for childhood cancers in Ghana and comparable health system contexts, complementary interventions to address patient- and system-level implementation challenges are required to translate improvements in HCW knowledge to sustained impact on health outcomes for children with cancer.
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Affiliation(s)
- Adeleke Fowokan
- Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Lorna Renner
- University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | | | - Sumit Gupta
- Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Avram Denburg
- Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada,Avram Denburg, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8 Canada; e-mail:
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Seneviratne S, Desloge A, Haregu T, Kwasnicka D, Kasturiratne A, Mandla A, Chambers J, Oldenburg B. Characteristics and Outcomes of Community Health Worker Training to Improve the Prevention and Control of Cardiometabolic Diseases in Low and Middle-Income Countries: A Systematic Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221112834. [PMID: 35916447 PMCID: PMC9350494 DOI: 10.1177/00469580221112834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 06/05/2022] [Accepted: 06/23/2022] [Indexed: 11/21/2022]
Abstract
Community health workers (CHWs) play an important role in controlling non-communicable diseases in low- and middle-income countries. The aim of this review was to describe the characteristics and outcomes of CHW training programs that focused on the prevention and control of cardiometabolic diseases in low- and middle-income countries (LMICs). Medline, CINAHL Complete, Academic Search Complete, Directory of Open Access Journal, ScienceDirect, ERIC, Gale Academic, and OneFile). Studies that described the training programs used to train CHWs for prevention and control of cardiovascular diseases and type2 diabetes mellitus in LMICs. Only studies that evaluated the outcomes of training programs in at least one of the 4 levels of Kirkpatrick's training evaluation model were included in the review. CHWs who underwent training focused on the prevention and control of cardiovascular disease and type 2 diabetes mellitus. We summarized the resulting evidence using qualitative synthesis through a narrative review. Training outcomes were assessed in relation to (1) CHW reactions to training, their degree of learning, and their behaviors following training, and (2) changes in biochemical and anthropometric indicators in target populations following the CHW program implementation. PROSPERO (CRD42020162116). Thirty-two studies were included. Methods used to train CHWs included: face-to-face lectures, interactive group activities, and blended teaching with online support. Training focused on identifying people with elevated risk of cardiometabolic diseases and their risk factors as well as supporting people to adopt healthy lifestyles. Many studies that utilized trained CHWs did not publish CHW training methods and evaluations, and therefore could not be included in this study. Training programs resulted in an increase in knowledge and skills among CHWs demonstrating that there are certain activities that can be shifted to CHWs following training.
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Affiliation(s)
- Shilanthi Seneviratne
- Ministry of Health, Colombo, Sri
Lanka
- University of Melbourne, Melbourne,
VIC, Australia
| | | | | | - Dominika Kwasnicka
- University of Melbourne, Melbourne,
VIC, Australia
- SWPS University of Social Sciences and
Humanities, Poland
| | | | | | - John Chambers
- Nanyang Technological University
(Singapore) and Imperial College London, London, UK
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Kavita, Unnas, Thakur J, Ghai S, Saini S. Task shifting of cardiovascular disease risk assessment to Anganwadi Worker in Northern India. J Family Med Prim Care 2022; 11:1109-1113. [PMID: 35495795 PMCID: PMC9051688 DOI: 10.4103/jfmpc.jfmpc_1119_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/09/2020] [Accepted: 10/14/2021] [Indexed: 11/04/2022] Open
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Okop KJ, Murphy K, Lambert EV, Kedir K, Getachew H, Howe R, Niyibizi JB, Ntawuyirushintege S, Bavuma C, Rulisa S, Kasenda S, Chipeta E, Bunn C, Crampin AC, Chapotera G, King AC, Banchoff A, Winter SJ, Levitt NS. Community-driven citizen science approach to explore cardiovascular disease risk perception, and develop prevention advocacy strategies in sub-Saharan Africa: a programme protocol. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:11. [PMID: 33637131 PMCID: PMC7907793 DOI: 10.1186/s40900-020-00246-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/09/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND In sub-Saharan Africa (SSA), which experiences a disproportionately high cardiovascular disease (CVD) burden, population-based screening and prevention measures are hampered by low levels of knowledge about CVD and associated risk factors, and inaccurate perceptions of severity of risk. METHODS This protocol describes the planned processes for implementing community-driven participatory research, using a citizen science method to explore CVD risk perceptions and to develop community-specific advocacy and prevention strategies in the rural and urban SSA settings. Multi-disciplinary research teams in four selected African countries will engage with and train community members living in rural and urban communities as citizen scientists to facilitate conceptualization, co-designing of research, data gathering, and co-creation of knowledge that can lead to a shared agenda to support collaborative participation in community-engaged science. The emphasis is on robust community engagement, using mobile technology to support data gathering, participatory learning, and co-creation of knowledge and disease prevention advocacy. DISCUSSION Contextual processes applied and lessons learned in specific settings will support redefining or disassembling boundaries in participatory science to foster effective implementation of sustainable prevention intervention programmes in Low- and Middle-income countries.
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Affiliation(s)
- Kufre Joseph Okop
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa.
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
| | - Kathy Murphy
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Estelle Victoria Lambert
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kiya Kedir
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | - Rawleigh Howe
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | | | - Charlotte Bavuma
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Stephen Rulisa
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Stephen Kasenda
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Effie Chipeta
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Christopher Bunn
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Gertrude Chapotera
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi
| | - Abby C King
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Ann Banchoff
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Sandra J Winter
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Finn M, Gilmore B, Sheaf G, Vallières F. What do we mean by individual capacity strengthening for primary health care in low- and middle-income countries? A systematic scoping review to improve conceptual clarity. HUMAN RESOURCES FOR HEALTH 2021; 19:5. [PMID: 33407554 PMCID: PMC7789571 DOI: 10.1186/s12960-020-00547-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Capacity strengthening of primary health care workers is widely used as a means to strengthen health service delivery, particularly in low- and middle-income countries. Despite the widespread recognition of the importance of capacity strengthening to improve access to quality health care, how the term 'capacity strengthening' is both used and measured varies substantially across the literature. This scoping review sought to identify the most common domains of individual capacity strengthening, as well as their most common forms of measurement, to generate a better understanding of what is meant by the term 'capacity strengthening' for primary health care workers. METHODS Six electronic databases were searched for studies published between January 2000 and October 2020. A total of 4474 articles were screened at title and abstract phase and 323 full-text articles were reviewed. 55 articles were ultimately identified for inclusion, covering various geographic settings and health topics. RESULTS Capacity strengthening is predominantly conceptualised in relation to knowledge and skills, as either sole domains of capacity, or used in combination with other domains including self-efficacy, practices, ability, and competencies. Capacity strengthening is primarily measured using pre- and post-tests, practical evaluations, and observation. These occur along study-specific indicators, though some pre-existing, validated tools are also used. CONCLUSION The concept of capacity strengthening for primary health care workers reflected across a number of relevant frameworks and theories differs from what is commonly seen in practice. A framework of individual capacity strengthening across intra-personal, inter-personal, and technical domains is proposed, as an initial step towards building a common consensus of individual capacity strengthening for future work.
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Affiliation(s)
- Mairéad Finn
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin, Ireland
| | - Frédérique Vallières
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
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Gupta AV, Phatak AG, Patel MU, Das N, Vaghela NP, Prakash H, Raithatha SJ. Effectiveness of a community health worker (CHW) training in monitoring and care of patients with chronic obstructive pulmonary disease (COPD) in rural Gujarat, India. J Family Med Prim Care 2020; 9:1910-1914. [PMID: 32670939 PMCID: PMC7346932 DOI: 10.4103/jfmpc.jfmpc_1193_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 12/26/2019] [Accepted: 01/02/2020] [Indexed: 11/11/2022] Open
Abstract
Context: Chronic obstructive pulmonary disease (COPD) is the second leading contributor to the disease burden of India. The current COPD burden cannot be managed effectively just through a physician-based approach. In a primary care setting, community health workers (CHWs) can play an effective role in making COPD care accessible and effective. Aim: Findings of an assessment of a training program for CHWs on COPD have been reported here. Methods: 90 CHWs working as a part of a noncommunicable disease prevention and care program in a rural primary care setting were exposed to a series of five training sessions. The sessions were designed and administered jointly by a team of public health experts and physiotherapists in the year 2017–18. Topics covered were basic clinical aspects of COPD, monitoring a patient with COPD, and basic aspects of pulmonary rehabilitation. The assessment comprised 12 MCQs and short questions, 7 video exercises, 2 case vignettes, and 5 skill assessments through objectively structured clinical examination (OSCE). Statistical Analysis: Mean percentage scores were calculated for each domain of assessment to make it comparable. Results: 70 CHWs with a mean age of 42.2 years completed all the training and underwent the assessment. Mean percentage score (SD) for knowledge was 62% (16.3). In OSCE assessment, scores were best in sputum clearance technique demonstration (92.1%) and the least in dyspnea relieving positions (59.2%). The CHWs had difficulties in identifying signs of respiratory distress (score - 55.1%). No statistically significant association was observed between performance scores and their sociodemographic profile. Conclusion: The results were encouraging and the program may be pilot tested in a government setting particularly using the health and wellness centers (HWC) platform.
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Affiliation(s)
- Ashish V Gupta
- K M Patel Institute of Physiotherapy, Karamsad, Anand, Gujarat, India
| | - Ajay G Phatak
- Central Research Services, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - Meha U Patel
- K M Patel Institute of Physiotherapy, Karamsad, Anand, Gujarat, India
| | - Neha Das
- Community Medicine, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - Nirav P Vaghela
- K M Patel Institute of Physiotherapy, Karamsad, Anand, Gujarat, India
| | - Harihara Prakash
- K M Patel Institute of Physiotherapy, Karamsad, Anand, Gujarat, India
| | - Shyamsudar J Raithatha
- Community Medicine and Extension Programmes Department, H M Patel Centre for Medical Care and Education, Karamsad, Anand, Gujarat, India
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Heller DJ, Kumar A, Kishore SP, Horowitz CR, Joshi R, Vedanthan R. Assessment of Barriers and Facilitators to the Delivery of Care for Noncommunicable Diseases by Nonphysician Health Workers in Low- and Middle-Income Countries: A Systematic Review and Qualitative Analysis. JAMA Netw Open 2019; 2:e1916545. [PMID: 31790570 PMCID: PMC6902752 DOI: 10.1001/jamanetworkopen.2019.16545] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Cardiovascular disease, cancer, and other noncommunicable diseases (NCDs) are the leading causes of mortality in low- and middle-income countries. Previous studies show that nonphysician health workers (NPHWs), including nurses and volunteers, can provide effective diagnosis and treatment of NCDs. However, the factors that facilitate and impair these programs are incompletely understood. OBJECTIVE To identify health system barriers to and facilitators of NPHW-led care for NCDs in low- and middle-income countries. DATA SOURCES All systematic reviews in PubMed published by May 1, 2018. STUDY SELECTION The search terms used for this analysis included "task shifting" and "non-physician clinician." Only reviews of NPHW care that occurred entirely or mostly in low- and middle-income countries and focused entirely or mostly on NCDs were included. All studies cited within each systematic review that cited health system barriers to and facilitators of NPHW care were reviewed. DATA EXTRACTION AND SYNTHESIS Assessment of study eligibility was performed by 1 reviewer and rechecked by another. The 2 reviewers extracted all data. Reviews were performed from November 2017 to July 2018. All analyses were descriptive. MAIN OUTCOMES AND MEASURES All barriers and facilitators mentioned in all studies were tallied and sorted according to the World Health Organization's 6 building blocks for health systems. RESULTS This systematic review and qualitative analysis identified 15 review articles, which cited 156 studies, of which 71 referenced barriers to and facilitators of care. The results suggest 6 key lessons: (1) select qualified NPHWs embedded within the community they serve; (2) provide detailed, ongoing training and supervision; (3) authorize NPHWs to prescribe medication and render autonomous care; (4) equip NPHWs with reliable systems to track patient data; (5) furnish NPHWs consistently with medications and supplies; and (6) compensate NPHWs adequately commensurate with their roles. CONCLUSIONS AND RELEVANCE Although the health system barriers to NPHW screening, treatment, and control of NCDs and their risk factors are numerous and complex, a diverse set of care models has demonstrated strategies to address nearly all of these challenges. These facilitating approaches-which relate chiefly to strong, consistent NPHW training, guidance, and logistical support-generate a blueprint for the creation and scale-up of such programs adaptable across multiple chronic diseases, including in high-income countries.
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Affiliation(s)
- David J. Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anirudh Kumar
- Department of Medicine, New York University School of Medicine, New York
| | - Sandeep P. Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Carol R. Horowitz
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York
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12
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Joseph LM, Lekha TR, Boban D, Jose P, Jeemon P. Perceived facilitators and barriers of enrolment, participation and adherence to a family based structured lifestyle modification interventions in Kerala, India: A qualitative study. Wellcome Open Res 2019; 4:131. [PMID: 31828226 PMCID: PMC6896244 DOI: 10.12688/wellcomeopenres.15415.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 02/03/2023] Open
Abstract
Background: The objective of the study was to describe participants’ and providers’ perspectives of barriers and facilitators of enrolment, participation and adherence to a structured lifestyle modification (SLM) interventions as part of the PROLIFIC trial in Kerala, India. Methods: Family members who had been enrolled for 12-months or more in a family-based cardiovascular risk reduction intervention study (PROLIFIC Trial) were purposively sampled and interviewed using a semi-structured guide. The non-physician health workers (NPHWs) delivering the intervention were also interviewed or included in focus groups (FGDs). Thematic analysis was used for data analysis. Results: In total, 56 in-depth interviews and three FGDs were conducted. The descriptive themes emerged were categorised as (a) motivation for enrolment and engagement in the SLM interventions, (b) facilitators of adherence, and (c) reasons for non-adherence. A prior knowledge of familial cardiovascular risk, preventive nature of the programme, and a reputed organisation conducting the intervention study were appealing to the participants. Simple suggestions of healthier alternatives based on existing dietary practices, involvement of the whole family, and the free annual blood tests amplified the adherence. Participants highlighted regular monitoring of risk factors and provision of home-based care by NPHWs as facilitators for adherence. Furthermore, external motivation by NPHWs in setting and tracking short terms goals were perceived as enablers of adherence. Nonetheless, home makers expressed difficulty in dealing with varied food choices of family members. Young adults in the programme noted that dietary changes were affected by eating out as they wanted to fit in with peers. Conclusions: The findings suggest that a family-based, trained healthcare worker led SLM interventions are desirable and feasible in Kerala. Increasing the number of visits by NPHWs, regular monitoring and tracking of lifestyle goals, and targeting young adults and children for dietary changes may further improve adherence to SLM interventions.
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Affiliation(s)
- Linju M Joseph
- Centre for Chronic Disease Control, New Delhi, New Delhi, 110016, India
| | - T R Lekha
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Dona Boban
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Prinu Jose
- Centre for Chronic Disease Control, New Delhi, New Delhi, 110016, India
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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Long H, Ma Z, Hanh TTD, Minh HV, Rawal LB, Urmi DS, Jafar TH, Tang S, Abdullah AS. Engaging village health workers in non-communicable disease (NCD) prevention and control in Vietnam: A qualitative study. Glob Public Health 2019; 15:611-625. [PMID: 31630629 DOI: 10.1080/17441692.2019.1678660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The burden of non-communicable diseases (NCDs) continues to grow in Vietnam, and reducing the burden of NCDs is a national priority. This study explored perspective of community health workers (CHWs), known as Village Health Workers (VHWs) in Vietnam, and public health leaders towards potential of expanding VHWs' role to deliver NCDs prevention and control services, and determined barriers and facilitators. We conducted focus group discussions (FGDs) with VHWs (n = 24) and in-depth interviews (IDIs) with public health administrators (n = 13). The findings show that VHWs in Vietnam deliver multiple public health services, including several NCDs related services. Perceived barriers include lack of policy support, shortages of trained health personnel, lack of training, imbalanced workload and inadequate remuneration. Perceived barriers include lack of policy support, shortages of trained health personnel, lack of training, imbalanced workload and inadequate remuneration. Facilitators include government commitment to NCDs prevention and control, priority on capacity building, professional recognition and provision of incentives with availability of appropriate resources. While additional quantitative studies are needed to supplement the current qualitative findings, the current results inform the policy and intervention development in engaging VHWs in the delivery of community-based NCDs prevention and control initiatives in Vietnam.
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Affiliation(s)
- Hongfei Long
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China
| | - Zhenyu Ma
- School of Public Health, Guangxi Medical University, Guangxi, People's Republic of China
| | | | | | - Lal B Rawal
- School of Health, Medical and Applied Sciences, CQ University, Sydney Campus, Australia
| | - Dilshat S Urmi
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China
| | - Tazeen H Jafar
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Shenglan Tang
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Abu S Abdullah
- Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China.,Duke Global Health Institute, Duke University, Durham, NC, USA.,Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
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14
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Anand TN, Joseph LM, Geetha AV, Chowdhury J, Prabhakaran D, Jeemon P. Task-sharing interventions for cardiovascular risk reduction and lipid outcomes in low- and middle-income countries: A systematic review and meta-analysis. J Clin Lipidol 2018; 12:626-642. [PMID: 29559305 PMCID: PMC5994347 DOI: 10.1016/j.jacl.2018.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/10/2018] [Accepted: 02/13/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND One of the potential strategies to improve health care delivery in understaffed low- and middle-income countries (LMICs) is task sharing, where specific tasks are transferred from more qualified health care cadre to a lesser trained cadre. Dyslipidemia is a major risk factor for cardiovascular disease but often it is not managed appropriately. OBJECTIVE We conducted a systematic review with the objective to identify and evaluate the effect of task sharing interventions on dyslipidemia in LMICs. METHODS Published studies (randomized controlled trials and observational studies) were identified via electronic databases such as PubMed, Embase, Cochrane Library, PsycINFO, and CINAHL. We searched the databases from inception to September 2016 and updated till 30 June 2017, using search terms related to task shifting, and cardiovascular disease prevention in LMICs. All eligible studies were summarized narratively, and potential studies were grouped for meta-analysis. RESULTS Although our search yielded 2938 records initially and another 1628 in the updated search, only 15 studies met the eligibility criteria. Most of the studies targeted lifestyle modification and care coordination by involving nurses or allied health workers. Eight randomized controlled trials were included in the meta-analysis. Task sharing intervention were effective in lowering low-density lipoprotein cholesterol (-6.90 mg/dL; 95% CI -11.81 to -1.99) and total cholesterol (-9.44 mg/dL; 95% CI -17.94 to -0.93) levels with modest effect size. However, there were no major differences in high-density lipoprotein cholesterol (-0.29 mg/dL; 95% CI -0.88 to 1.47) and triglycerides (-14.31 mg/dL; 95% CI -33.32 to 4.69). The overall quality of evidence based on Grading of Recommendations Assessment, Development and Evaluation was either "low" or "very low". CONCLUSION Available data are not adequate to make recommendations on the role of task sharing strategies for the management of dyslipidemia in LMICs. However, the studies conducted in LMICs demonstrate the potential use of this strategy especially in terms of reduction in low-density lipoprotein cholesterol and total cholesterol levels. Our review calls for the need of well-designed and large-scale studies to demonstrate the effect of task-sharing strategy on lipid management in LMICs.
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Affiliation(s)
- T N Anand
- Public Health Foundation of India, New Delhi, India
| | | | - A V Geetha
- Public Health Foundation of India, New Delhi, India
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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15
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Tsolekile LP, Schneider H, Puoane T. The roles, training and knowledge of community health workers about diabetes and hypertension in Khayelitsha, Cape Town. Curationis 2018; 41:e1-e8. [PMID: 29781697 PMCID: PMC6091590 DOI: 10.4102/curationis.v41i1.1815] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/05/2017] [Accepted: 12/21/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The current roles and capacity of community health workers (CHWs) in the management and control of non-communicable diseases (NCDs) remain poorly understood. OBJECTIVES To assess CHWs' current roles, training and knowledge about diabetes and hypertension in Khayelitsha, Cape Town. METHODS A cross-sectional study of 150 CHWs from two non-governmental organisations contracted to provide NCD care as part of a comprehensive package of services was conducted. An interviewer-administered closed-ended questionnaire was used to determine the roles, training, in-service support, knowledge and presence of NCDs. Descriptive analyses of these domains and multivariate analyses of the factors associated with CHWs' knowledge of hypertension and diabetes were conducted. RESULTS The vast majority (96%) of CHWs were female, with a mean age of 35 years; 88% had some secondary schooling and 53% had been employed as CHWs for 4 years or more. Nearly half (47%) reported having an NCD. CHWs' roles in NCDs included the delivery of medication, providing advice and physical assessment. Only 52% of CHWs reported some formal NCD-related training, while less than half of the trained CHWs (n = 35; 44%) had received follow-up refresher training. CHWs' knowledge of diabetes and hypertension was poor. In the multivariate analyses, higher knowledge scores were associated with having an NCD and frequency of supervisory contact (≥1 per month). CONCLUSIONS The roles performed by CHWs are broad, varied and essential for diabetes and hypertension management. However, basic knowledge about diabetes and hypertension remains poor while training is unstandardised and haphazard. These need to be improved if community-based NCD management is to be successful. The potential of peer education as a complementary mechanism to formal training needs as well as support and supervision in the workplace requires further exploration.
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16
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Kandasamy S, Anand SS. Cardiovascular Disease Among Women From Vulnerable Populations: A Review. Can J Cardiol 2018; 34:450-457. [PMID: 29571426 DOI: 10.1016/j.cjca.2018.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 12/14/2022] Open
Abstract
On a global scale, cardiovascular disease (CVD) is the leading cause of mortality. It is also the number 1 cause of death among women, resulting in 8.6 million deaths annually and constituting one third of all deaths in women worldwide. The burden of CVD and related risk factors has taken priority in the policy development for noncommunicable diseases. However, vulnerable populations, defined here as women who are socially or economically disadvantaged (eg, low income), nonwhite (specifically South Asian and indigenous women), and those who are elderly have often been overlooked in these discussions. These additional vulnerabilities, which may exist independently or in combination, place such women at higher risk for CVD. Specifically, these vulnerabilities include low socioeconomic status, a low sense of control, high stress, South Asian or indigenous ancestry, and increased age. Thus it is vital that we initiate a multipronged approach to CVD prevention that includes rigorous monitoring of CVD risk factors in high-risk populations and the implementation of timely, accurate, and contextually tailored prevention programs, services, and treatments. Well-trained nonphysician health care workers can support the accurate monitoring and management of CVD and CVD risk factors so that groups of women who may otherwise be overlooked can receive adequate attention.
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Affiliation(s)
- Sujane Kandasamy
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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17
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Abdel-All M, Putica B, Praveen D, Abimbola S, Joshi R. Effectiveness of community health worker training programmes for cardiovascular disease management in low-income and middle-income countries: a systematic review. BMJ Open 2017; 7:e015529. [PMID: 29101131 PMCID: PMC5695434 DOI: 10.1136/bmjopen-2016-015529] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs. METHODS A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project's Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers. RESULTS The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before-after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention. CONCLUSION The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.
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Affiliation(s)
- Marwa Abdel-All
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Putica
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Seye Abimbola
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rohina Joshi
- The George Institute for Global Health, Sydney, New South Wales, 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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Gottschlich A, Rivera-Andrade A, Grajeda E, Alvarez C, Mendoza Montano C, Meza R. Acceptability of Human Papillomavirus Self-Sampling for Cervical Cancer Screening in an Indigenous Community in Guatemala. J Glob Oncol 2017; 3:444-454. [PMID: 29094082 PMCID: PMC5646882 DOI: 10.1200/jgo.2016.005629] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Cervical cancer rates in Latin America are higher than those in developed countries, likely because of the lower prevalence of screening. Specifically, less than 40% of women in Guatemala are regularly screened and even fewer women are screened in indigenous communities. Current screening strategies-Pap smears and visual inspection with acetic acid-might not be the most effective methods for controlling cancer in these settings. We thus investigated the potential of self-collection of cervical samples with testing for human papillomavirus (HPV) to help prevent cervical cancer in an indigenous community in Guatemala. PATIENTS AND METHODS A community representative random sample of 202 indigenous women age 18 to 60 years residing in Santiago Atitlan, Guatemala, were surveyed to assess knowledge of and risk factors for HPV and cervical cancer. Women were then invited to self-collect a cervical sample using HerSwab collection kits to assess the prevalence of HPV and the acceptability of self-sampling. RESULTS Of 202 women who completed the survey, 178 (89%) provided a self-sample. In all, 79% of these women found the test comfortable, 91% found the test easy to use, and 100% reported they were willing to perform the test periodically as a screening method. Thirty-one samples (17%) were positive for at least one of 13 high-risk HPV types, and eight (4.5%) were positive for HPV 16/18. CONCLUSION HPV testing by using self-collected samples was well accepted, suggesting that it is a plausible modality for cervical cancer screening in indigenous communities. Further studies are needed to assess rates of follow-up after a positive test and to determine whether these findings extend to other indigenous and nonindigenous communities in Guatemala and Latin America.
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Affiliation(s)
- Anna Gottschlich
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Alvaro Rivera-Andrade
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Edwin Grajeda
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Christian Alvarez
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Carlos Mendoza Montano
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
| | - Rafael Meza
- Anna Gottschlich, Christian Alvarez, and Rafael Meza, University of Michigan, Ann Arbor, MI; Alvaro Rivera-Andrade and Carlos Mendoza Montano, Institute of Nutrition of Central America and Panama; Carlos Mendoza Montano, Universidad Mariano Galvez de Guatemala; Edwin Grajeda, Universidad Rafael Landivar, Guatemala City, Guatemala; and Alvaro Rivera-Andrade, The Hebrew University, Jerusalem, Israel
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Oikonomou E, Psaltopoulou T, Georgiopoulos G, Siasos G, Kokkou E, Antonopoulos A, Vogiatzi G, Tsalamandris S, Gennimata V, Papanikolaou A, Tousoulis D. Western Dietary Pattern Is Associated With Severe Coronary Artery Disease. Angiology 2017; 69:339-346. [DOI: 10.1177/0003319717721603] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The independent predictive value of an unhealthy diet on the severity of coronary artery disease (CAD) requires further investigation. We assessed the impact of dietary pattern on CAD severity. In this cohort study, we included 188 symptomatic stable patients with CAD. Patients were categorized as having severe CAD or nonsevere CAD by coronary angiography. Among several demographics and clinical characteristics, all patients were tested using a semiquantitative food frequency questionnaire. Concerning baseline demographic characteristics, there was no difference between patients with severe CAD and nonsevere CAD. Principal component analysis revealed 8 distinct dietary patterns. The first component Western dietary pattern (increased intake of fat, red meat, and carbohydrates and minimal consumption of fruits and green leafy vegetables) was predictive of severe CAD (area under the curve: 0.73, 95% confidence intervals: 0.64-0.83, P < .001). In conclusion, an unhealthy Western type of diet is associated with the severity of coronary artery lesions in patients with stable CAD. These findings highlight the role of dietary patterns when estimating cardiovascular risk for the management of patients with CAD.
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Affiliation(s)
- Evangelos Oikonomou
- First Department of Cardiology, “Hippokration” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- First Department of Cardiology, “Hippokration” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- First Department of Cardiology, “Hippokration” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleni Kokkou
- First Department of Cardiology, “Hippokration” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios Antonopoulos
- First Department of Cardiology, “Hippokration” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Vogiatzi
- First Department of Cardiology, “Hippokration” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsalamandris
- First Department of Cardiology, “Hippokration” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Gennimata
- First Department of Cardiology, “Hippokration” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aggelos Papanikolaou
- First Department of Cardiology, “Hippokration” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, “Hippokration” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Olaniran A, Smith H, Unkels R, Bar-Zeev S, van den Broek N. Who is a community health worker? - a systematic review of definitions. Glob Health Action 2017; 10:1272223. [PMID: 28222653 PMCID: PMC5328349 DOI: 10.1080/16549716.2017.1272223] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/22/2016] [Accepted: 12/08/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Community health workers (CHWs) can play vital roles in increasing coverage of basic health services. However, there is a need for a systematic categorisation of CHWs that will aid common understanding among policy makers, programme planners, and researchers. OBJECTIVE To identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers. DESIGN A systematic review of peer-reviewed papers and grey literature. RESULTS We identified 119 papers that provided definitions of CHWs in 25 countries across 7 regions. The review shows CHWs as paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community. CHWs can be categorised into three groups by education and pre-service training. These are lay health workers (individuals with little or no formal education who undergo a few days to a few weeks of informal training), level 1 paraprofessionals (individuals with some form of secondary education and subsequent informal training), and level 2 paraprofessionals (individuals with some form of secondary education and subsequent formal training lasting a few months to more than a year). Lay health workers tend to provide basic health services as unpaid volunteers while level 1 paraprofessionals often receive an allowance and level 2 paraprofessionals tend to be salaried. CONCLUSIONS This review provides a categorisation of CHWs that may be useful for health policy formulation, programme planning, and research.
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Affiliation(s)
- Abimbola Olaniran
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Smith
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Regine Unkels
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sarah Bar-Zeev
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Jeemon P, Narayanan G, Kondal D, Kahol K, Bharadwaj A, Purty A, Negi P, Ladhani S, Sanghvi J, Singh K, Kapoor D, Sobti N, Lall D, Manimunda S, Dwivedi S, Toteja G, Prabhakaran D. Task shifting of frontline community health workers for cardiovascular risk reduction: design and rationale of a cluster randomised controlled trial (DISHA study) in India. BMC Public Health 2016; 16:264. [PMID: 26975187 PMCID: PMC4791774 DOI: 10.1186/s12889-016-2891-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/18/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Effective task-shifting interventions targeted at reducing the global cardiovascular disease (CVD) epidemic in low and middle-income countries (LMICs) are urgently needed. METHODS DISHA is a cluster randomised controlled trial conducted across 10 sites (5 in phase 1 and 5 in phase 2) in India in 120 clusters. At each site, 12 clusters were randomly selected from a district. A cluster is defined as a small village with 250-300 households and well defined geographical boundaries. They were then randomly allocated to intervention and control clusters in a 1:1 allocation sequence. If any of the intervention and control clusters were <10 km apart, one was dropped and replaced with another randomly selected cluster from the same district. The study included a representative baseline cross-sectional survey, development of a structured intervention model, delivery of intervention for a minimum period of 18 months by trained frontline health workers (mainly Anganwadi workers and ASHA workers) and a post intervention survey in a representative sample. The study staff had no information on intervention allocation until the completion of the baseline survey. In order to ensure comparability of data across sites, the DISHA study follows a common protocol and manual of operation with standardized measurement techniques. DISCUSSION Our study is the largest community based cluster randomised trial in low and middle-income country settings designed to test the effectiveness of 'task shifting' interventions involving frontline health workers for cardiovascular risk reduction. TRIAL REGISTRATION CTRI/2013/10/004049 . Registered 7 October 2013.
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Affiliation(s)
- Panniyammakal Jeemon
- />Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Gitanjali Narayanan
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Dimple Kondal
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Kashvi Kahol
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Ashok Bharadwaj
- />Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh India
| | - Anil Purty
- />Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | | | - Jyoti Sanghvi
- />Sri Aurbindo Institute of Medical Sciences, Indore, India
| | - Kuldeep Singh
- />Sri Aurbindo Institute of Medical Sciences, Indore, India
| | - Deksha Kapoor
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Nidhi Sobti
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Dorothy Lall
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - Sathyaprakash Manimunda
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
- />National Centre for Disease Informatics and Research, ICMR, Bangalore, India
| | | | | | - Dorairaj Prabhakaran
- />Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
| | - On behalf of DISHA study investigators
- />Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
- />Centre for Chronic Disease Control, Sector 44, Plot 47, Gurgaon, Haryana India
- />Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh India
- />Pondicherry Institute of Medical Sciences, Puducherry, India
- />Indira Gandhi Medical College, Shimla, India
- />Aga Khan Health Services, Mumbai, India
- />Sri Aurbindo Institute of Medical Sciences, Indore, India
- />National Centre for Disease Informatics and Research, ICMR, Bangalore, India
- />Indian Council of Medical Research, New Delhi, India
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22
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S AG, Denman CA, Ta G, Ns L, T P. Challenges Facing Successful Scaling Up of Effective Screening for Cardiovascular Disease by Community Health Workers in Mexico and South Africa: Policy Implications. HEALTH SYSTEMS AND POLICY RESEARCH 2016; 3:26. [PMID: 27158629 PMCID: PMC4855872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The integration of community health workers (CHWs) into primary and secondary prevention functions in health programs and services delivery in Mexico and South Africa has been demonstrated to be effective. Task-sharing related to adherence and treatment, from nurses to CHWs, has also been effectively demonstrated in these areas. HIV/AIDS and TB programs in South Africa have seen similar successes in task-sharing with CHWs in the areas of screening for risk and adherence to treatment. In the area of non-communicable diseases (NCDs), there is a policy commitment to integrating CHWs into primary health care programs at public health facilities in both Mexico and South Africa in the areas of reproductive health and infant health. Yet current programs utilizing CHWs are not integrated into existing primary health care services in a comprehensive manner for primary and secondary prevention of NCDs. In a recently completed study, CHWs were trained to perform the basic diagnostic function of primary screening to assess the risk of suffering a CVD-related event in the community using a non-laboratory risk assessment tool and referring persons at moderate to high risk to local government clinics, for further assessment and management by a nurse or physician. In this paper we compare the experience with this CVD screening study to successful programs in vaccination, reproductive health, HIV/AIDS, and TB specifically to identify the barriers we identified as limitations to replicating these programs in the area of CVD diagnosis and management. We review barriers impacting the effective translation of policy into practice, including scale up issues; training and certification issues; integrating CHW to existing primary care teams and health system; funding and resource gaps. Finally, we suggest policy recommendations to replicate the demonstrated success of programs utilizing task-sharing with CHWs in infectious diseases and reproductive health, to integrated programs in NCD.
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Affiliation(s)
- Abrahams-Gessel S
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - C A Denman
- Center for Health and Society Studies, El Colegio de Sonora, Sonora, Mexico
| | - Gaziano Ta
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Levitt Ns
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Private Bag x3, Observatory 7935, Cape Town, South Africa
| | - Puoane T
- School of Public Health, University of the Western Cape, South Africa
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Engelgau MM, Sampson UK, Rabadan-Diehl C, Smith R, Miranda J, Bloomfield GS, Belis D, Narayan KMV. Tackling NCD in LMIC: Achievements and Lessons Learned From the NHLBI-UnitedHealth Global Health Centers of Excellence Program. Glob Heart 2016; 11:5-15. [PMID: 27102018 PMCID: PMC4843818 DOI: 10.1016/j.gheart.2015.12.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 01/14/2023] Open
Abstract
Effectively tackling the growing noncommunicable disease (NCD) burden in low- and middle-income countries (LMIC) is a major challenge. To address research needs in this setting for NCDs, in 2009, National Heart, Lung, and Blood Institute (NHLBI) and UnitedHealth Group (UHG) engaged in a public-private partnership that supported a network of 11 LMIC-based research centers and created the NHLBI-UnitedHealth Global Health Centers of Excellence (COE) Program. The Program's overall goal was to contribute to reducing the cardiovascular and lung disease burdens by catalyzing in-country research institutions to develop a global network of biomedical research centers. Key elements of the Program included team science and collaborative approaches, developing research and training platforms for future investigators, and creating a data commons. This Program embraced a strategic approach for tackling NCDs in LMICs and will provide capacity for locally driven research efforts that can identify and address priority health issues in specific countries' settings.
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Affiliation(s)
- Michael M Engelgau
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Uchechukwu K Sampson
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cristina Rabadan-Diehl
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Richard Smith
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jaime Miranda
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gerald S Bloomfield
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Deshiree Belis
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - K M Venkat Narayan
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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24
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Implementation research: an imperative for improving global health and health inequities. Glob Heart 2015; 10:1-2. [PMID: 25754560 DOI: 10.1016/j.gheart.2014.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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25
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Levitt NS, Puoane T, Denman CA, Abrahams-Gessel S, Surka S, Mendoza C, Khanam M, Alam S, Gaziano TA. Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa. Glob Health Action 2015; 8:26318. [PMID: 25854780 PMCID: PMC4390559 DOI: 10.3402/gha.v8.26318] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 11/14/2022] Open
Abstract
Background We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management. Design Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained. Results Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system. Conclusions The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment.
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Affiliation(s)
- Naomi S Levitt
- Chronic Disease Initiative for Africa, Cape Town, South Africa.,Division of Endocrinology and Diabetes, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Thandi Puoane
- Chronic Disease Initiative for Africa, Cape Town, South Africa.,School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Catalina A Denman
- Centro de Estudios en Salud y Sociedad, El Colegio de Sonora, Mexico
| | - Shafika Abrahams-Gessel
- Brigham & Women's Hospital, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| | - Sam Surka
- Chronic Disease Initiative for Africa, Cape Town, South Africa;
| | - Carlos Mendoza
- Institute of Nutrition of Central America and Panama (INCAP), Ciudad de Guatemala, Guatemala
| | - Masuma Khanam
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Chronic Non-Communicable Disease Unit, International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sartaj Alam
- Brigham & Women's Hospital, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| | - Thomas A Gaziano
- Brigham & Women's Hospital, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
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