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Deguma JJ. Catalyzing wellness and well-being: the undervalued role of Barangay health workers as informal caregivers in the Philippines. J Public Health (Oxf) 2024; 46:e351-e352. [PMID: 38102954 DOI: 10.1093/pubmed/fdad268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Indexed: 12/17/2023] Open
Affiliation(s)
- Jabin J Deguma
- College of Education, Cebu Technological University, Cebu City 6000, Philippines
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Simpson AN, Baxter NN, Sorvari A, Boury H, Shore EM, Bogler T, Campbell D, Gagliardi AR. Strategies to support maternal and early childhood wellness: insight from parent and provider qualitative interviews during the COVID-19 pandemic. BMJ Open 2024; 14:e079479. [PMID: 38272559 PMCID: PMC10824034 DOI: 10.1136/bmjopen-2023-079479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic resulted in rapid changes to the delivery of maternal and newborn care. Our aim was to gain an understanding from parents and healthcare professionals (HCPs) of how the pandemic and associated public health restrictions impacted the peripartum and postpartum experience, as well as longer-term health and well-being of families. DESIGN Qualitative study through focus groups. SETTING Ontario, Canada. PARTICIPANTS HCPs and parents who had a child born during the COVID-19 pandemic. INTERVENTIONS Semistructured interview guide, with questions focused on how the pandemic impacted their care/their ability to provide care, and strategies to improve care and support now or in future situations with similar healthcare restrictions. OUTCOME MEASURES Thematic analysis was used to describe participant experiences and recommendations. RESULTS We included 11 HCPs and 15 parents in 6 focus groups. Participants described their experiences as 'traumatic', with difficulties in accessing prenatal and postpartum services, and feelings of distress and isolation. They also noted delays in speech and development in children born during the pandemic. Key recommendations included the provision of partner accompaniment throughout the course of care, expansion of available services for young families (particularly postpartum), and special considerations for marginalised groups, including access to technology for virtual care or the option of in-person visits. CONCLUSIONS Our findings may inform the development of healthcare system and organisational policies to ensure the provision of maternal and newborn care in the event of future public health emergencies. Of primary importance to the participants was the accommodation of antenatal, intrapartum and postpartum partner accompaniment, and the provision of postpartum services.
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Affiliation(s)
- Andrea N Simpson
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Nancy N Baxter
- The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Anne Sorvari
- St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Himani Boury
- Toronto General Hospital, Toronto, Ontario, Canada
| | - Eliane M Shore
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Tali Bogler
- St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, University of Toronto, Toronto, ON, Canada
| | - Douglas Campbell
- St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Collins CC, Shediac-Rizkallah M, Dolata J, Hood E, Nonguierma E, Thornton D. "They should've talked to us more": lay health advisors' experiences with community-engaged hypertension research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:11. [PMID: 38273412 PMCID: PMC10809536 DOI: 10.1186/s40900-024-00544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Lay health advisors (LHAs) are increasingly being used to increase patient and public involvement in research, disseminate health information, and work toward preventing health disparities within communities at risk. This research explored LHAs' experiences with training and recruiting for a hypertension research project which ended due to minimal enrollment. METHODS The methodological design was qualitative description. One face-to-face semi-structured focus group was held with eight African American LHAs in Cleveland, Ohio, in the fall of 2019. The focus group was digitally recorded and transcribed by a professional transcriptionist and thematically analyzed. RESULTS Trainees reflected on how much they learned from the training and described feeling passionate and excited about their community work for the project. We identified three key themes from the data: (1) Systemic and Institutional Factors Affected LHAs' Experiences (subthemes: Unnecessarily Burdensome Requirements and Exploitation of Community Members for Research Gain; (2) Feeling Used Yet Unseen: Exclusion from Decision-Making Processes; (3) Worrying that Project Termination Damaged their Reputation; and (4) Disengaging from Research. We share lessons learned, including the need for LHAs' expertise to be integrated into research studies, and for projects to establish clear communication and expectations regarding research rigor and requirements. CONCLUSION Our results have implications for future studies attempting to build equitable and strong academic-community relationships to yield rigorous and useful research to reduce health disparities.
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Affiliation(s)
- Cyleste C Collins
- School of Social Work, Cleveland State University, 2121 Euclid Ave, RT 1438, Cleveland, 44115, OH, USA.
| | - Mona Shediac-Rizkallah
- Center For Health Equity, Engagement, Education, and Research, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Jacqueline Dolata
- Population Health Institute, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | | | - Elodie Nonguierma
- Center For Health Equity, Engagement, Education, and Research, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Daryl Thornton
- Center For Health Equity, Engagement, Education, and Research, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
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Silva M, Spielman K, Dougherty L, Kassegne S, Kalamar A. Results From a Multimethod Exploratory Scale Development Process to Measure Authoritarian Provider Attitudes in Democratic Republic of Congo and Togo. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200421. [PMID: 38035720 DOI: 10.9745/ghsp-d-22-00421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 07/17/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Health care providers' actions can significantly influence clients' experiences of care, adherence to recommendations, and likelihood of re-engaging with health services. There are currently no validated scales that measure provider attitudes that could affect service delivery in multiple health areas. METHODS We developed provider attitude measures in 3 phases. In phase 1 (2019), survey items were developed based on literature reviews, and quantitative items were tested through a health facility survey conducted in the Democratic Republic of the Congo (DRC). Health care providers (N=1,143) completed a 23-question survey focused on 3 subdomains: provider perceptions of clients, provider roles, and gender roles. In phase 2 (2021), cognitive interviews were administered to 17 health care providers in DRC to assess and improve respondents' understanding and interpretation of questionnaire items and response options. In phase 3 (2021), 52 family planning providers were sampled from urban health facilities in Togo to retest and validate the improved measures. RESULTS Phase 1 showed the provider attitude items had low scale reliability, and 8 survey items had low variability. In phase 2, results from the cognitive interviews of the 21 items retained from phase 1 found 16 questions were not well understood or had low response variability and thus modified, and 4 survey items were added to test different iterations of specific survey items. In phase 3, exploratory factor analysis resulted in 1 provider attitude scale of 14 items reflecting authoritarian attitudes related to the 3 initial subdomains. CONCLUSION This research highlights the importance of iteration and testing during scale development, implementable even across geographic locations. Provider behavior change programming should consider how authoritarian provider attitudes pertaining to professional roles, their clients, and gender norms may interact and influence the quality of health services provided.
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Affiliation(s)
- Martha Silva
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Kathryn Spielman
- Population Council, Washington, DC, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Wagner J, Barth C, Bermúdez-Millán A, Buxton OM, Kong S, Kuoch T, Lampert R, Pérez-Escamilla R, Scully M, Segura-Pérez S. Lay health worker research personnel for home-based data collection in clinical and translational research: Qualitative and quantitative findings from two trials in hard-to-reach populations. J Clin Transl Sci 2023; 7:e228. [PMID: 38028343 PMCID: PMC10643917 DOI: 10.1017/cts.2023.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/16/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Aims The role of lay health workers in data collection for clinical and translational research studies is not well described. We explored lay health workers as data collectors in clinical and translational research studies. We also present several methods for examining their work, i.e., qualitative interviews, fidelity checklists, and rates of unusable/missing data. Methods We conducted 2 randomized, controlled trials that employed lay health research personnel (LHR) who were employed by community-based organizations. In one study, n = 3 Latina LHRs worked with n = 107 Latino diabetic participants. In another study, n = 6 LHR worked with n = 188 Cambodian American refugees with depression. We investigated proficiency in biological, behavioral, and psychosocial home-based data collection conducted by LHR. We also conducted in-depth interviews with lay LHR to explore their experience in this research role. Finally, we described the training, supervision, and collaboration for LHR to be successful in their research role. Results Independent observers reported a very high degree of fidelity to technical data collection protocols (>95%) and low rates of missing/unusable data (1.5%-11%). Qualitative results show that trust, training, communication, and supervision are key and that LHR report feeling empowered by their role. LHR training included various content areas over several weeks with special attention to LHR and participant safety. Training and supervision from both the academic researchers and the staff at the community-based organizations were necessary and had to be well-coordinated. Conclusions Carefully selected, trained, and supervised LHRs can collect sophisticated data for community-based clinical and translational research.
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Affiliation(s)
| | - Cheryl Barth
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Sengly Kong
- Khmer Health Advocates, West Hartford, CT, USA
| | | | | | | | - Mary Scully
- Khmer Health Advocates, West Hartford, CT, USA
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Meredith E, O'Donovan J, Errington L, Mathur M, Hamilton D. The role of community healthcare workers in head and neck cancer: A systematic scoping review of the literature. Glob Public Health 2022; 17:3283-3302. [PMID: 35298354 DOI: 10.1080/17441692.2022.2049847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It is estimated that Head and Neck Cancer (HNC) will cause over 500,000 deaths worldwide by 2030. This is coupled with a shortage of trained healthcare professionals to manage HNC. An alternative cadre of workers - community healthcare workers (CHWs) - could be deployed to address this shortage. A systematic scoping review was conducted. Seven major databases were searched from inception to 30 June 2021. Studies were included from across the globe and excluded if the focus was not on HNC or CHWs. We identified 13 studies for inclusion. Twelve were based in India. CHWs were deployed in education and awareness raising initiatives, community screening, and ensuring compliance with treatment and follow-up. CHWs were compared to specialists for effectiveness in four studies with one reporting sensitivity of 94·3% and specificity 99·3% for HNC screening. This review highlights ways in which CHWs can be deployed to meet the growing demand for HNC services. The existing evidence suggests that CHWs can have potential roles in screening for HNC, therefore facilitating an earlier diagnosis. It is important this screening is implemented where there is appropriate capacity to manage HNC. Further research needs to be carried out to explore barriers and facilitators to these programmes.
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Affiliation(s)
- Ellen Meredith
- Newcastle Upon Tyne Hospital Trust, ENT Department, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Linda Errington
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Manu Mathur
- Public Health Foundation of India, Gurugram, India
| | - David Hamilton
- ENT Department, Freeman Hospital, Newcastle upon Tyne, UK
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O'Donovan J, Saul Namanda A, Hamala R. Exploring supervision for volunteer community health workers in Mukono District, Uganda: An exploratory mixed-methods study. Glob Public Health 2021; 17:1958-1972. [PMID: 34459360 DOI: 10.1080/17441692.2021.1969671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Community Health Worker (CHW) supervision is an under-researched area. This mixed-methods study engaged key stakeholders involved in CHW supervision in Mukono District, Uganda including CHWs (n = 14), District Health Office officials (n = 5), NGO programme managers (n = 3) and facility-based health staff (n = 3). Our study aimed to explore how supervision is currently conceptualised and delivered in this setting, the desired qualities of a potential supervisor, as well as the challenges regarding supervision and potential solutions to address these. To understand these concepts, we conducted structured surveys and individual interviews. Survey data were analysed in SPSS using descriptive statistics. Interview transcripts were thematically analysed in NVivo using conventional content analysis. This study revealed current CHW supervision in this context is fragmented. Supervision is perceived both as a means of motivating CHWs and facilitating ongoing training, as well as a way of holding CHWs accountable for their work. Stakeholders identified technical knowledge and expertise, strong interpersonal skills and cultural awareness as desirable qualities for a supervisor. Challenges surrounding supervision included a shortage of funding, a lack of guidelines on supervision, and infrequent supervision. To address these challenges, stakeholders proposed the need for increased funding, creating clearer job descriptions for supervisors, and in-person supervisory meetings.
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Affiliation(s)
- James O'Donovan
- Learning and New Technologies Research Group, Department of Education, University of Oxford, Oxford, UK.,Division of Research and Health Equity, Omni Med, Mukono, Uganda
| | | | - Rebecca Hamala
- Division of Research and Health Equity, Omni Med, Mukono, Uganda
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Lee KT, Zale AD, Ibe CA, Johnston FM. Patient Navigator and Community Health Worker Attitudes Toward End-of-Life Care. J Palliat Med 2021; 24:1714-1720. [PMID: 34403597 DOI: 10.1089/jpm.2021.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: There are racial/ethnic disparities in hospice use and end-of-life (EOL) care outcomes in the United States. Although the use of community health workers (CHWs) and patient navigators (PNs) has been suggested as a means of reducing them, CHW/PNs' attitudes toward a palliative care philosophy remain unknown. The purpose of this study was to examine how personal attributes affect a CHW/PN's attitude toward EOL care. Methods: CHWs/PNs were recruited from two state-wide organizations and invited to complete an online survey. We collected information on demographics, attitudes toward the palliative care philosophy, and comfort with caring for patients at the EOL. Results: Of the 70 CHWs/PNs who responded to the survey, 82.5% identified as female, 56.4% identified as black, and 56.2% had a four-year college degree or higher. The mean score on a validated scale to assess attitudes toward EOL care was 33.5 (SD = 4.9; possible range, 8-40). Eighty percent strongly agreed or agreed with being open to discussing death with a dying patient. Higher self-efficacy scores were associated with more favorable attitudes toward hospice (r = 0.306, p = 0.016). Conclusions: CHWs/PNs have an overall favorable attitude toward the palliative care philosophy and may be inclined to providing EOL care.
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Affiliation(s)
- Kimberley T Lee
- Moffitt Cancer Center, Departments of Breast Oncology and Health Outcomes and Behavior, Tampa, Florida, USA.,Johns Hopkins University, School of Medicine, Department of Oncology, Baltimore, Maryland, USA
| | - Andrew D Zale
- Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Chidinma A Ibe
- Johns Hopkins University, School of Medicine, Department of Internal Medicine, Baltimore, Maryland, USA
| | - Fabian M Johnston
- Johns Hopkins University, School of Medicine, Department of Surgery, Baltimore, Maryland, USA
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Thomas LS, Buch E, Pillay Y. An analysis of the services provided by community health workers within an urban district in South Africa: a key contribution towards universal access to care. HUMAN RESOURCES FOR HEALTH 2021; 19:22. [PMID: 33602255 PMCID: PMC7889710 DOI: 10.1186/s12960-021-00565-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/08/2021] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Community health worker teams are potential game-changers in ensuring access to care in vulnerable communities. Who are they? What do they actually do? Can they help South Africa realize universal health coverage? As the proactive arm of the health services, community health workers teams provide household and community education, early screening, tracing and referrals for a range of health and social services. There is little local or global evidence on the household services provided by such teams, beyond specific disease-oriented activities such as for HIV and TB. This paper seeks to address this gap. METHODS Descriptive secondary data analysis of community health worker team activities in the Ekurhuleni health district, South Africa covering approximately 280,000 households with 1 million people. RESULTS Study findings illustrated that community health workers in these teams provided early screening and referrals for pregnant women and children under five. They distributed condoms and chronic medication to homes. They screened and referred for hypertension, diabetes mellitus, HIV and TB. The teams also undertook defaulter and contact tracing, the majority of which was for HIV and TB clients. Psychosocial support provided was in the form of access to social grants, access to child and gender-based violence protection services, food parcels and other services. CONCLUSION Community health workers form the core of these teams and perform several health and psychosocial services in households and poor communities in South Africa, in addition to general health education. The teams studied provided a range of activities across many health conditions (mother and child related, HIV and TB, non-communicable diseases), as well as social services. These teams provided comprehensive care in a large-scale urban setting and can improve access to care.
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Affiliation(s)
- L. S. Thomas
- Gauteng Department of Health, School of Health Systems and Public Health, University of Pretoria, and School of Public Health, University of Witwatersrand, Gauteng, South Africa
| | - E. Buch
- School of Health Systems and Public Health, University of Pretoria and Colleges of Medicine, Gauteng, South Africa
| | - Y. Pillay
- Formerly National Department of Health, Pretoria, South Africa
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Bunn M, Gonzalez N, Falek I, Weine S, Acri M. Supporting and Sustaining Nonspecialists to Deliver Mental Health Interventions in Low- and Middle-Income Countries: An Umbrella Review. INTERVENTION 2021. [DOI: 10.4103/intv.intv_47_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Conte KP, Gwynn J, Turner N, Koller C, Gillham KE. Making space for Aboriginal and Torres Strait Islander community health workers in health promotion. Health Promot Int 2020; 35:562-574. [PMID: 31155649 PMCID: PMC7307184 DOI: 10.1093/heapro/daz035] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite a clear need, 'closing the gap' in health disparities for Aboriginal and Torres Strait Islander communities (hereafter, respectfully referred to as Aboriginal) continues to be challenging for western health care systems. Globally, community health workers (CHWs) have proven effective in empowering communities and improving culturally appropriate health services. The global literature on CHWs reflects a lack of differentiation between the types of roles these workers carry out. This in turn impedes evidence syntheses informing how different roles contribute to improving health outcomes. Indigenous CHW roles in Australia are largely operationalized by Aboriginal Health Workers (AHWs)-a role situated primarily within the clinical health system. In this commentary, we consider whether the focus on creating professional AHW roles, although important, has taken attention away from the benefits of other types of CHW roles particularly in community-based health promotion. We draw on the global literature to illustrate the need for an Aboriginal CHW role in health promotion; one that is distinct from, but complementary to, that of AHWs in clinical settings. We provide examples of barriers encountered in developing such a role based on our experiences of employing Aboriginal health promoters to deliver evidence-based programmes in rural and remote communities. We aim to draw attention to the systemic and institutional barriers that persist in denying innovative employment and engagement opportunities for Aboriginal people in health.
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Affiliation(s)
- Kathleen P Conte
- University Centre for Rural Health and the Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Level 2, Charles Perkins Centre, University of Sydney, NSW 2006, Australia
| | - Josephine Gwynn
- Faculty of Health Sciences and the Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Nicole Turner
- University of Canberra, Canberra, Australia
- Rural Doctors Network, New South Wales, Australia
| | - Claudia Koller
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Karen E Gillham
- Population Health, Hunter New England Local Health District, Wallsend, Australia
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MacRae MC, Fazal O, O'Donovan J. Community health workers in palliative care provision in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Glob Health 2020; 5:e002368. [PMID: 32457030 PMCID: PMC7252978 DOI: 10.1136/bmjgh-2020-002368] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Community health workers (CHWs) are currently deployed in improving access to palliative care in a limited number of low-income or middle-income countries (LMICs). This review therefore aimed to document evidence from LMICs regarding (1) where and how CHWs are currently deployed in palliative care delivery, (2) the methods used to train and support CHWs in this domain, (3) the evidence surrounding the costs attached with deploying CHWs in palliative care provision and (4) challenges and barriers to this approach. METHODS We conducted a systematic scoping review of the literature, adhering to established guidelines. 11 major databases were searched for literature published between 1978 and 2019, as well as the grey literature. FINDINGS 13 original studies were included, all of which were conducted in sub-Saharan African countries (n=10) or in India (n=3). Ten described a role for CHWs in adult palliative care services, while three described paediatric services. Roles for CHWs include raising awareness and identifying individuals requiring palliative care in the community, therapeutic management for pain, holistic home-based care and visitation, and provision of psychological support and spiritual guidance. Reports on training context, duration and outcomes were variable. No studies conducted a formal cost analysis. Challenges to this approach include training design and sustainability; CHW recruitment, retention and support; and stigma surrounding palliative care. CONCLUSION Despite relatively limited existing evidence, CHWs have important roles in the delivery of palliative care services in LMIC settings. There is a need for a greater number of studies from different geographical contexts to further explore the effectiveness of this approach.
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Affiliation(s)
| | - Owais Fazal
- Division of Research, Rice University, Houston, Texas, USA
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Conte KP, Held F, Pipitone O, Bowman S. The Feasibility of Recruiting and Training Lay Leaders During Real-World Program Delivery and Scale-up: The Case of Walk With Ease. Health Promot Pract 2019; 22:91-101. [PMID: 30971154 DOI: 10.1177/1524839919840004] [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: 11/17/2022]
Abstract
Introduction. To maximize limited resources, many health promotion programs are designed to be delivered by volunteer lay leaders. But this model poses challenges to implementation in real-world settings and barriers to successfully scaling-up programs. This study examines the current lay leader training model for Walk With Ease, a Centers for Disease Control and Prevention-funded evidence-based arthritis program delivered at-scale. Method. Recruited volunteers (n = 106) opted into free online or in-person training and agreed to deliver one Walk With Ease program within the following year-only 49%, however, did. Using logistic regression models and qualitative interviews, we explored predictors of volunteer delivery. Results. Volunteers had higher odds of delivering programs if they trained online (odds ratio [OR] = 9.04, 95% confidence interval [CI: 2.30, 48.36]), previously taught health programs (OR = 15.52, 95% CI [3.51, 103.55]) or trained in the second year of implementation (OR = 27.08, 95% CI [2.63, 415.78]). Qualitative findings underscored that successful volunteers were readied by their previous health education experience. Conclusions. While online training modes appear effective to prepare experienced volunteers, lay leaders required additional support. This calls into question whether lay-led delivery models are suitable for scaling-up programs with limited resources. Given the many lay-led health interventions for chronic disease self-management, investing in common training and infrastructures for lay leader development could advance the quality and sustainability of real-world program delivery.
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Affiliation(s)
| | - Fabian Held
- University of Sydney, Sydney, New South Wales, Australia
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