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Carboni C, Maroto IJ, Galindo M, Plessis L, Lambert Y, Bardon T, Vreden S, Suárez-Mutis M, Bordalo JM, Douine M, Sanna A. Training-of-trainers program for community health workers involved in an innovative and community-based intervention against malaria among goldminers in the Guiana shield: a quality and effectiveness evaluation. Front Public Health 2024; 11:1306432. [PMID: 38259795 PMCID: PMC10800722 DOI: 10.3389/fpubh.2023.1306432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction An innovative and community-based intervention is implemented in the Guiana Shield to eliminate malaria among people involved in artisanal and small-scale gold mining. The intervention consists of the distribution of malaria self-management kits to goldminers and the presumptive treatment for individuals at risk of carrying Plasmodium vivax hypnozoites. The intervention is possible owing to community health workers (CHWs) who are previously trained to master all intervention procedures, including health education activities and goldmining training. This study aimed to evaluate the training program provided to CHWs in terms of quality and effectiveness. Methods A training-of-trainers program for CHWs has been developed based on the CDC framework. A mixed-method case study was implemented in two steps between February and March 2023. The evaluation was based on a knowledge survey, satisfaction test, observations, and semi-structured interviews. Quantitative and qualitative data were analyzed and triangulated. Results A total of 20 CHWs participated in the training and the first-step evaluation. For the second step, four semi-structured interviews were conducted. The Qualitative data showed that group dynamics and adaptations were central elements of a high-quality training program. Quantitative analysis found that CHWs' satisfaction was elevated (> 4/5 overall), especially regarding format and learning results. Improvements in knowledge level demonstrated good effectiveness (pre-training vs. post-training, p < 0.05). Nevertheless, some difficulties persisted regarding tasks of the intervention procedure, such as informed consent and smartphone application procedures (with an inaccuracy rate of 29.2% and 16.7%, respectively). Further on-the-job training permitted to address these issues. The project team's previous experience and the Guiana Shield countries' commitment to the WHO-E-2025-initiative were identified as levers for the quality of the training, while the complexity of the project context was a challenge. Discussion High-quality, effective, and appropriate training programs are required for effective and sustainable interventions involving CHW profiles. Training design is a crucial point to address to accomplish quality and effectiveness. The training-of-trainers model has been shown to allow a high level of satisfaction, good learning results, and satisfactory implementation in the field. Initial and continuing training is an indispensable continuum to sustain good practices in the field and CHWs' motivation. Training evaluation permits standardizing methods and facilitates transferability.
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Affiliation(s)
- Carlotta Carboni
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Irene Jimeno Maroto
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Muriel Galindo
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Lorraine Plessis
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Yann Lambert
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Teddy Bardon
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Stephen Vreden
- Foundation for the Advancement of Scientific Research in Suriname (SWOS), Paramaribo, Suriname
| | - Martha Suárez-Mutis
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | | | - Maylis Douine
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Alice Sanna
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
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Ndu M, Andoniou E, McNally S, Olea Popelka F, Tippett M, Nouvet E. The experiences and challenges of community health volunteers as agents for behaviour change programming in Africa: a scoping review. Glob Health Action 2022; 15:2138117. [PMID: 36314363 PMCID: PMC9629118 DOI: 10.1080/16549716.2022.2138117] [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] [Indexed: 11/04/2022] Open
Abstract
Community health volunteers are considered a vital part of the community health structure in Africa. Despite this vital role in African health systems, very little is known about the community health volunteers’ day-to-day lived experiences providing services in communities and supporting other health workers. This scoping review aims to advance understanding of the day-to-day experiences of community health volunteers in Africa. In doing so, this review draws attention to these under-considered actors in African health systems and identifies critical factors and conditions that represent challenges to community health volunteers’ work in this context. Ultimately, our goal is to provide a synthesis of key challenges and considerations that can inform efforts to reduce attrition and improve the sustainability of community health volunteers in Africa. This scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews checklist to achieve the objectives. A comprehensive search of six databases returned 2140 sources. After screening, 31 peer-reviewed studies were selected for final review. Analytical themes were generated based on the reviewers’ extraction of article data into descriptive themes using an inductive approach. In reviewing community health volunteers’ accounts of providing health services, five key challenges become apparent. These are: (1) challenges balancing work responsibilities with family obligations; (2) resource limitations; (3) exposure to stigma and harassment; (4) gendered benefits and risks; and (5) health-system level challenges. This scoping review highlights the extent of challenges community health volunteers must navigate to provide services in communities. Sustained commitment at the national and international level to understand the lived experiences of community health volunteers and mitigate common stressors these health actors face could improve their performance and inform future programs.
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Affiliation(s)
- Mary Ndu
- Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Ellena Andoniou
- Faculty of Health Science, Western University, London, ON, Canada
| | - Sorcha McNally
- Faculty of Health Science, Western University, London, ON, Canada
| | - Francisco Olea Popelka
- Department of Pathology and Laboratory Medicine, Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Marisa Tippett
- Research & Scholarly Communications Librarian, Western Libraries, Western University, London, ON, Canada
| | - Elysée Nouvet
- Faculty of Health Science, Western University, London, ON, Canada
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Puchalski Ritchie LM, Kip EC, Mundeva H, van Lettow M, Makwakwa A, Straus SE, Hamid JS, Zwarenstein M, Schull MJ, Chan AK, Martiniuk A, van Schoor V. Process evaluation of an implementation strategy to support uptake of a tuberculosis treatment adherence intervention to improve TB care and outcomes in Malawi. BMJ Open 2021; 11:e048499. [PMID: 34215610 PMCID: PMC8256754 DOI: 10.1136/bmjopen-2020-048499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess implementation and to identify barriers and facilitators to implementation, sustainability and scalability of an implementation strategy to provide lay health workers (LHWs) with the knowledge, skills and tools needed to implement an intervention to support patient tuberculosis (TB) treatment adherence. DESIGN Mixed-methods design including a cluster randomised controlled trial and process evaluation informed by the RE-AIM framework. SETTING Forty-five health centres (HCs) in four districts in the south east zone of Malawi, who had an opportunity to receive cascade training. PARTICIPANTS Forty-five peer-trainers (PTs), 23 patients and 20 LHWs. INTERVENTION Implementation strategy employing peer-led educational outreach, a clinical support tool and peer support network to implement a TB treatment adherence intervention. OUTCOME MEASURES Process data were collected from study initiation to the end-of-study PT meeting, and included: LHW and patient interviews, quarterly PT meeting notes, training logs and study team observations and meeting notes. Data sources were first analysed in isolation, followed by method, data source and analyst triangulation. Analyses were conducted independently by two study team members, and themes revised through discussion and involvement of additional study team members as needed. RESULTS Forty-one HCs (91%) trained at least one LHW. Of 256 LHWs eligible to participate at study start 152 (59%) completed training, with the proportion trained per HC ranging from 0% to 100% at the end of initial cascade training. Lack of training incentives was the primary barrier to implementation, with intrinsic motivation to improve knowledge and skills, and to improve patient care and outcomes the primary facilitators of participation. CONCLUSION We identified important challenges to and potential facilitators of implementation, scalability and sustainability, of the TB treatment adherence intervention. Findings provide guidance to scale-up, and use of the implementation strategies employed, to address LHW training and supervision in other areas. TRIAL REGISTRATION NUMBER NCT02533089.
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Affiliation(s)
- Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Knowledge Translation Program, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Emergency Medicine, University Health Netowrk, Toronto, Ontario, Canada
- Institute of Health policy, management, and evaluation, university of toronto, toronto, ontario, canada
| | | | - Hayley Mundeva
- Knowledge Translation Program, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Monique van Lettow
- Dignitas International, Zomba, Malawi
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | | | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Knowledge Translation Program, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Jemila S Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, Canada
| | - Merrick Zwarenstein
- Family Medicine, Schulich School of Medicine and Dentistry Department of Family Medicine, London, Ontario, Canada
| | - Michael J Schull
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Adrienne K Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alexandra Martiniuk
- The George Institute for Global Health, Newtown, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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Puchalski Ritchie LM, van Lettow M, Makwakwa A, Kip EC, Straus SE, Kawonga H, Hamid JS, Lebovic G, Thorpe KE, Zwarenstein M, Schull MJ, Chan AK, Martiniuk A, van Schoor V. Impact of a tuberculosis treatment adherence intervention versus usual care on treatment completion rates: results of a pragmatic cluster randomized controlled trial. Implement Sci 2020; 15:107. [PMID: 33308257 PMCID: PMC7731739 DOI: 10.1186/s13012-020-01067-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 12/01/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND With the global shortage of skilled health workers estimated at 7.2 million, outpatient tuberculosis (TB) care is commonly task-shifted to lay health workers (LHWs) in many low- and middle-income countries where the shortages are greatest. While shown to improve access to care and some health outcomes including TB treatment outcomes, lack of training and supervision limit the effectiveness of LHW programs. Our objective was to refine and evaluate an intervention designed to address common causes of non-adherence to TB treatment and LHW knowledge and skills training needs. METHODS We employed a pragmatic cluster randomized controlled trial. Participants included 103 health centres (HCs) providing TB care in four districts in Malawi, randomized 1:1 stratified by district and HC funding (Ministry of Health, non-Ministry funded). At intervention HCs, a TB treatment adherence intervention was implemented using educational outreach, a point-of-care reminder tool, and a peer support network. Clusters in the control arm provided usual care. The primary outcome was the proportion of patients with successful TB treatment (i.e., cure or treatment completion). We used a generalized linear mixed model, with district as a fixed effect and HC as a random effect, to compare proportions of patients with treatment success, among the trial arms, with adjustment for baseline differences. RESULTS We randomized 51 HCs to the intervention group and 52 HCs to the control group. Four intervention and six control HCs accrued no eligible patients, and 371 of 1169 patients had missing outcome, HC, or demographic data, which left 74 HCs and 798 patients for analysis. Randomization group was not related to missing outcome, however, district, age, and TB type were significantly related and included in the primary analysis model. Among the 1153 patients with HC and demographic data, 297/605 (49%) and 348/548 (64%) in the intervention and control arms, respectively, had treatment success. The intervention had no significant effect on treatment success (adjusted odds ratio 1.35 [95% confidence interval 0.93-1.98]). CONCLUSION We found no significant effect of the intervention on TB treatment outcomes with high variability in implementation quality, highlighting important challenges to both scale-up and sustainability. TRIAL REGISTRATION ClinicalTrials.gov NCT02533089 . Registered August 20, 2015.
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Affiliation(s)
- Lisa M. Puchalski Ritchie
- Department of Medicine, University of Toronto, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2 Canada
- Li Ka Shing Knowledge Institute, St. Michaels Hospital, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8 Canada
- Department of Emergency Medicine, University Health Network, Toronto General Hospital, 200 Elizabeth Street, RFE G-480, Toronto, M5G 2C4 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
| | - Monique van Lettow
- Dignitas International, Zomba, Malawi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
| | | | | | - Sharon E. Straus
- Department of Medicine, University of Toronto, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2 Canada
- Li Ka Shing Knowledge Institute, St. Michaels Hospital, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8 Canada
| | | | - Jemila S. Hamid
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, ON I1G 5Z3 Canada
| | - Gerald Lebovic
- Li Ka Shing Knowledge Institute, St. Michaels Hospital, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
| | - Kevin E. Thorpe
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8 Canada
| | - Merrick Zwarenstein
- Department of Family Medicine, Western University, London, ON Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1 Canada
| | - Michael J. Schull
- Department of Medicine, University of Toronto, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2 Canada
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, c/o H2-66, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
- Dignitas International Toronto, C/O ICES attention Michael Schull, 2075 Bayview Avenue, G106, Toronto, ON M4N 3M5 Canada
| | - Adrienne K. Chan
- Department of Medicine, University of Toronto, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
- Dignitas International, Zomba, Malawi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, c/o H2-66, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Alexandra Martiniuk
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
- George Institute for Global Health, Sydney, Australia
- The University of Sydney, Edward Ford Building, Sydney, NSW Australia
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Topp SM, Carbone NB, Tseka J, Kamtsendero L, Banda G, Herce ME. " Most of what they do, we cannot do!" How lay health workers respond to barriers to uptake and retention in HIV care among pregnant and breastfeeding mothers in Malawi. BMJ Glob Health 2020; 5:e002220. [PMID: 32561513 PMCID: PMC7304641 DOI: 10.1136/bmjgh-2019-002220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In the era of Option B+ and 'treat all' policies for HIV, challenges to retention in care are well documented. In Malawi, several large community-facility linkage (CFL) models have emerged to address these challenges, training lay health workers (LHW) to support the national prevention of mother-to-child transmission (PMTCT) programme. This qualitative study sought to examine how PMTCT LHW deployed by Malawi's three most prevalent CFL models respond to known barriers to access and retention to antiretroviral therapy (ART) and PMTCT. METHODS We conducted a qualitative study, including 43 semi-structured interviews with PMTCT clients; 30 focus group discussions with Ministry of Health (MOH)-employed lay and professional providers and PMTCT LHWs; a facility CFL survey and 2-4 hours of onsite observation at each of 8 sites and in-depth interviews with 13 programme coordinators and MOH officials. Thematic analysis was used, combining inductive and deductive approaches. RESULTS Across all three models, PMTCT LHWs carried out a number of 'targeted' activities that respond directly to a range of known barriers to ART uptake and retention. These include: (i) fulfilling counselling and educational functions that responded to women's fears and uncertainties; (ii) enhancing women's social connectedness and participation in their own care and (iii) strengthening service function by helping clinic-based providers carry out duties more efficiently and effectively. Beyond absorbing workload or improving efficiency, however, PMTCT LHWs supported uptake and retention through foundational but often intangible work to strengthen CFL, including via efforts to strengthen facility-side responsiveness, and build community members' recognition of and trust in services. CONCLUSION PMTCT LHWs in each of the CFL models examined, addressed social, cultural and health system factors influencing client access to, and engagement with, HIV care and treatment. Findings underscore the importance of person-centred design in the 'treat-all' era and the contribution LHWs can make to this, but foreground the challenges of achieving person-centredness in the context of an under-resourced health system. Further work to understand the governance and sustainability of these project-funded CFL models and LHW cadres is now urgently required.
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Affiliation(s)
- Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | | | | | | | - Godfrey Banda
- University of North Carolina Project, Lilongwe, Malawi
| | - Michael E Herce
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel HIll, North Carolina, USA
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
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Lee YJ, Adusumilli G, Kyakulaga F, Muwereza P, Kazungu R, Blackwell TS, Saenz J, Schubert MC. Survey on the prevalence of dyspepsia and practices of dyspepsia management in rural Eastern Uganda. Heliyon 2019; 5:e01644. [PMID: 31338438 PMCID: PMC6580192 DOI: 10.1016/j.heliyon.2019.e01644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 02/25/2019] [Accepted: 04/30/2019] [Indexed: 02/09/2023] Open
Abstract
Aim To investigate the current prevalence and management of dyspepsia in rural Eastern Uganda. Methods Residents older than 18 years of age across 95 study sites in Namutumba District, Eastern Uganda were surveyed. Each respondent was administered a questionnaire about dyspepsia and pertinent health-seeking behaviors. Health workers at 12 different clinics were also assessed on their competence in managing dyspepsia. Proportion-based analysis was used to determine self-reported outcome variables reported in this study, including: prevalence of dyspepsia; breakdown of symptoms; initial diagnosis location; management strategies; and appropriate medication usage. Results 397 residents (average age of 41.2 years) participated in this study (54.4% males, 45.6% females). 57.9% self-reported currently having dyspepsia, of average duration 4.5 years. Of this subset, 87% reported experiencing epigastric pain, and 42.2% believed that ulcers were “wounds in the stomach.” Only 3% of respondents had heard of Helicobacter pylori (Hp). Respondents varied in their management of dyspepsia, with frequent eating (39.1%), doing nothing (23.9%), and taking Western medicine (20%) being the most common strategies. The diagnosis of “peptic ulcer disease” was made by a health worker in 64.3% of cases, and 27% of cases were self-diagnosed. Notably, 70.3% of diagnoses at formal health centers were based on clinical symptoms alone and only 22.7% of respondents received treatment according to Ugandan Ministry of Health guidelines. Among the 12 health care workers surveyed, 10 cited epigastric pain as a common symptom of “ulcer,” although only two reported having heard of Hp. Only two out of 12 clinics had the capability to prescribe the triple therapy as treatment for presumed Hp. Conclusion There is a high incidence of dyspepsia in Eastern Uganda, and current management strategies are poor and inconsistent, and may contribute to antibiotic resistance. Further studies are needed to investigate the causes of dyspepsia to guide appropriate management.
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Affiliation(s)
- Yang Jae Lee
- Washington University School of Medicine, USA.,Empower Through Health, USA
| | - Gautam Adusumilli
- Washington University School of Medicine, USA.,Empower Through Health, USA
| | | | - Peter Muwereza
- Makerere University School of Public Health, USA.,Empower Through Health, USA
| | | | | | - Jose Saenz
- Washington University School of Medicine, USA
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O’Donovan J, O’Donovan C, Kuhn I, Sachs SE, Winters N. Ongoing training of community health workers in low-income andmiddle-income countries: a systematic scoping review of the literature. BMJ Open 2018; 8:e021467. [PMID: 29705769 PMCID: PMC5931295 DOI: 10.1136/bmjopen-2017-021467] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/06/2018] [Accepted: 04/10/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Understanding the current landscape of ongoing training for community health workers (CHWs) in low-income and middle-income countries (LMICs) is important both for organisations responsible for their training, as well as researchers and policy makers. This scoping review explores this under-researched area by mapping the current delivery implementation and evaluation of ongoing training provision for CHWs in LMICs. DESIGN Systematic scoping review. DATA SOURCES MEDLINE, Embase, AMED, Global Health, Web of Science, Scopus, ASSIA, LILACS, BEI and ERIC. STUDY SELECTION Original studies focusing on the provision of ongoing training for CHWs working in a country defined as low income and middle income according to World Bank Group 2012 classification of economies. RESULTS The scoping review found 35 original studies that met the inclusion criteria. Ongoing training activities for CHWs were described as supervision (n=19), inservice or refresher training (n=13) or a mixture of both (n=3). Although the majority of studies emphasised the importance of providing ongoing training, several studies reported no impact of ongoing training on performance indicators. The majority of ongoing training was delivered inperson; however, four studies reported the use of mobile technologies to support training delivery. The outcomes from ongoing training activities were measured and reported in different ways, including changes in behaviour, attitudes and practice measured in a quantitative manner (n=16), knowledge and skills (n=6), qualitative assessments (n=5) or a mixed methods approach combining one of the aforementioned modalities (n=8). CONCLUSIONS This scoping review highlights the diverse range of ongoing training for CHWs in LMICs. Given the expansion of CHW programmes globally, more attention should be given to the design, delivery, monitoring and sustainability of ongoing training from a health systems strengthening perspective.
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Affiliation(s)
| | | | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Niall Winters
- Department of Education, University of Oxford, Oxford, UK
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Limato R, Ahmed R, Magdalena A, Nasir S, Kotvojs F. Use of most significant change (MSC) technique to evaluate health promotion training of maternal community health workers in Cianjur district, Indonesia. EVALUATION AND PROGRAM PLANNING 2018; 66:102-110. [PMID: 29091785 DOI: 10.1016/j.evalprogplan.2017.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 09/08/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
Maternal health promotion is a defined activity in the community integrated posts (Posyandu) in Indonesia. However, it is often neglected due to limited knowledge and skills of the community health workers (kader). We conducted health promotion training for the kader and village midwives in four villages in Cianjur district. This study describes the use of "most significant change" (MSC) technique to evaluate impact of health promotion to the beneficiaries and community at large. The MSC uses stories as raw data. Through interviews focused on perception of change, stories were collected from four pregnant women, eight kader and three village midwives. A Panel consisting of policy and programme managers and implementers read all the stories. The story by a pregnant woman who routinely attended Posyandu was selected as the story with most significant change. Her story highlighted changes in kader's knowledge and communication of health messages and attitude towards pregnant women. She expressed these changes impacted community awareness about health and to seek help from kader.The MSC technique enabled stakeholders to view raw data and evaluate the impact of health promotion from the beneficiary's perspective. At the same time, recipients of health promotion contributed to the decision process of evaluation through their stories. The different perspectives on the MSC reflected individual's objectives of the health promotion. The application of this technique is limited in maternal health promotion programme in Indonesia, and none have been published in peer reviewed journals.
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Affiliation(s)
- Ralalicia Limato
- Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta 10430, Indonesia.
| | - Rukhsana Ahmed
- Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta 10430, Indonesia; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA, UK.
| | - Amelia Magdalena
- Consortium Tirta Global, BP Tangguh LNG Clinic, Teluk Bintuni, Papua Barat, Indonesia.
| | - Sudirman Nasir
- Faculty of Public Health, Hasanuddin University, Jl. Perintis Kemerdekaan KM 10, Tamalanrea Makassar 90245, Sulawesi Selatan, Indonesia.
| | - Fiona Kotvojs
- Kurrajong Hill Pty Ltd, 701 Dignams Creek, Narooma 2546, New South Wales, Australia.
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Wu S, Roychowdhury I, Khan M. Evaluations of training programs to improve human resource capacity for HIV, malaria, and TB control: a systematic scoping review of methods applied and outcomes assessed. Trop Med Health 2017; 45:16. [PMID: 28680324 PMCID: PMC5493875 DOI: 10.1186/s41182-017-0056-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/16/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Owing to the global health workforce crisis, more funding has been invested in strengthening human resources for health, particularly for HIV, tuberculosis, and malaria control; however, little is known about how these investments in training are evaluated. This paper examines how frequently HIV, malaria, and TB healthcare provider training programs have been scientifically evaluated, synthesizes information on the methods and outcome indicators used, and identifies evidence gaps for future evaluations to address. METHODS We conducted a systematic scoping review of publications evaluating postgraduate training programs, including in-service training programs, for HIV, tuberculosis, and malaria healthcare providers between 2000 and 2016. Using broad inclusion criteria, we searched three electronic databases and additional gray literature sources. After independent screening by two authors, data about the year, location, methodology, and outcomes assessed was extracted from eligible training program evaluation studies. Training outcomes evaluated were categorized into four levels (reaction, learning, behavior, and results) based on the Kirkpatrick model. FINDINGS Of 1473 unique publications identified, 87 were eligible for inclusion in the analysis. The number of published articles increased after 2006, with most (n = 57, 66%) conducted in African countries. The majority of training evaluations (n = 44, 51%) were based on HIV with fewer studies focused on malaria (n = 28, 32%) and TB (n = 23, 26%) related training. We found that quantitative survey of trainees was the most commonly used evaluation method (n = 29, 33%) and the most commonly assessed outcomes were knowledge acquisition (learning) of trainees (n = 44, 51%) and organizational impacts of the training programs (38, 44%). Behavior change and trainees' reaction to the training were evaluated less frequently and using less robust methods; costs of training were also rarely assessed. CONCLUSIONS Our study found that a limited number of robust evaluations had been conducted since 2000, even though the number of training programs has increased over this period to address the human resource shortage for HIV, malaria, and TB control. Specifically, we identified a lack evaluation studies on TB- and malaria-related healthcare provider training and very few studies assessing behavior change of trainees or costs of training. Developing frameworks and standardized evaluation methods may facilitate strengthening of the evidence base to inform policies on and investments in training programs.
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Affiliation(s)
- Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
| | - Imara Roychowdhury
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
| | - Mishal Khan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore.,Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
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Evaluating the impact of healthcare provider training to improve tuberculosis management: a systematic review of methods and outcome indicators used. Int J Infect Dis 2016; 56:105-110. [PMID: 27979785 DOI: 10.1016/j.ijid.2016.11.421] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Developing human resources capacity is vital for tuberculosis (TB) control in low- and middle-income countries. Although investments in TB healthcare provider (HCP) training programmes have increased, it is unclear whether these are robustly evaluated. The objective of this systematic review was to synthesize the methods and outcome indicators used to assess TB HCP training programmes. METHODS A systematic scoping review of publications reporting on evaluations of training programmes for TB HCPs - including doctors, nurses, paramedics, and lay health workers - was conducted through a search in three electronic databases, Google Scholar, and five websites of non-profit organizations. Data on the study location, population trained, outcomes assessed, and evaluation approach were extracted. RESULTS After screening 499 unique publications, 21 were eligible for inclusion in the analysis. The majority of evaluations were conducted in Africa. The most common evaluation methods were a review of patient records (n=8, 38%) and post-training interview with trainees (n=7, 33%). In terms of outcomes, more than half of the studies (n=12, 57%) evaluated knowledge acquisition of trainees, with only six (29%) assessing on-the-job behaviour change. CONCLUSIONS Even though more funds have been invested in TB HCP training, publications from robust evaluations assessing the impact on quality of care and behaviour change are limited.
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Jaribu J, Penfold S, Manzi F, Schellenberg J, Pfeiffer C. Improving institutional childbirth services in rural Southern Tanzania: a qualitative study of healthcare workers' perspective. BMJ Open 2016; 6:e010317. [PMID: 27660313 PMCID: PMC5051329 DOI: 10.1136/bmjopen-2015-010317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe health workers' perceptions of a quality improvement (QI) intervention that focused on improving institutional childbirth services in primary health facilities in Southern Tanzania. DESIGN A qualitative design was applied using in-depth interviews with health workers. SETTING This study involved the Ruangwa District Reproductive and Child Health Department, 11 dispensaries and 2 health centres in rural Southern Tanzania. PARTICIPANTS 4 clinical officers, 5 nurses and 6 medical attendants from different health facilities were interviewed. RESULTS The healthcare providers reported that the QI intervention improved their skills, capacity and confidence in providing counselling and use of a partograph during labour. The face-to-face QI workshops, used as a platform to refresh their knowledge on maternal and newborn health and QI methods, facilitated peer learning, networking and standardisation of care provision. The onsite follow-up visits were favoured by healthcare providers because they gave the opportunity to get immediate help, learn how to perform tasks in practice and be reminded of what they had learnt. Implementation of parallel interventions focusing on similar indicators was mentioned as a challenge that led to duplication of work in terms of data collection and reporting. District supervisors involved in the intervention showed interest in taking over the implementation; however, funding remained a major obstacle. CONCLUSIONS Healthcare workers highlighted the usefulness of applying a QI approach to improve maternal and newborn health in rural settings. QI programmes need careful coordination at district level in order to reduce duplication of work.
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Affiliation(s)
- Jennie Jaribu
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Basel University, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Basel University, Basel, Switzerland
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12
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Puchalski Ritchie LM, van Lettow M, Makwakwa A, Chan AK, Hamid JS, Kawonga H, Martiniuk ALC, Schull MJ, van Schoor V, Zwarenstein M, Barnsley J, Straus SE. The impact of a knowledge translation intervention employing educational outreach and a point-of-care reminder tool vs standard lay health worker training on tuberculosis treatment completion rates: study protocol for a cluster randomized controlled trial. Trials 2016; 17:439. [PMID: 27604571 PMCID: PMC5015212 DOI: 10.1186/s13063-016-1563-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/19/2016] [Indexed: 11/29/2022] Open
Abstract
Background Despite availability of effective treatment, tuberculosis (TB) remains an important cause of morbidity and mortality globally, with low- and middle-income countries most affected. In many such settings, including Malawi, the high burden of disease and severe shortage of skilled healthcare workers has led to task-shifting of outpatient TB care to lay health workers (LHWs). LHWs improve access to healthcare and some outcomes, including TB completion rates, but lack of training and supervision limit their impact. The goals of this study are to improve TB care provided by LHWs in Malawi by refining, implementing, and evaluating a knowledge translation strategy designed to address a recognized gap in LHWs’ TB and job-specific knowledge and, through this, to improve patient outcomes. Methods/design We are employing a mixed-methods design that includes a pragmatic cluster randomized controlled trial and a process evaluation using qualitative methods. Trial participants will include all health centers providing TB care in four districts in the South East Zone of Malawi. The intervention employs educational outreach, a point-of-care reminder tool, and a peer support network. The primary outcome is proportion of treatment successes, defined as the total of TB patients cured or completing treatment, with outcomes taken from Ministry of Health treatment records. With an alpha of 0.05, power of 0.80, a baseline treatment success of 0.80, intraclass correlation coefficient of 0.1 based on our pilot study, and an estimated 100 clusters (health centers providing TB care), a minimum of 6 patients per cluster is required to detect a clinically significant 0.10 increase in the proportion of treatment successes. Our process evaluation will include interviews with LHWs and patients, and a document analysis of LHW training logs, quarterly peer trainer meetings, and mentorship meeting notes. An estimated 10–15 LHWs and 10–15 patients will be required to reach saturation in each of 2 planned interview periods, for a total of 40–60 interview participants. Discussion This study will directly inform the efforts of knowledge users within TB care and, through extension of the approach, other areas of care provided by LHWs in Malawi and other low- and middle-income countries. Trial registration ClinicalTrials.gov NCT02533089. Registered 20 August 2015. Protocol Date/Version 29 May 2016/Version 2. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1563-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Emergency Medicine, University Health Network, Toronto, ON, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Monique van Lettow
- Dignitas International, P.O. Box 1071, Zomba, Malawi.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Austine Makwakwa
- National Tuberculosis Control Program, Ministry of Health, P.O. Box 30377, Lilongwe, Malawi
| | - Adrienne K Chan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Center, Toronto, ON, Canada.,Dignitas International, 550 Queen Street East, Suite 335, Toronto, ON, Canada
| | - Jemila S Hamid
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Harry Kawonga
- Dignitas International, P.O. Box 1071, Zomba, Malawi
| | - Alexandra L C Martiniuk
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Dignitas International, 550 Queen Street East, Suite 335, Toronto, ON, Canada.,George Institute for Global Health, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Michael J Schull
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Center, Toronto, ON, Canada.,Dignitas International, 550 Queen Street East, Suite 335, Toronto, ON, Canada
| | | | - Merrick Zwarenstein
- Department of Family Medicine, Western University, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Jan Barnsley
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
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