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Kowalczyk M, Yao N, Gregory L, Cheatham J, DeClemente T, Fox K, Ignoffo S, Volerman A. Community health worker perspectives: examining current responsibilities and strategies for success. Arch Public Health 2024; 82:94. [PMID: 38907308 PMCID: PMC11191347 DOI: 10.1186/s13690-024-01313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/02/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Community health worker (CHW) interventions have demonstrated positive impacts globally, with the COVID-19 pandemic further highlighting the potential of CHWs at the frontline to support prevention, outreach, and healthcare delivery. As the workforce expands, understanding the work and capabilities of CHWs is key to design successful interventions. This study examines the perspectives of experienced CHWs in Chicago about their current work and strategies for success. METHODS As part of a community-academic partnership in Chicago, semi-structured interviews were completed with individuals who held positions aligned with CHW. Interviews were conducted between January and April 2022. Questions focused on participants' work and factors contributing to their effectiveness to gain insights into workforce strategies for success to be applied in healthcare and community settings. De-identified transcripts were analyzed using inductive reasoning with codes organized into themes and subthemes under two domains identified a priori. The themes informed a logic model focused on the early stages to support the success of CHWs in their role. RESULTS Fourteen individuals participated in the study. The two predetermined domains in this study were: current work of CHWs and strategies for CHWs to be successful. Five themes were identified about CHWs' current work: providing services, building alliances with clients, establishing and maintaining collaborations, collecting data, and experiencing challenges in role. From their perspectives, all these responsibilities enhance client care and support workforce sustainability efforts. Five themes emerged about strategies for the success of CHWs: background of CHWs, champions to support work of CHWs, materials to perform work of CHWs, preparation for CHW role, and characteristics of CHWs. Participants described key traits CHWs should possess to be hired, individuals who can champion and advocate for their work, and specific materials needed to fulfill responsibilities. They reported that training and familiarity with the community were integral to developing and refining the qualities and skills necessary to be effective in their role. CONCLUSION CHWs play an increasingly important role in enhancing healthcare delivery and improving health outcomes. This study offers a framework for policymakers, communities, and organizations to utilize for preparing CHWs to succeed in their roles.
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Affiliation(s)
- Monica Kowalczyk
- Department of Medicine, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Nicole Yao
- Department of Medicine, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA
| | - LaToya Gregory
- Department of Medicine, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Jeannine Cheatham
- Department of Pediatrics, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA
| | - Tarrah DeClemente
- Chicago Public Schools Office of Student Health and Wellness, 42 W. Madison St, Chicago, IL, USA
| | - Kenneth Fox
- Chicago Public Schools Office of Student Health and Wellness, 42 W. Madison St, Chicago, IL, USA
| | - Stacy Ignoffo
- Sinai Urban Health Institute, 1500 S. Fairfield Ave, Chicago, IL, #1782, USA
| | - Anna Volerman
- Department of Medicine, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA.
- Department of Pediatrics, University of Chicago Biological Sciences Division, 5841 S. Maryland Ave, Chicago, IL, USA.
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Panaite A, Desroches O, Warren É, Rouly G, Castonguay G, Boivin A. Engaging with peers to integrate community care: Knowledge synthesis and conceptual map. Health Expect 2024; 27:e14034. [PMID: 38567865 PMCID: PMC10989131 DOI: 10.1111/hex.14034] [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: 12/22/2023] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
CONTEXT Engaging with peers is gaining increasing interest from healthcare systems in numerous countries. Peers are people who offer support by drawing on lived experiences of significant challenges or 'insider' knowledge of communities. Growing evidence suggests that peers can serve as a bridge between underserved communities and care providers across sectors, through their ability to build trust and relationships. Peer support is thus seen as an innovative way to address core issues of formal healthcare, particularly fragmentation of care and health inequalities. The wide body of approaches, goals and models of peer support speaks volumes of such interest. Navigating the various labels used to name peers, however, can be daunting. Similar terms often hide critical differences. OBJECTIVES/BACKGROUND This article seeks to disentangle the conceptual multiplicity of peer support, presenting a conceptual map based on a 3-year knowledge synthesis project involving peers and programme stakeholders in Canada, and international scientific and grey literature. SYNTHESIS/MAIN RESULTS The map introduces six key questions to navigate and situate peer support approaches according to peers' roles, pathways and settings of practice, regardless of the terms used to label them. As a tool, it offers a broad overview of the different ways peers contribute to integrating health and community care. DISCUSSION We conclude by discussing the map's potential and limitations to establish a common language and bridge models, in support of knowledge exchange among practitioners, policymakers and researchers. PATIENT OR PUBLIC CONTRIBUTION Our team includes one experienced peer support worker. She contributed to the design of the conceptual map and the production of the manuscript. More than 10 peers working across Canada were also involved during research meetings to validate and refine the conceptual map.
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Affiliation(s)
- Andreea‐Cătălina Panaite
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
| | - Odile‐Anne Desroches
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
- School of Public HealthUniversité de MontréalMontréalQuébecCanada
| | - Émilie Warren
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
| | - Ghislaine Rouly
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
| | - Geneviève Castonguay
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
| | - Antoine Boivin
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
- School of Public HealthUniversité de MontréalMontréalQuébecCanada
- Department of Family MedicineUniversité de MontréalMontréalQuébecCanada
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Yao N, Kowalczyk M, Gregory L, Cheatham J, DeClemente T, Fox K, Ignoffo S, Volerman A. Community health workers' perspectives on integrating into school settings to support student health. Front Public Health 2023; 11:1187855. [PMID: 37415701 PMCID: PMC10320159 DOI: 10.3389/fpubh.2023.1187855] [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: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction While schools represent key venues for supporting health, they continue to experience gaps in health resources. The integration of community health workers (CHWs) into schools has the potential to supplement these resources but has been underexplored. This study is the first to examine perspectives of experienced CHWs about how CHWs can be applied in school settings to support student health. Methods This qualitative study involved conducting semi-structured interviews focused on implementation of CHWs in schools with individuals who held positions aligned with the CHW scope of work. De-identified transcripts were analyzed, and codes were organized into domains and themes. Results Among 14 participants, seven domains emerged about the implementation of CHWs in schools: roles and responsibilities, collaborations, steps for integration, characteristics of successful CHWs, training, assessment, and potential challenges. Participants shared various potential responsibilities of school-based CHWs, including educating on health topics, addressing social determinants of health, and supporting chronic disease management. Participants emphasized the importance of CHWs building trusting relationships with the school community and identified internal and external collaborations integral to the success of CHWs. Specifically, participants indicated CHWs and schools should together determine CHWs' responsibilities, familiarize CHWs with the school population, introduce CHWs to the school community, and establish support systems for CHWs. Participants identified key characteristics of school-based CHWs, including having familiarity with the broader community, relevant work experience, essential professional skills, and specific personal qualities. Participants highlighted trainings relevant to school-based CHWs, including CHW core skills and health topics. To assess CHWs' impact, participants proposed utilizing evaluation tools, documenting interactions with students, and observing indicators of success within schools. Participants also identified challenges for school-based CHWs to overcome, including pushback from the school community and difficulties related to the scope of work. Discussion This study identified how CHWs can have a valuable role in supporting student health and the findings can help inform models to integrate CHWs to ensure healthy school environments.
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Affiliation(s)
- Nicole Yao
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Monica Kowalczyk
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - LaToya Gregory
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Jeannine Cheatham
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
| | - Tarrah DeClemente
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, IL, United States
| | - Kenneth Fox
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, IL, United States
| | - Stacy Ignoffo
- Sinai Urban Health Institute, Chicago, IL, United States
| | - Anna Volerman
- Department of Medicine, University of Chicago, Chicago, IL, United States
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
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Rose AL, Feng Y, Rai S, Shrestha P, Magidson JF, Kohrt BA. Pretraining Skills as Predictors of Competence of Nonspecialists in Delivery of Mental Health Services. Psychiatr Serv 2023; 74:614-621. [PMID: 36625138 PMCID: PMC10238614 DOI: 10.1176/appi.ps.202100691] [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] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Task-shared delivery of mental health care, which includes training people who are not mental health specialists to deliver components of care, has been identified as a core strategy for increasing access to mental health care globally. However, after standard training, nonspecialists attain variable and sometimes poor competence in task-shared mental health care. This study examined whether pretraining interpersonal skills (nonverbal communication, verbal communication, rapport building, and empathy-warmth) are related to posttraining competence in task-shared mental health care among nonspecialists in Nepal. METHODS Nonspecialists (e.g., auxiliary health workers and health assistants) (N=185) were assessed at pretraining and posttraining (4 months after training and supervision) in a task-shared mental health care program in Nepal. This study employed both a classification algorithm and a logistic regression model to examine the relationship between pretraining interpersonal skills and posttraining competence. RESULTS The classification model predicted posttraining competence at above-chance levels on the basis of pretraining interpersonal skills. In particular, pretraining nonverbal communication skill distinguished participants whose posttraining competence was rated as acceptable from those whose rating was not acceptable. Nonverbal communication was also a significant predictor in the regression model. No other interpersonal skills were significantly related to posttraining competence outcomes in the regression model. CONCLUSIONS Some pretraining interpersonal skills of nonspecialists may predict overall competence outcomes in task-shared mental health care. Future studies confirming the relationship between pretraining interpersonal skills and posttraining competence in care delivery could improve staff selection and training strategies in task-shared mental health care programs.
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Affiliation(s)
- Alexandra L Rose
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
| | - Yi Feng
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
| | - Sauharda Rai
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
| | - Pragya Shrestha
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
| | - Jessica F Magidson
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
| | - Brandon A Kohrt
- Department of Psychology (Rose, Magidson) and Measurement, Statistics, and Evaluation Program (Feng), University of Maryland, College Park; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (Rai, Shrestha, Kohrt); Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C. (Rai, Kohrt)
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Ingenhoff R, Munana R, Weswa I, Gaal J, Sekitoleko I, Mutabazi H, Bodnar BE, Rabin TL, Siddharthan T, Kalyesubula R, Knauf F, Nalwadda CK. Principles for task shifting hypertension and diabetes screening and referral: a qualitative study exploring patient, community health worker and healthcare professional perceptions in rural Uganda. BMC Public Health 2023; 23:881. [PMID: 37173687 PMCID: PMC10176286 DOI: 10.1186/s12889-023-15704-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND A shortage of healthcare workers in low- and middle-income countries (LMICs) combined with a rising burden of non-communicable diseases (NCDs) like hypertension and diabetes mellitus has resulted in increasing gaps in care delivery for NCDs. As community health workers (CHWs) often play an established role in LMIC healthcare systems, these programs could be leveraged to strengthen healthcare access. The objective of this study was to explore perceptions of task shifting screening and referral for hypertension and diabetes to CHWs in rural Uganda. METHODS This qualitative, exploratory study was conducted in August 2021 among patients, CHWs and healthcare professionals. Through 24 in-depth interviews and ten focus group discussions, we investigated perceptions of task shifting to CHWs in the screening and referral of NCDs in Nakaseke, rural Uganda. This study employed a holistic approach targeting stakeholders involved in the implementation of task shifting programs. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically guided by the framework method. RESULTS Analysis identified elements likely to be required for successful program implementation in this context. Fundamental drivers of CHW programs included structured supervision, patients' access to care through CHWs, community involvement, remuneration and facilitation, as well as building CHW knowledge and skills through training. Additional enablers comprised specific CHW characteristics such as confidence, commitment and motivation, as well as social relations and empathy. Lastly, socioemotional aspects such as trust, virtuous behavior, recognition in the community, and the presence of mutual respect were reported to be critical to the success of task shifting programs. CONCLUSION CHWs are perceived as a useful resource when task shifting NCD screening and referral for hypertension and diabetes from facility-based healthcare workers. Before implementation of a task shifting program, it is essential to consider the multiple layers of needs portrayed in this study. This ensures a successful program that overcomes community concerns and may serve as guidance to implement task shifting in similar settings.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Richard Munana
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Julia Gaal
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Hillary Mutabazi
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tracy L Rabin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, USA
| | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Physiology, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Christine K Nalwadda
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
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Asare SF, Rodriguez-Muñoz MF. Understanding Healthcare Professionals' Knowledge on Perinatal Depression among Women in a Tertiary Hospital in Ghana: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15960. [PMID: 36498033 PMCID: PMC9740295 DOI: 10.3390/ijerph192315960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Health conditions affecting women in the perinatal period still account for a major contribution to disease burden in Sub-Saharan Africa, yet there is a dearth of empirical research to understanding health professionals' perspective on their experiences and how they care for perinatal women in depression. We used a qualitative exploratory descriptive approach through a face- to face-interview to explore the knowledge of 11 health professionals of Komfo Anokye Teaching Hospital, Kumasi- Ghana. Interviews were taped recorded and transcribed verbatim. The study adopted Haase's modification of Colaizzi's method for the analysis. Four main themes emerged: ineffective communication (Referral lapses among care providers, long waiting time, lack of confidentiality), workload (Inefficient staff to meet perinatal women's need, no screening tools and time constraints), Reaction to patients symptoms (Identifying patient's symptoms, assessment through patient's centeredness and Education and counselling). Our results emerged that time constraints, stigmatization and lack of awareness delayed the care and management of perinatal depression among healthcare professionals in the hospital setting. There is the need to improve healthcare professionals' knowledge on perinatal depression and it is imperative for the hospital administrators to invest in continuous training and professional development for healthcare professionals.
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Affiliation(s)
- Sandra Fremah Asare
- Department of Personality, Assessment and Psychological Treatment, Universidad Nacional de Educación a Distancia, 28015 Madrid, Spain
- Discipline of Nursing, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
- Seventh-Day Adventist Nursing and Midwifery Training College, Kwadaso, Kumasi P.O. Box PC 96, Ghana
| | - Maria F. Rodriguez-Muñoz
- Department of Personality, Assessment and Psychological Treatment, Universidad Nacional de Educación a Distancia, 28015 Madrid, Spain
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Zhang Y, Guy R, Camara H, Applegate TL, Wiseman V, Treloar C, Lafferty L. Barriers and facilitators to HIV and syphilis rapid diagnostic testing in antenatal care settings in low-income and middle-income countries: a systematic review. BMJ Glob Health 2022; 7:bmjgh-2022-009408. [PMID: 36319030 PMCID: PMC9628546 DOI: 10.1136/bmjgh-2022-009408] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/24/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Testing and treatment during pregnancy is a well-established and cost-effective prevention strategy, which relies largely on use of rapid diagnostic tests (RDTs). Yet, in many low-income and-middle-income countries, the uptake of RDTs is suboptimal. A qualitative meta-synthesis was conducted to identify the barriers and enablers to use of HIV and syphilis RDTs among pregnant women in low-income and middle-income countries. METHODS This review was conducted using PRISMA guidelines. Eligible studies included peer-reviewed publications, which used qualitative methods to explore HIV and syphilis RDT in antenatal care clinics in low-income and middle-income countries. Studies focusing on perspectives of pregnant women, healthcare workers and/or stakeholders were included. We used an inductive approach informed by a modified socioecological model to synthesise the data. RESULTS 62 manuscripts met the eligibility criteria. For pregnant women, initial acceptance of the RDT and continuation in antenatal care depends on the perception that engaging in testing will be a beneficial experience for their baby and themselves, often influenced by the provision of services that are gender-sensitive, confidential, respectful, flexible and considers their well-being into the future. Local sociocultural beliefs about pregnancy and diseases, awareness of diseases and gender roles in society also influenced RDT acceptability among pregnant women. For healthcare workers, the ability to provide high-quality RDT care required ongoing training, accurate and easy to use tests, support from supervisors and communities, sufficient resources and staffing to provide services, and reliable salary. At the stakeholder level, well-developed guidelines and health system infrastructures were imperative to the delivery of RDT in antenatal clinics. CONCLUSION Our findings highlight clear gaps to the provision of sustainable and culturally acceptable maternal HIV and/or syphilis screening using RDTs. In addition, greater attention needs to be paid to community stakeholders in promoting the uptake of RDT in antenatal clinics. PROSPERO REGISTRATION NUMBER CRD42018112190.
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Affiliation(s)
- Ye Zhang
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Hawa Camara
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lise Lafferty
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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Bellas HC, Bulhões B, Arcuri R, Vidal MCR, de Carvalho PVR, Jatobá A. Community health workers’ non-technical skills for delivering primary healthcare in low-income areas. Work 2022; 72:1047-1054. [DOI: 10.3233/wor-205089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: To overcome the poor conditions of low-income areas in developing countries like Brazil, Community Health Workers (CHWs) are required to exceed the regular set of formal skills they are used to employ. OBJECTIVE: In this study, we aim at identifying the non-technical skills CHWs must develop to cope with the extraordinary situations that occur in vulnerable communities. METHODS: 41 CHWs based in two primary healthcare clinics in Brazil underwent two rounds of in-depth interviews. The analysis was carried out using the Analytical Hierarchy Process, resulting in the prioritization of social skills according to their calculated importance to house calls. RESULTS: Among the ten higher-scored skills, we find communication and advocacy skills being of high importance. Civility was found to be the most important attribute, confirming that community action relies strongly on the relationship between health professionals and the community. CONCLUSION: The results of our study contribute primarily to the improvement of community-based primary care programs as it helps to identify major skills required for community action.
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Affiliation(s)
- Hugo Cesar Bellas
- Centro de Estudos Estratégicos Antônio Ivo de carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Bárbara Bulhões
- Instituto de Medicina Social Hesio Cordeiro (IMS), Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo Arcuri
- Centro de Estudos Estratégicos Antônio Ivo de carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Mario Cesar Rodríguez Vidal
- Instituto Alberto Luiz Coimbra de Pós-graduação e Pesquisa em Engenharia (COPPE), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Alessandro Jatobá
- Centro de Estudos Estratégicos Antônio Ivo de carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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9
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Branquinho M, Shakeel N, Horsch A, Fonseca A. Frontline health professionals’ perinatal depression literacy: A systematic review. Midwifery 2022; 111:103365. [DOI: 10.1016/j.midw.2022.103365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
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Ryan LM, Mahmood MA, Laurence CO. Incidence of concomitant illnesses in pregnancy in Indonesia: Estimates from 1990-2019, with projections to 2030. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 10:100139. [PMID: 34327350 PMCID: PMC8315454 DOI: 10.1016/j.lanwpc.2021.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
Background ‘Indirect’ causes of maternal death including concomitant illnesses such as infectious and non-communicable diseases (NCDs), accounted for 23% of maternal deaths in Indonesia in 2010. Reproductive-age women in Indonesia face a “double burden” of disease with increasing rates of NCDs and persisting rates of infectious disease. However, there is a lack of data on the burden of these diseases in pregnancy. The aim of this study was to estimate incidence of concomitant illnesses among pregnant women in Indonesia from 1990–2030. Methods Publicly available data was accessed including incidence of concomitant illnesses in Indonesian reproductive-age women, population data and crude birth rate data from 1990–2019, and formed basis for projections to 2030. A dataset of estimates for all variables was generated for each year and sampled from a binomial distribution. Using these estimates, pregnancy estimates and incidence in pregnant women were calculated. A cubic splines model was fitted to generate estimates of incidence of concomitant illnesses in pregnancy. Findings Past trends to 2019 show a decline in incident cases of infectious diseases except for HIV/AIDs, and an increase in most NCDs. In 2019, the most common disease was sexually transmitted infections. From 2020–2030, incidences of diabetes and lower respiratory infections are estimated to continue to increase. Interpretation With an increasing incidence of NCDs and high-incidence of infectious diseases in pregnancy, Indonesian policymakers and stakeholders should consider what evidence-based strategies and interventions are best to reduce potential impacts of concomitant illnesses on pregnancy outcomes. Funding Australian Government Research Training Program Scholarship.
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Affiliation(s)
- Lareesa M Ryan
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
| | - Mohammad A Mahmood
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia.,Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Caroline O Laurence
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
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Zaman SB, Evans RG, Singh R, Singh A, Singh P, Singh R, Thrift AG. Feasibility of community health workers using a clinical decision support system to screen and monitor non-communicable diseases in resource-poor settings: study protocol. Mhealth 2021; 7:15. [PMID: 33634198 PMCID: PMC7882273 DOI: 10.21037/mhealth-19-258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/02/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND It is imperative that coordinated and systematic action is undertaken, at all levels, to minimize the consequences of the growing global burden of non-communicable diseases (NCDs). An integrated multi-disciplinary primary care-based preventive program has the potential to reduce lifestyle-related risk factors contributing to NCDs. Accredited Social Health Activists (ASHAs), who are community health workers (CHWs), may be employed to screen populations for NCDs in rural India. To enable ASHAs to be supported when they are on their own in the community, we have developed a clinical decision support system (CDSS) "Arogya Sahyog" (a Hindi term meaning 'health assistant') to guide them through the process. Herein, we describe the protocol for testing this CDSS and the associated community-based management program for people with NCDs. METHODS This mixed-method study involving both qualitative and quantitative approaches will be conducted in two phases to test: (I) feasibility of the CDSS itself, and (II) feasibility of utilizing the app to develop capacity within the ASHA workforce. First, we will use a semi-structured questionnaire to determine details about the acceptance of using the app, satisfaction with the CDSS, perceived barriers, ideas for improvement, and willingness to use the CDSS. We will also test the usability of this CDSS for the identification of people with hypertension, with or without co-morbidities, by ASHAs and their supervisors. The CDSS will be installed on a tablet and is designed to help ASHAs to screen, provide lifestyle advice, and refer critical patients to primary care physicians. Second, to develop capacity within the ASHA workforce, ASHAs will be taught about NCDs, so they can motivate people to adhere to healthy activities and self-manage their NCDs. We will also test whether this training program improves ASHAs' knowledge about NCDs. We will further evaluate ASHAs' capacity to provide health promotional interventions to patients with, or at risk of, NCDs using the tablet device. DISCUSSION The study will enable us to test a CDSS and an educational training program. Specifically, we will test whether the program is user-friendly, easy-to-comprehend, easy-to-deliver, workflow-oriented, and comprehensive. We will determine whether mobilizing this ASHA workforce with the support of a CDSS could result in better management of hypertension and co-morbidities than usual care.
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Affiliation(s)
- Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Roger G. Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | - Rajkumari Singh
- Garhwal Community Development and Welfare Society, Chamba, Tehri Garhwal, Uttarakhand, India
| | - Akash Singh
- Garhwal Community Development and Welfare Society, Chamba, Tehri Garhwal, Uttarakhand, India
| | - Parul Singh
- Garhwal Community Development and Welfare Society, Chamba, Tehri Garhwal, Uttarakhand, India
| | - Rajesh Singh
- Garhwal Community Development and Welfare Society, Chamba, Tehri Garhwal, Uttarakhand, India
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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