1
|
Zaman SB, Singh R, Evans RG, Singh A, Singh R, Singh P, Prakash H, Kumar M, Thrift AG. Development and evaluation of a training program on non-communicable diseases to empower community health workers in rural India. PEC INNOVATION 2024; 4:100305. [PMID: 38974935 PMCID: PMC11225916 DOI: 10.1016/j.pecinn.2024.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 07/09/2024]
Abstract
Objective We developed and evaluated a training program for Accredited Social Health Activists (ASHAs), female community health workers (CHWs) in India, on non-communicable diseases (NCDs). Methods A 5-day training program, developed using government-approved manuals, was tested in a randomised controlled trial in the Tehri-Garhwal district. Quantitative comparisons were undertaken using Student's t-test and two-way ANOVA. ASHAs in the intervention group were asked questions about new skills learnt. Results Thirty-six ASHAs (20 intervention, 16 controls) participated (response rate 75.0%). Mean pre-test knowledge score was 43.3/100 points (95% CI 36.7-49.9) for the intervention group and 44.4 (38.9-49.9) for controls. The mean post-test knowledge score increased more in the intervention group (48.5-point increase; P < 0.0001), than in controls (9.8-point increase, P = 0.016; ANOVA interaction term (time*allocation) P < 0.0001). ASHAs in the intervention group reported learning new skills for detecting NCDs. Conclusion The training program increased knowledge of ASHAs on NCDs and improved their skills to detect NCDs. Our development and testing process for this training program, coupled with open-source resources, fosters innovation and collaboration in managing NCDs in LMICs. Innovation Our novel and adaptable training program incorporates interactive elements, case studies, and real-world scenarios to augment routine communication between ASHAs and community members for preventing NCDs.
Collapse
Affiliation(s)
- Sojib Bin Zaman
- Department of Health Sciences, James Madison University, Harrisonburg, VA, USA
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rajkumari Singh
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Roger G. Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
- Florey Institute of Neurosciences and Mental Health, University of Melbourne, Melbourne, Australia
| | - Akash Singh
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Rajesh Singh
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Parul Singh
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Hem Prakash
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Manoj Kumar
- Garhwal Community Development and Welfare Society, Tehri-Gharwal, Uttarakhand, India
| | - Amanda G. Thrift
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Rao S, Rao P, Shetty R, Prabhu N, Kulala Y, Suresh S, Baliga MS. Usefulness of structured teaching module in improving knowledge about cancer in Accredited Social Health Activist: A pilot study. J Cancer Res Ther 2023; 19:1803-1811. [PMID: 38376282 DOI: 10.4103/jcrt.jcrt_2110_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/09/2022] [Indexed: 02/21/2024]
Abstract
AIM In India, the Accredited Social Health Activists (abbreviated as ASHA) are an important group of community health workers and are involved in initiating and maintaining health care programs in the rural communities they live. This study was conducted with a purpose to evaluate the effectiveness of a structured teaching module in improving knowledge on cancer cause, diagnosis, and treatment in the ASHA workers. MATERIALS AND METHODS This was a cross-sectional pretest posttest study and was conducted from April 2017 to February 2020 with ASHA workers working in the various Primary Health Centers in Udupi and South Kanara districts of Karnataka and Kasargod district of Kerala in India after obtaining the permission from the medical officer in charge of the respective primary health centers. The participants were briefed about the study objective and also that confidentiality will be maintained. A validated investigator developed questionnaire consisting of 20 questions categorized into four domains (general, subject, diagnosis, and treatment aspects) was distributed to the willing volunteers before the start of the program. They were instructed to fill the pretest form before and posttest after the teaching program. Informed content was taken in a separate sheet and volunteers were informed not to write any personal or identification details. Resource persons with experience in cancer cause, diagnosis and treatment delivered the structured talk in the local language Kannada. The data collected from the filled questionnaires were subjected to frequency, percentage, mean, and standard deviation and appropriately subjected to Chi-square test or paired t-test. A P < 0.05 was considered statistically significant. RESULTS The demographic detail suggest that majority of the women were Hindus (79.3%), married (93.7%), between the age of 31-40 (46.7%) and had only matriculation as the highest education (68%). The analysis of the pretest administration collected before the start of teaching program indicates that most participants were aware of self-breast examination (79.74%) and that cancer is a disease as old as human civilization (70.26%), while only 8.82% were unaware of which is the leading type of cancer in rural women. The results analyzed from posttest indicate that the highest percentage change (323.96%) was observed for domain on treatment aspects followed by for general (64.03%), diagnosis (56.70%), and subject (36.42%) aspect and was significant (P < 0.001). The total mean values changed from 6.48 ± 2.01 in pretest to 11.81 ± 2.15 in posttest indicating an increase of 5.33 ± 1.91 and percentage change of 82.25% (P < 0.001). The results also showed that 60.8% had average, while 39.2% had good increment in the knowledge at the end of the program. CONCLUSIONS The observations of the current study indicate the usefulness of the structured teaching module in improving knowledge on cancer cause, diagnosis and treatment in the ASHA workers. It is proposed that with further training ASHA workers can be very useful in the propagation of cancer awareness and screening in the community they serve.
Collapse
Affiliation(s)
- Suresh Rao
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Pratima Rao
- Department of Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Rajesh Shetty
- Department of Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Nagraj Prabhu
- Department of Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Yathish Kulala
- Department of Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Sucharitha Suresh
- Department of Community Medicine, Father Muller Medical College, Mangalore, Karnataka, India
| | | |
Collapse
|
3
|
Mor N, Ananth B, Ambalam V, Edassery A, Meher A, Tiwari P, Sonawane V, Mahajani A, Mathur K, Parekh A, Dharmaraju R. Evolution of community health workers: the fourth stage. Front Public Health 2023; 11:1209673. [PMID: 37333563 PMCID: PMC10270722 DOI: 10.3389/fpubh.2023.1209673] [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: 04/21/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Comprehensive primary care is a key component of any good health system. Designers need to incorporate the Starfield requirements of (i) a defined population, (ii) comprehensive range, (iii) continuity of services, and (iv) easy accessibility, as well as address several related issues. They also need to keep in mind that the classical British GP model, because of the severe challenges of physician availability, is all but infeasible for most developing countries. There is, therefore, an urgent need for them to find a new approach which offers comparable, possibly even superior, outcomes. The next evolutionary stage of the traditional Community health worker (CHW) model may well offer them one such approach. Methods We suggest that there are potentially four stages in the evolution of the CHW - the health messenger, the physician extender, the focused provider, and the comprehensive provider. In the latter two stages, the physician becomes much more of an adjunct figure, unlike in the first two, where the physician is at the center. We examine the comprehensive provider stage (stage 4) with the help of programs that have attempted to explore this stage, using Qualitative Comparative Analysis (QCA) developed by Ragin. Starting with the 4 Starfield principles, we first arrive at 17 potential characteristics that could be important. Based on a careful reading of the six programs, we then attempt to determine the characteristics that apply to each program. Using this data, we look across all the programs to ascertain which of these characteristics are important to the success of these six programs. Using a truth table, we then compare the programs which have more than 80% of the characteristics with those that have fewer than 80%, to identify characteristics that distinguish between them. Using these methods, we analyse two global programs and four Indian ones. Results Our analysis suggests that the global Alaskan and Iranian, and the Indian Dvara Health and Swasthya Swaraj programs incorporate more than 80% (> 14) of the 17 characteristics. Of these 17, there are 6 foundational characteristics that are present in all the six stage 4 programs discussed in this study. These include (i) close supervision of the CHW; (ii) care coordination for treatment not directly provided by the CHW; (iii) defined referral pathways to be used to guide referrals; (iv) medication management which closes the loop with patients on all the medicines that they need both immediately and on an ongoing basis (the only characteristic which needs engagement with a licensed physician); (v) proactive care: which ensures adherence to treatment plans; and (vi) cost-effectiveness in the use of scarce physician and financial resources. When comparing between programs, we find that the five essential added elements of a high-performance stage 4 program are (i) the full empanelment of a defined population; (ii) their comprehensive assessment, (iii) risk stratification so that the focus can be on the high-risk individuals, (iv) the use of carefully defined care protocols, and (v) the use of cultural wisdom both to learn from the community and to work with them to persuade them to adhere to treatment regimens.
Collapse
Affiliation(s)
- Nachiket Mor
- Banyan Academy of Leadership in Mental Health, Chennai, India
| | | | | | | | | | | | | | | | | | - Amishi Parekh
- Artificial Intelligence and Robotics Technology Park, Bengaluru, India
| | - Raghu Dharmaraju
- Artificial Intelligence and Robotics Technology Park, Bengaluru, India
| |
Collapse
|
4
|
Wang L, Chen X, Zhang L, Li L, Huang Y, Sun Y, Yuan X. Artificial intelligence in clinical decision support systems for oncology. Int J Med Sci 2023; 20:79-86. [PMID: 36619220 PMCID: PMC9812798 DOI: 10.7150/ijms.77205] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Artificial intelligence (AI) has been widely used in various medical fields, such as image diagnosis, pathological classification, selection of treatment schemes, and prognosis analysis. Especially in the image-aided diagnosis of tumors, the cooperation of human-computer interactions has become mature. However, the ethics of the application of AI as an emerging technology in clinical decision-making have not been fully supported, so the clinical decision support system (CDSS) based on AI technology has not fully realized human-computer interactions in clinical practice as the image-aided diagnosis system. The CDSS was currently used and promoted worldwide including Watson for Oncology, Chinese society of clinical oncology-artificial intelligence (CSCO AI) and so on. This paper summarized the applications and clarified the principle of AI in CDSS, analyzed the difficulties of AI in oncology decisions, and provided a reference scheme for the application of AI in oncology decisions in the future.
Collapse
Affiliation(s)
- Lu Wang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xinyi Chen
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Lu Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Long Li
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - YongBiao Huang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yinan Sun
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xianglin Yuan
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| |
Collapse
|
5
|
Zaman SB, Evans RG, Singh R, Singh R, Singh A, Goh TY, Singh P, De Silva N, Thrift AG. Usability and acceptability of the software ‘Arogya Sahyog’ to assess non-communicable diseases in rural India. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|