Application of primary healthcare principles in national community health worker programmes in low-income and middle-income countries: a scoping review

OBJECTIVE

To identify which primary healthcare (PHC) principles are reflected in the implementation of national community health worker (CHW) programmes and how they may contribute to the outcomes of these programmes in the context of low-income and middle-income countries (LMICs).

DESIGN

Scoping review.

DATA SOURCES

A systematic search was conducted through PubMed, CINAHL, EMBASE and Scopus databases.

ELIGIBILITY CRITERIA

The review considered published primary studies on national programmes, projects or initiatives using the services of CHWs in LMICs focused on maternal and child health. We included only English language studies. Excluded were programmes operated by non-government organisations, study protocols, reviews, commentaries, opinion papers, editorials and conference proceedings.

DATA EXTRACTION AND SYNTHESIS

We reviewed the application of four PHC principles (universal health coverage, community participation, intersectoral coordination and appropriateness) in the CHW programme's objectives, implementation and stated outcomes. Data extraction was undertaken systematically in an excel spreadsheet while the findings were synthesised in a narrative manner. The quality appraisal of the selected studies was not performed in this scoping review.

RESULTS

From 1280 papers published between 1983 and 2019, 26 met the inclusion criteria. These 26 papers included 14 CHW programmes from 13 LMICs. Universal health coverage and community participation were the two commonly reported PHC principles, while intersectoral coordination was generally missing. Similarly, the cultural acceptability aspect of the principle of appropriateness was present in all programmes as these programmes select CHWs from within the communities. Other aspects, particularly effectiveness, were not evident.

CONCLUSION

The implementation of PHC principles across national CHW programmes in LMICs is patchy. For comprehensiveness and improved health outcomes, programmes need to incorporate all attributes of PHC principles. Future research may focus on how to incorporate more attributes of PHC principles while implementing national CHW programmes in LMICs. Better documentation and publications of CHW programme implementation are also needed.

A case for community health programs for sickle cell anemia in low- to middle-income countries: An integrative review

OBJECTIVE

The purpose of this review is to determine the factors associated with the outcomes of community health programs with particular focus on low- to middle-income countries. In addition, this review aims to suggest how these factors can affect the creation of a Sickle Cell Anemia health program in sub-Saharan Africa.

DESIGN AND SAMPLE

A literature review spanning the last decade (March 2007 to February 2017) was conducted using the Whittemore and Knafl integrative review framework.

RESULTS

Community ownership, networking, and resource allocation were identified as themes that affect community health program outcomes. Attempts to use a guiding principle or process to implement community health programs were also apparent in the literature.

CONCLUSION

More rigorous scientific investigation is needed to ensure that these community health programs are effective and have measurable outcomes. Nursing is well positioned, considering the metaparadigm concepts that guide practice, to forge this research. Nursing scientists could fill the gap in knowledge related to community health program outcomes in low- to middle-income countries while achieving global objectives focused on decreasing noncommunicable disease burden.

How does the impact of a community trial on cardio-metabolic risk factors differ in terms of gender and living area? Findings from the Isfahan healthy heart program

OBJECTIVE

To assess the impact of gender and living area on cardiovascular risk factors in the context of a comprehensive lifestyle intervention program.

DESIGN

Data from independent sample surveys before (2000--2001) and after (2007) a community trial, entitled the Isfahan Healthy Heart Program (IHHP) were used to compare differences in the intervention area (IA) and reference area (RA) by gender and living area.

SETTING

The interventions targeted the population living in Isfahan and Najaf-Abad counties as IA and Arak as RA.

PARTICIPANTS

Overall, 12 514 individuals who were more than 19 years of age were studied at baseline, and 9570 were studied in postintervention phase.

INTERVENTIONS

Multiple activities were conducted in connection with each of the four main strategies of healthy nutrition, increasing physical activity, tobacco control, and coping with stress.

MAIN OUTCOMES

Comparing serum lipids levels, blood pressure, blood glucose and obesity indices changes between IA and RA based on sex and living areas during the study.

RESULTS

In IA, while the prevalence of hypertension declined in urban and rural females (P < 0.05). In IA, the prevalence of hypercholesterolemia and hypertriglyceridemia decreased in both females and males of urban and rural areas except for hypercholesterolemia in rural males (P < 0.01). In RA, the significant changes include both decrease in the hypercholesterolemia among rural males (P < 0.001) and hypertriglyceridemia in urban females (P < 0.01), while hypertriglyceridemia was significantly increased in rural females (P < 0.01).

CONCLUSIONS

This comprehensive community trial was effective in controlling many risk factors in both sexes in urban and rural areas. These findings also reflect the transitional status of rural population in adopting urban lifestyle behaviors.