195 Feasibility of Disseminating First Aid and Cardiopulmonary Resuscitation Education to Community Health Workers in India

Abstract

To examine the feasibility of training community health workers in first aid and cardiopulmonary resuscitation (CPR) as a means to implement an integrated emergency medical care model in rural India. In India, the main components of emergency medicine (EM) care are inadequate: in the community, during transportation, and at health care facilities. The current public health system in place, which incorporates community health workers (CHW) to disseminate vaccines and health education, could be built upon to alleviate this. This is a mixed-method, prospective observational study conducted in the community of Anupshahr in India’s Bulandshahr District. Inclusion criteria included all anganwadi workers (government CHW) and women of the self-help group (private CHW) who presented for the training sessions held at the Pardada Pardadi Educational society (PPES) school. CHWs were trained in CPR and first aid through a program developed by emergency physicians at Wayne State University School of Medicine in October 2016. The program’s efficacy was tested using a pretest before training and posttest conducted after retraining and evaluation at 6 months. These tests addressed knowledge, self-confidence in abilities, and self-reported behavior. Statistical analysis was done using Wilcoxon Rank Sum t-Test Approximation. There were 28 CHWs who received the initial training. 30 CHWs showed up for the follow-up training at 6 months, but only 8 were from the initial group. Mean experience was 17.5 years in post-test group and 13.9 which were not significantly different (p= 0.537). Mean number of CPR uses increased to 18.2 in past 6 months in the post-test group vs. 0.4 in the pre-test group, which is statistically different (p= 0.0010). However, the average score on the knowledge component of the pre-and post-test, as well as the percentage of CHWs who comfortable performing CPR were not significantly different (p-values of 0.4427 and 0.4914, respectively). CPR knowledge component (count and depth of performing CPR) showed improvement from pre to post tests, which were statistically significant (p-values of 0.0004 and 0.0015, respectively). Furthermore, wound cleaning and collapse treatment on the knowledge component also were statistically significant (p-values of 0.0104 and 0.0037, respectively). There seems to be an increase in confidence in performing CPR due to the education intervention, and an increase in the knowledge level of the recipients in areas including CPR technique, wound cleaning, and collapse treatment. Exact effectiveness of our training model was lost with differing pre-and post-test groups. As shown by this feasibility study, a simple interventional approach to CHW education has significant limitations. There continues to be limited data on the potential relationship between EM care and CHW interventions and the next phase of the study will build upon our results to introduce a more structured and effective intervention. A structured training that incorporates more rigorous follow-up methods to target education of the CHW workforce at a greater degree may serve to bridge the gap between effectiveness of EM care and the rural population.