Assessing the knowledge and skill of ASHA community health workers in blood pressure measurement and primary care of hypertension.

Abstract

India has a high burden of hypertension, and community health workers (CHWs) can contribute to its primary care. Studies of small-scale interventions have shown that trained CHWs can be useful contributors to hypertension care. No assessments are available in India on effectiveness of CHW training when conducted on a large scale. A study was conducted in Chhattisgarh, where 38,000 Accredited Social Health Activist (ASHA) CHWs had been trained in blood pressure (BP) measurement and counselling skills related to hypertension. The study involved a skill test and a knowledge test with ten points each, administered to two representative samples of trained CHWs - 433 in rural areas and 422 in urban slums. The mean skill score out of 10 was 7.79 (7.59-7.99) and 8.11 (7.93-8.29) for the rural and urban CHWs, respectively. Around 75.3% (71.0-79.1%) of the rural and 80.3% (76.2-83.9%) of urban CHWs were able to score 70% (7 out of 10) or higher in the skill test. The mean knowledge score out of 10 was 8.18 (8.04-8.33) and 8.82 (8.78-8.93) for the rural and urban CHWs, respectively. Around 83.2% (79.3-86.4%) and 95.0% (94.4-96.7%) of the rural and urban CHWs, respectively, were able to score 70% or higher in the knowledge test. The ASHAs in Chhattisgarh demonstrated the necessary competence to contribute to BP measurement and primary care of hypertension. It shows feasibility of training a large number of CHWs in such skills. Efforts to equip and support the 1 million strong cadre of ASHAs across India need to be speeded up.