Abstract
BackgroundIn the backdroup of a rapidly increasing burden of diabetes in Nepal, a community-based diabetes management program is implemented involving female community health volunteers (FCHVs) under the government run FCHVs program. FCHVs received an intensive one-week training workshop on prevention, control and management of diabetes. The training program was implemented and evaluated to enhance diabetes knowledge of FCHVs and matched according to their literacy level.MethodsA range of teaching methods were applied, including desk review, active participation, lectures, presentations, discussions, role plays, demonstration and field test. Evaluation of the knowledge attained was done by testing before and after the workshop. Major milestones in the development of the training module were presented from desk review and ending in stakeholder’s participation in reviewing and revising the training package. The qualitative interview transcripts of FCHVs were analyzed thematically.ResultsA 5-day training package was developed through a desk review of interventions using community health workers (CHWs) on diabetes management from similar settings. Training module included home-based blood glucose monitoring and home-based health education on life style counselling delivered through a participatory learning approach. There were 20 participants with a mean age of 47 years (SD ± 5.7). The overall assessment of knowledge of diabetes before-after the training, evaluated by the Diabetes Knowledge Questionnaire (DKQ) showed increases in mean score from 40.4% before training to a mean score of 63.3% after training (Paired t-test: t = − 11.1, P < 0.001, and Wilcoxon test for paired samples: z = − 3.930, P = 0.0001). Focus group discussions (FGDs) revealed that FCHVs had a favorable perception of the training program’s effectiveness.ConclusionsIf FCHVs are appropriately trained they may be instrumental in providing counseling and screening for diabetes management in their communities.
Highlights
In the backdroup of a rapidly increasing burden of diabetes in Nepal, a community-based diabetes management program is implemented involving female community health volunteers (FCHVs) under the government run Female Community Health Volunteers (FCHV) program
Education levels ranged from 4 to 12 years of schooling with 5% having attained grades 12 years. 85% had worked as FCHVs for more than 10 years 65% were from upper-caste, 60% had up to mid-level education, the mean years of being FCHVs was 18.8 (SD ± 7.3)
The overall assessment of knowledge of diabetes addressed by the Diabetes Knowledge Questionnaire (DKQ) questionnaire increased from a mean score of 40.4% before training to a mean score of 63.3% after training (Paired t-test, t = − 11.1, P = 0.000 and Wilcoxon test for paired samples: z = − 3.930, P = 0.0001)
Summary
In the backdroup of a rapidly increasing burden of diabetes in Nepal, a community-based diabetes management program is implemented involving female community health volunteers (FCHVs) under the government run FCHVs program. FCHVs received an intensive one-week training workshop on prevention, control and management of diabetes. More than 422 million adults were living with diabetes in 2014, with almost half remaining undiagnosed (47%); this number is projected to almost double by 2030 [2]. Gyawali et al BMC Public Health (2018) 18:641 This is linked to the changes in lifestyle among the Nepalese populations formerly at less risk in a predominantly agriculture based economy. Many people with diabetes remain untreated and the burden of disease has exerted an extra pressure on the already fragile health system. The World Health Organization (WHO) recommends a community-based program for prevention and control of diabetes as the optimal strategy for mitigating the emerging burden [5]
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