Feasibility of community health workers using a clinical decision support system to screen and monitor non-communicable diseases in resource-poor settings: study protocol.

Abstract

It is imperative that coordinated and systematic action is undertaken, at all levels, to minimize the consequences of the growing global burden of non-communicable diseases (NCDs). An integrated multi-disciplinary primary care-based preventive program has the potential to reduce lifestyle-related risk factors contributing to NCDs. Accredited Social Health Activists (ASHAs), who are community health workers (CHWs), may be employed to screen populations for NCDs in rural India. To enable ASHAs to be supported when they are on their own in the community, we have developed a clinical decision support system (CDSS) "Arogya Sahyog" (a Hindi term meaning 'health assistant') to guide them through the process. Herein, we describe the protocol for testing this CDSS and the associated community-based management program for people with NCDs. This mixed-method study involving both qualitative and quantitative approaches will be conducted in two phases to test: (I) feasibility of the CDSS itself, and (II) feasibility of utilizing the app to develop capacity within the ASHA workforce. First, we will use a semi-structured questionnaire to determine details about the acceptance of using the app, satisfaction with the CDSS, perceived barriers, ideas for improvement, and willingness to use the CDSS. We will also test the usability of this CDSS for the identification of people with hypertension, with or without co-morbidities, by ASHAs and their supervisors. The CDSS will be installed on a tablet and is designed to help ASHAs to screen, provide lifestyle advice, and refer critical patients to primary care physicians. Second, to develop capacity within the ASHA workforce, ASHAs will be taught about NCDs, so they can motivate people to adhere to healthy activities and self-manage their NCDs. We will also test whether this training program improves ASHAs' knowledge about NCDs. We will further evaluate ASHAs' capacity to provide health promotional interventions to patients with, or at risk of, NCDs using the tablet device. The study will enable us to test a CDSS and an educational training program. Specifically, we will test whether the program is user-friendly, easy-to-comprehend, easy-to-deliver, workflow-oriented, and comprehensive. We will determine whether mobilizing this ASHA workforce with the support of a CDSS could result in better management of hypertension and co-morbidities than usual care.