Community Health Care Workers Research Articles

Feasibility of Engaging Community Healthcare Workers to Identify and Enhance Subfertility Care in The Northern Province, Sri Lanka

Feasibility of Engaging Community Healthcare Workers to Identify and Enhance Subfertility Care in The Northern Province, Sri Lanka

Strengthening community actions to improve diabetes mellitus care optimising public health facilitators

BackgroundDiabetes mellitus is the second leading cause of death in South Africa, and almost 90,000 people died from diabetes-related causes in the year 2019. This study aimed to investigate facilitators that can be harnessed to strengthen community actions and barriers that should be redressed in structured public health and health promotion programs for people with diabetes mellitus at a primary healthcare level.MethodsAn exploratory qualitative study was conducted using face-to-face interviews among 20 conveniently sampled participants. The Ottawa Charter was adopted to guide health promotion and strengthening actions for people with diabetes mellitus. This study was conducted at Ngangelizwe Community Health Centre. Ngangelizwe is one of the townships located about 2 km east of Mthatha Town in the Eastern Cape Province of South Africa. The thematic analysis method was used to analyse data with the assistance of Atlas ti, version 23 software.ResultsFive overarching themes were yielded and categorized as facilitators and barriers. Facilitators included enhancing the role of community healthcare workers and strengthening health education activities. Barriers included lack of support groups, food insecurity, and unavailability of community health promotion programs.ConclusionWe conclude that a collaborative health promotion intervention with the necessary competencies should be designed to assess needs and develop, implement, and evaluate relevant empowerment programs at the household and community levels. This approach involves active engagement with health promoters/ public health practitioners and community health workers at the local level, allowing individuals and communities to access motivation and knowledge regarding the control of diabetes mellitus.

Targeted distribution of long-lasting insecticidal nets by community health workers to sustain household coverage: A pilot feasibility study in Western Uganda.

Universal coverage is defined by the World Health Organization as 1 long-lasting insecticidal net (LLIN) for 2 people in a household. While Uganda has been a leader in the distribution of LLINs, there are concerns regarding the longevity of LLINs. The main aim of this study was to address the LLIN coverage gap that emerges in the period after mass distribution campaigns through the implementation of a novel LLIN distribution strategy utilizing the existing community healthcare worker (CHW) infrastructure. We conducted a pilot feasibility study in two villages randomized to be the control or intervention. CHWs in both villages carried out their regular duties and calculated household eligibility to receive LLINs, classified as having a child under five positive for malaria and being below universal coverage. Only CHWs in the intervention village distributed LLINs to eligible households to reach universal coverage. Summary statistics were calculated for intervention implementation and malaria outcomes. Structured interviews were conducted with CHWs to assess burden and community acceptability of the intervention. Of the children evaluated by the CHWs, 102 of 169 (60.3%) and 112 of 171 (65.5%) were tested for malaria, of which 62 (60.7%) and 71 (63.3%) tested positive in the intervention and control villages, respectively. Only three households were at universal coverage. There was an increase from 4.0% to 6.5% of households meeting universal coverage in the intervention village, compared to a decrease from 7.8% to 1.8% in the control village after the follow-up period. There was an increase in the number of children under the age of 5 who slept under an LLIN the previous night from 15.7% to 31.6% in the intervention village compared to a decrease in the control village from 29.1% to 10.5%. No CHWs reported an increased burden from the intervention and all reported favorable opinions. Our pilot study demonstrates the feasibility and acceptability of targeted LLIN distributions leveraging the existing structure to supplement national distribution campaigns in Uganda. Overall, this work highlights the critical need for novel approaches to sustain LLIN coverage between distribution campaigns, particularly towards the end of the 3-year cycle.

An evaluation of a community dementia screening program in rural Kenya: DEM-SKY.

This study describes the implementation outcomes and evaluation of DEM-SKY, a community-based dementia screening program developed in rural Kenya with the support of community health care workers (CHWs). DEM-SKY was delivered to 3546 older adults in Makueni County, Kenya, over a 6-month period. Using a mixed-methods design, we explored implementation outcomes with stakeholders through surveys and interviews. The program demonstrated good acceptability, adoption, and fidelity and was effective in instigating behavior change. Individuals who screened positive for dementia were 28.7 times more likely to intend to speak to a doctor. Qualitative data showed that participants valued the program but indicated scope for improvement, particularly further down the diagnostic pathway. DEM-SKY was successful across several implementation metrics. Although the program demonstrates that community-based screening can be conducted effectively with minimal resources, future research needs to explore the long-term benefits of dementia screening in Kenya. Community-based dementia screening is feasible in rural Africa. Involving community health workers strengthens trust in health care systems. Empowering community health workers enhances the community capacity to address dementia Screening promotes proactive health seeking among older adults.

Role of Public Health Campaigns in Increasing Vaccination Rates in Rural Communities in Bangladesh

Purpose: The aim of the study was to investigate the role of public health campaigns in increasing vaccination rates in rural communities. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Public health campaigns have proven effective in increasing vaccination rates in rural communities, especially when using a combination of media and direct methods like community meetings or mobile health units. Multi-channel approaches, such as multimedia campaigns, have shown significant increases in vaccine uptake by targeting different demographic groups. Community-led educational sessions have also led to notable improvements by leveraging trusted local figures to address myths and encourage immunization. SMS reminders have helped improve adherence to vaccination schedules, though challenges like phone ownership and literacy still exist. Unique Contribution to Theory, Practice and Policy: Health belief model (HBM), diffusion of innovations theory & social ecological model (SEM) may be used to anchor future studies on the role of public health campaigns in increasing vaccination rates in rural communities. It is essential to leverage the power of trusted local figures, such as community leaders, healthcare workers, and teachers, to address vaccine hesitancy. Governments and public health bodies should develop policies that prioritize context-specific, culturally sensitive, and linguistically appropriate campaigns in rural areas.

Perceptions of community healthcare workers on the use of teledentistry for seniors in Singapore: A qualitative study.

This study aimed to identify barriers and facilitators surrounding the implementation of TDOCS from Community Health Workers (CHW)'s perspective before TDOCS implementation. A descriptive qualitative study was conducted through semistructured interviews with a purposive sampling of CHWs from partner nursing homes and home care teams. A French framework outlining barriers to asynchronous oral teleconsultation adoption was used to develop the topic guide for this study. Then, the Consolidated Framework for Implementation research (CFIR 1.0) was used to guide coding and analysis. A total of 43 CHWs from participating institutions were interviewed prior to receiving teledentistry training. Perceived barriers included low awareness about the importance of dental care, limiting conditions to T-DOCS participation among beneficiaries, limited understanding of T-DOCS, perceived low self-efficacy among CHWs, manpower shortages, perceived low priority of dental care, competition with other nursing duties and restricted access due to COVID-19. Facilitators included existing relationships between CHWs and beneficiaries, receptivity towards participation, CHWs' motivation to upskill and improve dental care for seniors, prior experience with other telemedicine technology, perceived need for change, supportive management, colleagues and existing impediments to access dental care. This study identified barriers and facilitators to implementing T-DOCS from the CHWs' perspectives. We recommend for targeted CHW training, programme champions, workflow integration and incentivisation schemes. Addressing challenges like manpower strain and resource limitations through efficient scheduling and capacity building is vital for sustainability. Policy-level support, including legal frameworks, funding and regulatory structures, is essential for integrating teledentistry into mainstream healthcare.

Help-seeking intention for mental illness and associated factors among Dessie town residents in Northeast Ethiopia

Despite the increasing global burden of mental illness and the availability of effective evidence-based treatments, many individuals with mental illness do not seek professional help. Therefore, this study aimed to assess help-seeking intention for mental illness and associated factors among Dessie town residents, Northeast Ethiopia, 2021. A community-based cross-sectional study was conducted among 501 Dessie town residents. The data were collected by face-to-face interview. The General Help Seeking Questionnaire was used to assess help-seeking intention. Bivariable and multivariable logistic regression analysis techniques were used. Finally, a statistically significant level was declared at a p-value less than 0.05. Among 501 participants, 67.5% were likely to seek help from health professionals. Being female (AOR = 4.695, 95% CI = 1.63– 13.50), being single (AOR = 0.330, 95% CI = 0.12–0.89), and having good knowledge (AOR = 3.030, 95% CI = 1.25–7.35) were significantly associated with help-seeking intention. This study indicated that the participants’ help-seeking intention was inadequate. Sex, marital status, monthly income, and knowledge of mental illness were found to be associated with help-seeking intentions for mental illnesses. Therefore, community healthcare workers, healthcare administrators, and religious and community leaders should work to enhance the help-seeking intention of the community.

Tackling Cardiovascular Care Deserts in Romania: Expanding Population Access in Underserved Areas

Background: Cardiovascular deserts are areas that lack medical facilities, specialists and equipment to effectively diagnose, treat and manage cardiovascular diseases (CVDs). Romania registers the highest incidence and the highest mortality due to CVDs in Europe. Population ageing is a significant concern, as it increases the risk of CVDs and the demand for specialised care. Although almost 50% of Romanians still live in rural areas, most medical resources are concentrated in a few large cities, leaving large parts of the country underserved. Methods: This study used the Application Programming Interface (API) Matrix service from Google Maps and open data sources to identify cardiovascular (CV) deserts. Results: This research indicates that over 64% of the Romanian population resides in areas lacking CV care, having to travel more than 60 km and over 30 min to reach the nearest facility that offers specialised treatment. Moreover, 14% live in areas affected by a high degree of cardiovascular desertification. These areas are primarily located in northeastern, southern and western Romania. They experience higher mortality rates from CVDs and an ageing population, along with a shortage of general physicians and a scarcity of cardiologists. Conclusions: The identified cardiovascular deserts in this study overlap mountainous regions, the Danube Delta and remote rural areas with poor transportation infrastructure. Implementing telemedicine or mobile healthcare services, involving community healthcare workers and policy support could be solutions to expand access to specialised care in cardiovascular deserts.

A unique combination of coping strategies promotes each domain of post-traumatic growth during COVID-19: Differences between community residents and healthcare workers

Undeniably the COVID-19 pandemic has resulted in unprecedented threats and severe traumas for human beings. However, for a proportion of people, the struggle with this crisis has led to positive mental health outcomes, known as posttraumatic growth (PTG). This study compared the PTG levels between community residents and healthcare workers (HCWs) across two time points and identified the coping strategies that promote each PTG domain separately. An online questionnaire was administered to 2,437 respondents (499 and 253 HCWs and 1157 and 528 community residents, at timepoints 1 and 2, respectively). The Post-Traumatic Growth Inventory assessed the five PTG domains and the Brief COPE the coping strategies. After controlling for gender, age, and education, ANCOVA showed a significant interaction effect; although HCWs had lower scores on PTG compared to community residents at T1, at T2 they had significantly higher scores. The coping strategies of positive reframing and religion positively predicted all PTG domains among both groups. Denial was the third most frequently used strategy, followed by active coping. On the other hand, certain coping strategies were unique predictors of specific PTG domains or groups. Self‒Distraction predicted community residents’ Personal Strength (also Behavioral Disengagement) and Appreciation of life, Emotional Support predicted community residents’ Relating to others and HCWs’ Appreciation of life, and self-blame predicted HCWs’ Relating to others and Personal Strength. The identification of these compilations of coping strategies for each PTG domain can guide preventive training programs targeting specific coping strategies that need to be enhanced in each sampling group.

Preface to the health-psychology article collection

Health psychology is a relatively new subfield of psychology that emphasizes the biopsychosocial model, where physical well-being and disease reflect a complex set of interrelated processes, involving psychological, social, and biological factors. Health psychologists use psychological science to promote health, prevent illness, and improve health care systems. Despite significant advancements in research and practice, the field faces numerous challenges, such as the application of technology and telehealth to monitoring health behaviors, the integration of mental health care with physical health services, the reduction in health disparities, the shift towards primary and secondary prevention, the adoption of an interdisciplinary collaboration approach, and the development and implementation of policy and advocacy strategies. In this special issue, six health psychology-related papers are included that address the role of coping and stress mindset in the intensity of stress responses, the importance of emotional states and expert influence in vaccination decisions against human papillomavirus, the posttraumatic growth of community residents and healthcare workers during the COVID-19 pandemic, the impact of COVID-19 fear on healthcare professionals’ quality of life, the relationship between COVID-related stress and COVID-related immunity and self-regulation factors, as well as the associations between optimism and health orientation during the COVID-19 pandemic. By examining psychosocial factors related to health problems and health-related issues, the authors have contributed to advancing our understanding of how such factors can help individuals better manage and cope with health challenges. The findings from these studies may help inform targeted interventions and strategies to improve overall well-being and address the psychological aspects of health and illness, particularly in the context of global health problems.

A multi-phase structured cascade model for mass training of community healthcare workers in performing clinical breast exams in remote regions.

Clinical breast exam (CBE) by outreach healthcare workers (HCW) may help downstage breast cancer in resource-limited areas where mammography may not be feasible. We evaluated the effectiveness of a pilot cascade-model training programme for HCWs in remote areas of Pakistan. The training programme comprised three phases. In phase one, fellowship-trained breast surgeons at a metropolitan academic centre trained six HCWs to perform CBEs. In phase two, these six HCWs (master trainers) trained 15 additional HCWs, implementing cascade training. In phase three, the consultant breast surgeon conducted a re-evaluation and refresher course for all 21 HCWs at least one year after the original training session. We assessed CBE ability and skills through pre- and post-changes through self-reported confidence and direct observation of procedural skills. Significant improvements in learners' self-reported confidence and CBE skills were observed in both phases one and two. The median scores in the learners' post-training self-reported confidence and CBE skills (inspection, palpation, and lymph node examination) improved by 20% and 46.2%, respectively, indicating excellent learning outcomes of the cascade training sessions. Phase three showed sustained high scores in self-reported confidence and CBE skills more than one year later. Mass training of outreach HCWs in remote regions in performing CBE may be possible with a structured multiphase cascade-training model and may be an important step in downstaging symptomatic breast cancer in low-resource settings.

Improving stunting prevention program through community healthcare workers training and home-based growth monitoring: A quality improvement model

Improving stunting prevention program through community healthcare workers training and home-based growth monitoring: A quality improvement model

Knowledge of dementia: A cross-sectional survey of Aboriginal and Torres Strait Islander community members and health-care workers providing care to Aboriginal and Torres Strait Islander people.

To examine (1) the knowledge of dementia among Aboriginal and Torres Strait Islander community members and health-care workers providing care to Aboriginal and Torres Strait Islander people; (2) the factors associated with higher levels of knowledge about dementia. An online cross-sectional survey was conducted. Aboriginal and Torres Strait Islander community members were recruited through social media advertisements and an online market research platform. Health-care workers (general practitioners, nurses, Aboriginal health workers and allied health professionals) were recruited via emailed invitations from a peak body and a community service organisation. Participants answered an online survey containing 34 true/false items examining knowledge of dementia. Separate linear regressions were used to examine the factors associated with higher levels of knowledge about dementia among community members and health-care workers. Two hundred and twenty individuals (74 community members and 146 health-care workers) participated. The overall mean knowledge of dementia score for all participants was 26.80 (SD = 4.43). Health-care workers had higher knowledge (M = 27.23, SD = 4.66) than community members (M = 25.96, SD = 3.82, p = .04). Community members with higher levels of education answered 6% (95% CI 1%-11%) more items correctly than participants with lower levels of education. General practitioners and nurses had significantly higher knowledge of dementia; however, health-care workers who provided care to a family member or friend living with dementia had significantly lower knowledge of dementia. Novel approaches are needed to increase knowledge of dementia amongst both Aboriginal and Torres Strait Islander community members and health-care workers who provide care to ensure culturally sensitive and effective support.

Empathy and Awareness: Shifting Perceptions on HIV in Underserved Communities

HIV continues to disproportionately affect underserved communities, where stigma, misinformation, and limited healthcare access often hinder effective prevention and treatment. This review explores the role of empathy and awareness in transforming attitudes toward HIV in these communities. Empathy-driven interventions, alongside targeted awareness campaigns, can reduce stigma, promote understanding, and encourage individuals to engage in HIV testing and prevention. By humanizing the issue of HIV, these initiatives foster compassion, shift perceptions, and create supportive environments for people living with HIV, ultimately improving health outcomes. The review highlights the importance of culturally sensitive HIV education and the critical role of peer-led initiatives in changing community perceptions. Peer educators, especially those living with HIV, help break down barriers by offering relatable, nonjudgmental support. These programs empower individuals to take charge of their health and seek HIV-related care without fear of discrimination. Through local influencers, such as community leaders and healthcare workers, awareness campaigns can effectively challenge harmful myths and promote accurate information about HIV transmission, prevention, and treatment. Keywords: Empathy, HIV awareness, underserved communities, stigma reduction, healthcare access

Routine Immunization Microplanning Challenges and Opportunities in Low- and Middle-Income Countries: A Mixed-Method Landscape Analysis.

Microplanning is widely recognized as a critical tool for improving immunization coverage and equity and is considered a core component of routine immunization. However, there is limited evidence on how microplans are developed and implemented and the effectiveness of microplanning. As such, this study sought to review the existing evidence on implementation and institutionalization of microplanning; identify strategies to improve microplanning; and document evidence on new approaches to microplanning, including digitally enhanced and integrated microplanning. We employed a three-stage mixed-method approach. First, we conducted a literature review on microplanning for routine immunization. Second, we administered an online survey to gather insights into the factors that constrained and enabled microplanning in low-resource settings. Third, we conducted key informant interviews to better understand the barriers and enablers. We found a paucity of published literature describing the drivers and effectiveness of microplanning and how to sustain it over time. Our review indicates that factors at both the development and implementation stages influence implementation and whether the process is sustained over time. These include the level of community engagement and health care worker ownership, access to data, the complexity of the microplanning tools, and the extent to which supervisors follow up on the plans. Our review indicates that microplanning is successful when health care workers and communities are engaged in the development process. While these findings highlight the benefits of a 'bottom-up' approach to microplanning, this may be more resource-intensive, and there remains a need for more research on the costs and benefits.

The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on family cohesion among children in Uganda: Analysis of the cluster randomized SMART Africa-Uganda scale-up study (2016-2022).

Family functioning plays a critical role in childhood disruptive behavior disorders (The Family Journal, 2003, 11(1), 33-41; Research in Nursing and Health, 2016, 39(4), 229-243). Yet, there is limited research on the impact of evidence-based family strengthening interventions on improving family cohesion as a protective factor among children experiencing behavioral challenges. To address this gap, we analyzed data (N = 636) from the SMART Africa-Uganda study (2016-2022), a cluster randomized clinical trial testing an evidence-based family-strengthening intervention called Amaka Amasanyufu (translated as "Happy Families" in the local language). Children aged 8-13 and their caregivers were recruited from 26 public primary schools that were randomized to: (1) control condition receiving generalized psychosocial literature (10 schools), (2) intervention delivered via parent peers (eight schools), and (3) intervention delivered via community healthcare workers (eight schools). Children completed the family cohesion questionnaire at baseline, 8 weeks, 16 weeks, and 6 months post-intervention completion. The intervention effectiveness was evaluated via a three-level logistic mixed effects model with pairwise comparisons across study conditions within each time point. Participants in the parent-peer intervention group had greater odds of being in the higher family cohesion group than participants in the control group at 8 weeks (OR = 3.24), 16 weeks (OR = 1.88) and 6 months (OR = 2.07). At 8 weeks, 16 weeks, and 6 months, participants in the community health worker group had 3.98, 2.08, and 1.79 times greater odds of being in the higher family cohesion group than participants in the control group, respectively. Our findings strengthen the evidence base for Amaka Amansayufu as an effective intervention that can be utilized in SSA to improve family cohesion in families with children experiencing behavioral challenges.

A feasibility study of upcycled smartphone-based colposcopy for visual inspection of cervix performed by community healthcare workers in rural Vietnam

A feasibility study of upcycled smartphone-based colposcopy for visual inspection of cervix performed by community healthcare workers in rural Vietnam

Provider and community perceptions of integrated COVID-19 and routine childhood immunisation programmes in Nigeria: a qualitative exploratory study

BackgroundIn Nigeria, COVID-19 vaccines were delivered through outreach activities, as well as integrated within routine immunisation. However, evaluations of integrated approaches for novel vaccines are scarce. We aimed to understand the perceived benefits and challenges of integrating the COVID-19 vaccine within routine immunisation in Nigeria, and identify ways to strengthen this approach.MethodsWe conducted 30 semi-structured interviews with community members and healthcare workers in primary healthcare facilities (PHCs) in Jigawa (n = 16) and Oyo (n = 14) states, Nigeria from 08 August to 13 September 2022. Participants were selected purposively from PHCs. We obtained information on participants’ perception about routine immunisation, and perceived benefits and challenges associated with integrated COVID-19 vaccine delivery. Healthcare worker and community interviews were analysed separately following a thematic analysis approach.ResultsWe identified four themes that describe the community and healthcare workers’ responses, perceived impact, and the health system adaptions to the challenges associated with the integrated vaccine delivery approach. Community members expressed concern that children might be given COVID-19 vaccines instead of routine immunisations, while others appreciated the integrated approach due to their trust in the efficacy of COVID-19 vaccines, government, and healthcare providers. Healthcare providers perceived the integrated approach as improving vaccination coverage and awareness but noted additional problems of increased workload, vaccine scarcity, and prolonged clinic visits. Insufficient resources were subsisting barriers to effective integration in both states, but the provider’s gender was also a challenge in Jigawa state. Additionally, the use of incentives to generate demand had ambiguous effects in Jigawa state.ConclusionTaking an integrated approach to deliver COVID-19 vaccines was acceptable by healthcare providers but community members expressed concerns. Given existing vaccination programmes have persistent challenges, it is pertinent to address these barriers to enhance effectiveness of an integrated approach.

Perceptions of roles of community healthcare workers in early childhood in Limpopo, South Africa.

As part of the Reengineering Primary Health Care initiative, the South African National Department of Health (NDoH) has committed to expanding access to home-based care provided by community health workers. The NDOH also prioritised Community Health Workers (CHWs) in their agenda to improve child development outcomes in South Africa. However, there is limited research on CHWs' experiences and knowledge of early childhood development. To explore CHWs' motivation for work, their background, training and scope of work around Early Child Development (ECD). The study was conducted in Mopani District, Limpopo province, South Africa, in 2017. Five focus group discussions (FGDs) were conducted with 41 CHWs participating within a large cluster-randomised study. Data were analysed thematically using an inductive approach. Community health workers' motivation to work was influenced by personal experiences, community needs and community service. In terms of knowledge, CHWs indicated that a nutritious diet with extended breastfeeding, immunisations and preschool education is imperative for a child to thrive. The Road to Health Booklet, weighing scales and the mid-upper arm circumference tape were used as screening tools for ECD. Community health workers perceived their knowledge around ECD to be insufficient. Community health workers play a crucial role in healthcare; therefore, capacity development on ECD and the provision of ECD screening tools to optimise their under-five child visits are necessary.Contribution:This study will potentially contribute to the improvement of the CHW programme in ensuring that children under 5 years of age are holistically cared for to ensure that they thrive.

Development and Validation of the Communities Geriatric Mild Cognitive Impairment Risk Calculator (CGMCI-Risk).

Objectives: The aim was to develop and validate the Communities Geriatric Mild Cognitive Impairment Risk Calculator (CGMCI-Risk), aiding community healthcare workers in the early identification of individuals at high risk of mild cognitive impairment (MCI). Methods: Based on nationally representative community survey data, backward stepwise regression was employed to screen the variables, and logistic regression was utilized to construct the CGMCI-Risk. Internal validation was conducted using bootstrap resampling, while external validation was performed using temporal validation. The area under the receiver operating characteristic curve (AUROC), calibration curve, and decision curve analysis (DCA) were employed to evaluate the CGMCI-Risk in terms of discrimination, calibration, and net benefit, respectively. Results: The CGMCI-Risk model included variables such as age, educational level, sex, exercise, garden work, TV watching or radio listening, Instrumental Activity of Daily Living (IADL), hearing, and masticatory function. The AUROC was 0.781 (95% CI = 0.766 to 0.796). The calibration curve showed strong agreement, and the DCA suggested substantial clinical utility. In external validation, the CGMCI-Risk model maintained a similar performance with an AUROC of 0.782 (95% CI = 0.763 to 0.801). Conclusions: CGMCI-Risk is an effective tool for assessing cognitive function risk within the community. It uses readily predictor variables, allowing community healthcare workers to identify the risk of MCI in older adults over a three-year span.