Trained Community Health Workers Research Articles

Feasibility of a Motivational Interviewing Training for Community Health Workers

Feasibility of a Motivational Interviewing Training for Community Health Workers

Assessing the effect of the Health[e]Community blended e-learning training for Community Health Workers in Suriname

Assessing the effect of the Health[e]Community blended e-learning training for Community Health Workers in Suriname

The feasibility of establishing parent support groups for children with congenital Zika syndrome and their families: a mixed-methods study.

Background: The 2015 - 2016 Zika epidemic highlighted gaps in health and social care services for parents of children with developmental disabilities. In response, we developed the 'Juntos' intervention, a 10 week community-based early intervention support group for parents of children with congenital Zika syndrome (CZS). The intervention's components include participatory learning sessions, practical skill acquisition, peer support, and psychological support, aiming to improve caregiver's knowledge and confidence in caring for their children. This study aimed to evaluate the feasibility of implementing 'Juntos' in Colombia. Methods: Two facilitators delivered 'Juntos' to four groups of 8-10 caregivers between 2017 and 2018. One researcher observed each group. Data were collected from: observation notes from 40 sessions, focus group discussions held after each session, pre- post intervention questionnaires with 34 caregivers, and semi-structured interviews conducted with four facilitators, 12 caregivers and three stakeholders. We used the Bowen framework in data analysis. Results:The feasibility evaluation revealed that 'Juntos' was highly acceptable and in demand among the target population. The intervention was predominantly delivered with fidelity. Practicality was facilitated by providing transport costs and selecting convenient locations. Additional organisational and social media support was required for successful implementation. Community health worker training may support integration and the established groups could facilitate programme expansion. However, participants perceived lack of prioritisation as a limitation within existing health systems. Participants' knowledge and confidence to care for their child improved after programme enrolment. Conclusion:The 'Juntos' intervention demonstrated high acceptability, demand, and practicality in supporting parents of children with CZS in Colombia. However, its implementation faces challenges due to existing gaps in health system support for children with CZS.

Feasibility of Training Community Health Workers to Use Smartphone-Attached Microscopy for Point-of-Care Visualization of Soil-Transmitted Helminths in the Peruvian Amazon.

The prevalence of soil-transmitted helminths (STH) is high in communities within the Peruvian Amazon despite repeated mass-drug administration, demanding alternative strategies of control. Smartphone-attached microscopy (SAM) permits visualization of STH from a small portable microscope through a smartphone screen, potentially providing an inexpensive and rapid method of STH visualization in communities where diagnostic laboratories with microscopes are inaccessible. In this study, a total of 45 community health workers who work within the health systems of Loreto, Peru, attended a 1-day training session with lectures and practicums on STH and SAM. Participants received a pre- and post-intervention questionnaire. Post-intervention, participants were significantly more confident using SAM and identifying parasite images, symptoms, transmission, and treatment (P ≤ 0.0045). Post-intervention, participants correctly labeled a median of five of seven SAM apparatus components and five of eight steps of Kato-Katz technique, were less likely to choose taking medicine to prevent parasite infection (P = 0.0075), and were more likely to select Kato-Katz technique as a type of diagnostic test (P < 0.0001). Most participants felt ready to use SAM in their communities and stated that it could help rural communities far from health centers or laboratories (24%); provide faster identification, results, diagnosis (19%); permit at-home or on-the-spot visualization (14%); and save money (14%). Results show that community health workers show a high level of willingness and competency to learn about both STH and SAM and may be a yet-unexplored practical method of augmenting STH visualization, bringing healthcare to communities in Loreto with poor access to diagnostic laboratories and clinics.

Addressing Training Gaps: A Competency-Based, Telehealth Training Initiative for Community Health Workers.

To overcome vast variations in Community Health Worker (CHW) training, investigators for the CHW Core Consensus Project (CCCP) derived three types of CHW (Category 1, 2, 3) and established competencies for each category. However, studies are needed that implement these competencies in real-world settings. Using the six competency domains of the CCCP as a theoretical backbone, we developed and evaluated a training for Category 1 CHWs, individuals whose focus is on community outreach and advocacy. We developed five telehealth-based, bilingual (Spanish/English) training sessions and implemented them among Category 1 Latino(a) CHWs. We measured the number of CHWs who achieved ≥70% correct on a domain-based posttest, attendance, and qualitative feedback. All (18/18) CHWs achieved at least 70% on the posttest (mean: 93.7%; range 73.3-100%). Training attendance was 98.9%. Using a six-point scale, CHWs reported high levels of satisfaction overall (5.72 ± 0.57/6.0), with telehealth (5.72 ± 0.58/6.0), effectiveness of teaching strategies/methods (5.89 ± 0.32/6.0), achieving training objectives (5.96 ± 0.15/6.0), knowledge improvement (5.72 ± 0.57/6.0), and interest (5.78 ± 0.43/6.0). We successfully developed and evaluated a bilingual training program for Category 1 CHWs to address core competency gaps. High CHW attendance reinforces the value of telehealth modalities and their potential to increase the reach for CHW training. To overcome gaps in chronic disease training, investigations are needed to address additional CHW trainings. NCT04835493.

Embedding Care in Communities: Mixed-Methods Evaluation of a Community Health Worker Training Initiative in Rural Haiti.

Community Health Workers (CHWs) are valuable members within the communities they serve and increase access to health care by garnering the trust of their fellow neighbors, providing services including facilitating access to care, and improving the quality and cultural competence of service delivery. In Southern Haiti, there is a health care provider shortage with one doctor or nurse per 3,000 persons. CHWs are critical to help close the gap of the lack of access to care and facilitate the provision of basic health care. To describe the CHW training initiative at capra-care, a community-based health care provider in rural Haiti, using survey and focus groups results highlighting key findings and implications for the CHW initiative. A mixed-method approach was used to evaluate capracare's CHW Training program. Focus groups were conducted that documented the lived experience of CHWs following the training program; examined barriers and facilitators to translating the training skills to practice in the community. Pretest and post-test data assessed change in knowledge post the Community Health Worker Training (CHWT) program. Findings included 51 (57%) of the graduates. A significant increase was observed in mean test scores from baseline (n = 51; m = 61.48 ± 1.80) to post-test (m = 76.93 ± 1.73; t-7.69; P &lt; 0.001), indicating that the CHW training was successful in increasing participants' knowledge. Themes that emerged from the qualitative analysis were comprehension of skills learned, community benefit, and empowerment. Results from this CHWT program has implications to increase the health care workforce thus facilitating access to care among community residents in under-resourced regions.

Comparing an Intermittent Fasting Intervention With a Continuous Energy Restriction Intervention On Weight Loss in Community-Based Black Adults

Introduction: Compared to other racial/ethnic groups, Blacks have the highest rates of obesity, a well-established risk factor for some cancers. Continuous caloric energy restriction (CER) interventions consist of small reductions in daily caloric intake and are recommended by government agencies to treat obesity. However, these interventions are difficult to adhere to and cause less weight loss in Blacks compared to Whites. Intermittent fasting (IF), which can consist of eating 25% of one's daily calorie intake per day on some days and ad libitum intake on other days, causes the same amount of weight loss as CER interventions. IF may be easier for participants to adhere to and may lower cancer risk and prognosis to a greater extent than can be attributed to weight loss alone. However, most IF studies have been conducted with White participants, and have provided participants with standardized meals and/or nutrition counseling not readily available in real-world situations. Thus, the purpose of our study is to test the effect of IF interventions in diverse groups outside of controlled settings. Methods: We are comparing a 6-month CER intervention with a 6-month IF intervention on weight loss in Black adults using a blinded randomized controlled comparative effectiveness trial. Trained community health workers are delivering the interventions. Six churches (anticipated n = 60) were randomized to either intervention. Staff blinded to treatment condition are collecting anthropometric, 3-day dietary food recall, and survey data at baseline and 6-month follow-up. Results: To date, four churches (n = 29) have completed baseline and follow-up assessments. Most participants were female (82.6%) with a mean age of 57.9 years. There were significant within group differences, with both IF and CER participants losing 3.2% (4.4) and 2.8% (4.5), respectively, of their body weight from baseline to 6-month follow-up. Conclusion: This is the first study to test an IF intervention designed for community-based Black adults in a 'real-world' setting. If proven effective, this IF intervention has the potential to serve as an alternative to CER interventions for weight loss and cancer risk reduction in minority populations.

Caring for community members during the COVID-19 pandemic: results of a statewide survey.

Community health workers (CHWs) and home visitors (HVs) are members of the public health workforce who are uniquely poised to support vulnerable populations during the COVID-19 pandemic. In this study, we assess the experiences of CHWs and HVs in Wisconsin during the early stages of the COVID-19 pandemic to learn about their experiences related to mitigation strategies and vaccination efforts. Working closely with community partners, we recruited CHWs and HVs via email to complete an online survey between June 24 and August 10, 2021. Participants were eligible if they worked at any time since March 25, 2020, when the Safer at Home Order was put into place. The survey asked CHWs and HVs about their experiences during the COVID-19 pandemic and vaccination efforts. Eligible respondents included 48 HVs and 26 CHWs. Most CHWs (96%) and HVs (85%) reported discussing the COVID-19 vaccine with clients, and 46% of HVs and 85% of CHWs said they planned to encourage their clients to vaccinate themselves against COVID-19. We found that many CHWs and HVs identified the COVID-19 pandemic as a threat to the health of the US population, and many reported that they thought mitigation strategies were effective at keeping people safe from COVID-19. There was inconsistency in regard to respondents plans to encourage their clients to receive vaccination for COVID-19. Future study, training, and support for CHWs and HVs should focus on facilitating vaccination efforts and other emerging public health interventions.

Embedding Care in Communities: Mixed-Methods Evaluation of a Community Health Worker Training Initiative in Rural Haiti.

Embedding Care in Communities: Mixed-Methods Evaluation of a Community Health Worker Training Initiative in Rural Haiti.

The feasibility of establishing parent support groups for children with congenital Zika syndrome and their families: a mixed-methods study

Background: The 2015 – 2016 Zika epidemic highlighted gaps in health and social care services for parents of children with developmental disabilities. In response, we developed the ‘Juntos’ intervention, a 10 week community-based early intervention support group for parents of children with congenital Zika syndrome (CZS). The intervention's components include participatory learning sessions, practical skill acquisition, peer support, and psychological support, aiming to improve caregiver’s knowledge and confidence in caring for their children. This study aimed to evaluate the feasibility of implementing ‘Juntos’ in Colombia. Methods: Two facilitators delivered ‘Juntos’ to four groups of 8-10 caregivers between 2017 and 2018. One researcher observed each group. Data were collected from: observation notes from 40 sessions, focus group discussions held after each session, pre- post intervention questionnaires with 34 caregivers, and semi-structured interviews conducted with four facilitators, 12 caregivers and three stakeholders. We used the Bowen framework in data analysis. Results: The feasibility evaluation revealed that 'Juntos' was highly acceptable and in demand among the target population. The intervention was predominantly delivered with fidelity. Practicality was facilitated by providing transport costs and selecting convenient locations. Additional organisational and social media support was required for successful implementation. Community health worker training may support integration and the established groups could facilitate programme expansion. However, participants perceived lack of prioritisation as a limitation within existing health systems. Participants’ knowledge and confidence to care for their child improved after programme enrolment. Conclusion: The 'Juntos' intervention demonstrated high acceptability, demand, and practicality in supporting parents of children with CZS in Colombia. However, its implementation faces challenges due to existing gaps in health system support for children with CZS.

The Laro Kwo Project: A train the trainer model combined with mobile health technology for community health workers in Northern Uganda.

Community Health Workers (CHWs) in low and middle income countries (LMICs) provide invaluable health resources to their community members. Best practices for developing and sustaining CHW training programs in LMICs have yet to be defined using rigorous standards and measures of effectiveness. With the expansion of digital health to LMICs, few studies have evaluated the role of participatory methodologies combined with the use of mobile health (mHealth) for CHW training program development. We completed a three-year prospective observational study aligned with the development of a community-based participatory CHW training program in Northern Uganda. Twenty-five CHWs were initially trained using a community participatory training methodology combined with mHealth and a train-the-trainer model. Medical skill competency exams were evaluated after the initial training and annually thereafter to assess retention with use of mHealth. After three years, CHWs who advanced to trainer status redeveloped all program materials using a mHealth application and trained a new cohort of 25 CHWs. Implementation of this methodology coupled with longitudinal mHealth training demonstrated an improvement in medical skills over three years among the original cohort of CHWs. Further, we found that the train-the-trainer model with mHealth was highly effective, as the new cohort of 25 CHWs trained by the original CHWs exhibited higher scores when tested on medical skill competencies. The combination of mHealth and participatory methodologies can facilitate the sustainability of CHW training programs in LMIC. Further investigations should focus on comparing specific mHealth modalities for training and clinical outcomes using similar combined methodologies.

Feasibility, Uptake, and Results of COVID-19 Antigen Rapid Diagnostic Tests among Refugees and Migrants in a Pilot Project in North-West Syria.

North-west Syria (NWS) is a conflict-affected and unstable area. Due to its limited health infrastructure, accessing advanced COVID-19 testing services is challenging. COVID-19 antigen rapid diagnostic tests (Ag-RDTs) have the potential to overcome this barrier. A pilot project was implemented to introduce Ag-RDTs in NWS, aiming to determine the feasibility, uptake, and results of Ag-RDTs and identify facilitators and barriers to testing with Ag-RDTs. A cross-sectional study design involving secondary analysis of data collected during the project was employed. A local non-governmental organization implemented 25,000 Ag-RDTs that were conducted cross-border by trained community health workers. In total, 27,888 eligible individuals were enrolled, 24,956 (89.5%) consented to test, and 121 (0.5%) were COVID-19-positive. The highest positivity was observed among those with severe COVID-19 symptoms (12.7%), with respiratory illnesses (2.5%), enrolled at hospitals in Afrin (2.5%), and healthcare workers (1.9%). A non-random sample of 236 individuals underwent confirmatory RT-PCR testing. Observed sensitivity, specificity, and positive and negative predictive values were 80.0%, 96.1%, 91.4%, and 90.3%, respectively. Challenges included obtaining informed consent and conducting confirmatory testing. Ag-RDTs represent a feasible screening/diagnostic tool for COVID-19 infections in NWS, with nearly 90% uptake. Embedding Ag-RDTs into COVID-19 testing and screening strategies would be highly beneficial.

Community-based rehabilitation interventions on quality of care for people with schizophrenia in China (CRISC): study protocol for a cluster-randomized controlled trial

BackgroundInternational consensus shows that community-based rehabilitation (CBR) service is an effective way to improve functioning and negative symptoms and address the treatment gap for schizophrenia. Rigorous trials are needed in China to demonstrate effective and scalable CBR interventions to significantly improve outcomes for people with schizophrenia and to provide evidence of the economic benefits. The objectives of this trial are to examine the effectiveness of CBR as an adjunct to test the usual facility-cased care (FBC) in comparison to FBC alone in improving a range of outcomes in people with schizophrenia and their caregivers.Methods This trial is a cluster randomized controlled trial design in China. The trial will be conducted at three districts of Weifang city, Shandong province. Eligible participants will be identified from the psychiatric management system where community-dwelling patients with schizophrenia have been registered. Participants will be recruited after providing informed consent. 18 sub-districts will be randomly allocated in a 1:1 ratio to facility-based care (FBC) plus CBR (intervention arm) or FBC alone (control arm). The structured CBR intervention will be delivered by trained psychiatric nurses or community health workers. We aim to recruit 264 participants. The primary outcomes include symptoms of schizophrenia, personal and social function, quality of life, family burden of caring, etc. The study will be conducted according to good ethical practice, data analysis and reporting guidelines.Discussion If the hypothesized clinical benefit and cost-effectiveness of CBR intervention are confirmed, this trial will provide significant implications for policy makers and practitioners to scale up rehabilitation services, as well as for people with schizophrenia and their family to promote recovery and social inclusion, and to alleviate the burden of care.Trial registrationChinese Clinical Trial Registry (ChiCTR2200066945). Registered December 22, 2022.

Design thinking to improve rational use of oral rehydration salts: lessons from an innovative co-packaged diarrhoea treatment kit

IntroductionWe explored whether greater consideration of product design, informed by end users’ opinions, led to improved utilisation (ie, rational use) of oral rehydration salts (ORS) in home settings. We tested...

Recognizing the need for standardized training for community health workers (CHWs)

AbstractIntroductionDespite global improvements in maternal health, disparities in maternal mortality rates in the United States have worsened in recent years. Community health workers (CHWs) as maternal health educators have previously been studied in low‐ and middle‐income countries, however their use in the United States has been limited.MethodologyTo address the ongoing disparities in maternal mortality, we conducted a mixed methods pilot study consisting of discussion groups and a written survey with CHWs in two boroughs in NYC. The study's goal was to identify and explore CHW professional training, their daily tasks, and roles as well as their insights and perspectives regarding the needs of their pregnant clients.ResultsEighteen CHWs participated in the discussion groups and 11 participated in the survey. Participants were predominantly Black and/or Latina. Key themes were very consistent across group discussion and survey data. Major themes were a lack of standardized training for CHWs on basic maternal health topics, the existence of racism and bias in the provision of care for Black and other minority individuals, along with pregnant peoples’ needs for support to better advocate to overcome systemic barriers.ConclusionThis study suggests that targeted maternal health training of CHWs is needed to better enable them to identify pregnancy risks and advance health literacy and promote self‐advocacy among their pregnant clients. This will ultimately yield a more effective CHW workforce and better health outcomes for pregnant people.

Verbal and Social Autopsy of Adult Deaths and Adult Care-Seeking Pattern in Mozambique, 2019-2020.

In sub-Saharan Africa, recent data about causes of adult death and care-seeking during illnesses are limited. This analysis examines adult deaths using verbal and social autopsy data from a nationally and provincially representative sample registration system in Mozambique. Causes of death among those 18 years and older were assigned using the InSilicoVA algorithm, and underlying social causes were examined using the pathway to survival model. Care-seeking was analyzed in different groups to determine if care was sought from formal providers (doctor, nurse/midwife, and trained community health worker) or other providers (traditional provider, family member, and pharmacist), using χ2 tests and multinomial regression models. Among the 4,040 adult deaths reported during 2019-2020, the major causes were HIV (17%), cancer (13%), injury (10%), cardiovascular diseases (9%), pneumonia (7%), tuberculosis (5%), and maternal causes (3%). Formal care-seeking was more likely among adults who had primary or higher level education (relative risk ratio [RRR]: 1.6, P < 0.001; RRR: 1.7, P < 0.01), were married (RRR: 1.3, P < 0.01), and had highest household wealth (RRR: 3.1, P < 0.001). Formal care-seeking was less likely among adults who were male (RRR: 0.7, P < 0.001), had social capital (RRR: 0.7, P < 0.05), or resided in the southern region (RRR: 0.4, P < 0.001). Information about adult causes of death is useful for formulating policy and for developing, monitoring, and evaluating programs to improve adult health in Mozambique. Care-seeking-related information helps identify barriers for seeking care from formal health providers while emphasizing the need for generating local resources and strengthening outreach health systems service delivery.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Impact evaluation of the TAMANI project to improve maternal and child health in Tanzania

BackgroundThe Tabora Maternal and Newborn Health Initiative project was a multicomponent intervention to improve maternal and newborn health in the Tabora region of Tanzania. Components included training healthcare providers and...

Community health worker-led household screening and management of neonatal hyperbilirubinemia in rural Bangladesh: a cluster randomized control trial protocol

Background: Extreme hyperbilirubinemia leading to neurologic disability and death is disproportionately high in low to middle income countries (LMIC) such as Bangladesh, and is largely preventable through timely treatment. Of the estimated 50% of newborns born in LMICs born at home, few receive screening or treatment for hyperbilirubinemia, leading to 6 million newborns per year who need phototherapy treatment for hyperbilirubinemia but are untreated. Household screening and treatment for neonatal hyperbilirubinemia with phototherapy administered by a trained community health worker (CHW) may increase indicated treatment for neonatal hyperbilirubinemia in comparison to the existing care system in Bangladesh. Methods: 530 Bangladeshi women in their 2nd or 3rd trimester of pregnancy from the rural community of Sakhipur, Bangladesh will be recruited for a cluster randomized trial and randomized to the intervention arm — home screening and treatment for neonatal hyperbilirubinemia — or the comparison arm to receive usual care. In the intervention arm, CHWs will provide mothers with two prenatal visits, visit newborns by 2 days of age and then daily for 3 days to measure transcutaneous bilirubin (TcB) and monitor clinical danger signs. Newborns without danger signs but with a TcB above the treatment threshold &lt;15 mg/dL will be treated with light-emitting diode (LED) phototherapy at home. Newborns with danger signs or TcB &gt;15 mg/dL will be referred to a hospital for treatment. Treatment rates for neonatal hyperbilirubinemia in each arm will be compared. Conclusion: This study will evaluate the effectiveness of CHW-led home phototherapy to increase neonatal hyperbilirubinemia treatment rates in rural Bangladesh. LMICs are expanding access to postnatal care by using CHWs, and our work will give CHWs a curative treatment option for neonatal hyperbilirubinemia. Similar projects in other LMICs can be pursued to dramatically extend healthcare access to vulnerable newborns with hyperbilirubinemia.

Addressing Tobacco Use in Underserved Communities Outside of Primary Care: The Need to Tailor Tobacco Cessation Training for Community Health Workers.

Individuals from communities with a low socioeconomic status have the highest rates of tobacco use but are less likely to receive assistance with quitting. Community health workers (CHWs) are well-positioned to engage these communities; however, CHWs face barriers in receiving relevant tobacco cessation training. The objective of this study was to conduct a mixed methods needs assessment to describe tobacco practices and the desire for training among CHWs. After incorporating CHW feedback, we developed a needs assessment survey to understand knowledge, practices, and attitudes about tobacco cessation in Chicago, IL. CHWs (N = 23) recruited from local community-based organizations completed the survey online or in-person. We then conducted a focus group with CHWs (N = 6) to expand upon the survey and used the Framework Method to analyze the qualitative data. CHWs reported that their clients had low incomes, low literacy levels, and high smoking rates (e.g., "99%" of patients). About 73.3% reported discussing tobacco use during visits, but fewer reported that they had provided cessation advice (43%) or intervened directly (9%). CHWs described high variability in their work environments (e.g., location, duration, content of visits, etc.) and greater continuity of care. CHWs discussed that existing training on how to conduct tobacco interventions is ineffective, because of its stand-alone design. Our findings illustrate how CHWs adapt to their clients' needs, and that the currently available "gold-standard" cessation curricula are incompatible with the training needs and flexible care delivery model of CHWs. A curriculum tailored to the CHW experience is needed to maximize the strengths of the CHW care model by training CHWs to adaptively intervene regarding tobacco use in their highly burdened patients.