Involving Community Health Research Articles

Utilizing intricate care networks: An ethnography of patients and families navigating palliative care in a resource-limited setting.

The increase in non-communicable disease burdens and aging populations has led to a rise in the need for palliative care across settings. In resource-limited settings such as Indonesia, however, notably in rural areas, there is a lack of professional palliative care. Little is known about specific palliative care navigation, as previous studies have mostly focused on cancer care navigation. A locally tailored approach is crucial. To explore how patients and families navigate palliative care and the problems they experience. An ethnographic study using in-depth interviews and observations, analyzed using reflexive thematic analysis. Interviews with 49 participants (patients, family caregivers, and health professionals) and 12 patient-family unit observations in Banyumas, Indonesia. Patients and families navigated palliative care through different strategies: (1) helping themselves, (2) utilizing complementary and alternative medicine, (3) avoiding discussing psychological issues, (4) mobilizing a compassionate and advocating community, and (5) seeking spiritual care through religious practices. Our participants used intricate care networks despite limited resources in navigating palliative care. Several problems were rooted in barriers in the healthcare system and a lack of palliative care awareness among the general public. Local primary health centers could be potential palliative care leaders by building upon pre-existing programs and involving community health volunteers. Cultivating a shared philosophy within the community could strengthen care collaboration and support.

Intervention model in reducing the unmet need for contraception: a systematic literature review on technology-based, community, and health worker interventions

The unmet need for contraception is a serious public health problem, and efforts to reduce the unmet need for family planning are a challenge due to the many and complex factors that contribute to the unmet needs. The aim of this study was to systematically review scientific evidence on intervention models that effectively reduce the unmet need for contraception. This study used a systematic review to identify relevant scientific articles. The article search was based on the PICO approach and used a database from https://www.scopus.com/, https://www.sciencedirect.com/, https://pubmed.ncbi.nlm.nih.gov/, https://www.mdpi.com/, https://www.jstor.org/, https://www.nature.com/, https://link.springer.com/. The reviewed material was full-text articles and open-access articles published from 2013 to 2023. Data extraction included author, country, type of intervention, research design, sample, and main research findings. Twelve studies were included in our qualitative synthesis. Technology-based interventions, such as mobile phone instant messaging apps, were implemented in countries like Tajikistan, Bolivia, and Mozambique. Community-based interventions included the Community Family Health=Family Wealth program in Uganda, the Tékponon Jikuagou (TJ) program in Benin, and the Married Adolescent Girls Club (MAG club) and Participatory Women's Group Intervention in Bangladesh. Health worker-led interventions involved community health volunteers in Nepal, postpartum contraceptive counseling, contraceptive counseling for all ages, structured counseling for childbearing couples in Indonesia, and the "Consult and Choose" client-centered family service in Jordan. The findings underscore that varying intervention models can significantly enhance contraceptive use, tailored to specific cultural and regional contexts. These interventions, therefore, hold substantial implications for public health practices aiming to address and reduce the global unmet need for contraception. This systematic review provides valuable insights into the effectiveness of diverse interventions and suggests avenues for public health strategies to expand contraceptive access and use globally.

Knowledge and beliefs about lung cancer screening among Black individuals at high risk: a qualitative approach.

Despite its efficacy in reducing lung cancer (LC)-specific mortality by 20%, screening with low-dose computed tomography (LDCT) in eligible groups remains low (5-16%). Black individuals are more commonly affected by LC than other racial/ethnic groups in the United States (U.S.) but less likely to undergo LC screening (LCS). Our study aimed to explore the knowledge and beliefs of Black individuals at high risk regarding LCS. Black individuals (n=17) who met the 2021 United States Preventive Services Task Force (USPSTF) LCS eligibility criteria were recruited in upstate New York. In-depth semi-structured interviews were conducted, audio recorded, and transcribed to explore knowledge and beliefs that could influence the uptake of LCS. A qualitative thematic analysis method was used to identify and analyze themes within the data. We identified principal themes about LC and LCS. Although most participants reported that smoking was the major risk factor for LC, some participants placed more emphasis on other factors as the major risk factors for LC and de-emphasized the role of smoking. Most participants were not aware that screening for LC existed. Several barriers and facilitators for LCS were identified. Awareness about LCS among Black individuals is low. Addressing barriers may help increase LCS rates among Black individuals, ultimately reducing their LC mortality. The findings from our study have important implications in designing more effective interventions involving community health workers and healthcare clinicians to increase LCS uptake among Black individuals at high risk.

Snakebite incidence and healthcare-seeking behaviors in Eastern Province, Rwanda: A cross-sectional study.

Snakebite envenoming (SBE) is a potentially life-threatening event that can lead to severe physical, mental, and economic hardships, particularly in under-resourced regions like sub-Saharan Africa. In Rwanda, there have been no epidemiological assessments of SBE to guide the Ministry of Health in its efforts to reduce the burden. This study had two main objectives: first, to estimate the incidence of snakebites across districts, and second, to describe formal versus informal healthcare seeking behaviors among snakebite victims in Eastern Province, Rwanda in 2020. This cross-sectional study utilized a cluster sampling approach, involving Community Health Workers (CHWs) who recorded snakebite cases across seven districts. The descriptive analysis considered sampling weights, and healthcare seeking behavior was assessed based on the type of care sought as the first point of treatment. The study surveyed 390,546 individuals across 763 villages and estimated a provincial annual incidence rate of 4.3 cases per 1,000 individuals. Incidence estimates ranged from 1.1 cases per 1,000 in Nyagatare to 9.1 cases per 1,000 individuals in Bugesera and Ngoma districts. Among the 2,545 cases recorded by CHWs, three resulted in deaths. Regarding healthcare-seeking behavior, 13% of snakebite victims (143 out of 1,098) initially consulted formal care providers (CHWs, health post/center, or hospital), while 87% sought informal care (family/friends, pharmacist, or traditional healer). Approximately half of the victims (583, 53.1%) reported severe symptoms. Unsafe practices included skin cutting/burning, tourniquet application, use of black stones, and venom extraction; only 24 cases (2.2%) received anti-venom. This large-scale community-based assessment highlights variations in snakebite incidence between districts and confirms frequent involvement of traditional healers in management. Improving access to anti-venom and community education on the risks of ineffective practices, along with timely use of formal healthcare, are crucial. Collaboration between healthcare providers, traditional healers, community leaders, and policymakers is essential to implement targeted interventions for enhancing snakebite prevention and management strategies.

Effectiveness of team-based care interventions in improving blood pressure outcomes among adults with hypertension in Africa: a systematic review and meta-analysis

ObjectiveWe evaluated the effectiveness of team-based care interventions in improving blood pressure (BP) outcomes among adults with hypertension in Africa.DesignSystematic review and meta-analysis.Data sourcePubMed, CINAHL, EMBASE, Cochrane Library, HINARI and...

IJCM_219A: A “One Health” Model for Prevention and Control of Anthrax in Koraput, Odisha, India

Background: Anthrax, a neglected zoonotic disease caused by Bacillus anthracis, poses a significant threat in Odisha, India, particularly in the tribal district of Koraput, which has reported numerous human cases and deaths but lacks consistent robust surveillance. Objectives: This study aimed to pilot a “One Health” surveillance model in Koraput, involving community health workers, para-veterinarians, and block- level teams in outbreak investigations. Methodology: As part of the “One Health Approach to Anthrax Control in India (OHAI)” project Odisha University of Agriculture and Technology (OUAT), in collaboration with the Departments of Animal Husbandry and Health and Family Welfare, Government of Odisha, initiated prospective laboratory-based anthrax surveillance in three blocks of Koraput. Confirmed cases in animals were identified via microscopic, culture, or PCR testing for Bacillus anthracis. Community awareness programs and rapport-building exercises were conducted with human and veterinary officials at the block and district levels following the detection of outbreaks. Results: Between March and June 2023, five anthrax outbreaks were detected in Koraput, with four involving both cutaneous human and animal deaths and one in animals only. Livestock losses included cattle (27), goats (2), and buffalo (1). Of the 38 samples collected (blood, bone, tissue, and soil), 11 (35%) tested positive for anthrax by RT-PCR. OUAT rapidly communicated results (<24 hours) to the state health department, leading to joint investigations and control measures, including livestock vaccination, safe carcass disposal, and medical outreach camps for screening and prophylaxis. In total, five district/block level meetings and two state-level consultations were held, culminating in a zoonotic roadmap draft, which included an anthrax prevention and control action plan. Conclusion: The study’s adoption of the One Health framework facilitated a rapid response to anthrax outbreaks in Koraput, effectively managing both human and animal cases. This model presents a viable approach for controlling anthrax in endemic areas of India.

Pengembangan Seni Hidangan Alternatif dan Terinspirasi pada Kader Posyandu Balita Sesuai Kandungan Gizi Isi Piringku di Desa Karangsono Kabupaten Jember

Stunting poses a serious health issue in Indonesia. In 2022, the national prevalence of stunting stood at 22.6%, exceeding the World Health Organization's requirement of below 20%. According to the Indonesian Nutrition Status Survey (SSGI) 2022 by the Ministry of Health, Jember Regency has the highest prevalence of stunted toddlers in East Java, reaching 34.9% or approximately 35,000 toddlers. To address the stunting problem, health efforts are being made through the prevention of stunting diseases with the implementation of the "SEHATI" (Seni Hidangan Alternatif dan Terinspirasi or Alternative or Inspired Food Art) program in Karangsono Village, Bangsalsari Subdistrict, Jember Regency. This program involves community health volunteers managing meals according to the "Isi Piringku" guidelines with appropriate nutritional content for toddlers. The aim of this activity is to raise awareness and knowledge among community health volunteers about the importance of managing balanced and nutritious meals according to the "Isi Piringku" program issued by the Ministry of Health. This study uses a Pre-Experimental Design method with a Pretest-Posttest design model to measure the increase in knowledge of community health volunteers after socialization about the "Isi Piringku" program. The research results show that 90% of volunteers experienced an average knowledge increase of 13.5 after the counseling activities. The "SEHATI" program successfully stimulates children's appetite through unique and appealing foods with balanced nutritional value. The "SEHATI" program is expected to serve as an example for the community in preparing balanced and nutritious meals for children. Through accurate and easily understandable nutrition education, it is hoped that awareness of the importance of healthy and nutritious food intake will increase, ultimately aiding in the prevention of stunting and other nutritional problems in Jember Regency.

Documents, education, and aesthetics: Exploring processes of subjectification among community health workers in Peru

ABSTRACT This article examines the processes of subjectification involving community health workers in the Peruvian Andes. Community health worker programmes keep education at the core, striving to provide marginalized people with information about mother-and-child health, family planning, nutrition, and illness prevention, among other things. Education is one of the arenas where Foucauldian themes of subjectification are most explicit (Kipnis 2011). However, the subjectivities such development programmes seek to produce by training and monitoring those involved are not necessarily those that emerge. In studies of health policies and their implementation in targeted areas, the focus tends to be on how governmentality discourses and techniques produce responsible and governable subjects. However, little attention has been paid to understanding the processes of subjectification and how they are interpreted and enacted by the targeted subjects (Winkler-Reid 2017). This article aims to illuminate how community health workers use their embodied understanding of school literacy and aesthetics to engage with specific community health-related tasks. It argues that aesthetics is a central part of the formation of subjectivity and that expectations of aesthetic qualities similar to those of classroom situations contribute to accentuating the community health workers becoming ‘good students’. In this specific setting, being evaluated as a ‘good student’ receives more emphasis than other goals of the community health worker programme, such as providing easier access to health care services for their fellow community members.

Are community health agents the link to integrating care? Lesson from Brazil

Purpose This viewpoint piece will highlight the contribution of trained lay community health workers to the integrated workforce in rural, remote and island settings, drawing on experience from a system strengthening project involving community health agents (CHAs) in four municipalities in Litoral Norte, a remote coastal and island region in the state of São Paulo, Brazil.Design/methodology/approach This viewpoint reflects on experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.Findings CHAs took forward actions that touched the lives of thousands of vulnerable families with low income and complex needs in communities with high levels of social and health inequalities. They acted as a bridge between patients and families at home, primary healthcare professionals and wider community partners and services. Their valuable insight into the healthcare issues and social challenges experienced by the community informed and supported family centred practice and population health goals. The CHAs rapidly pivoted to became an essential public health workforce during the Covid-19 pandemic.Practical implications As the authors establish integrated care systems and embrace proactive care and population health, the conditions are favourable for introducing a similar role in the UK. For psychological safety and avoidance of burnout people in such new roles will require training, supervision and full integration within community teams.Originality/value This viewpoint reflects experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.

Implementing patient-public engagement for improved health: Lessons from three Ghanaian community-based programmes.

Community-based health interventions have been implemented as a key strategy for achieving improved health outcomes in Ghana. Effectiveness, however, largely depends on the successful implementation of patient-public engagement (PPE). Although several PPE studies have been conducted in Ghana, little research has been doneto understandthe specific role of PPE in the context of implementing community-based health programmes. This paper, therefore, examines the extent of PPE implementation in three selected community-based health programmes (Community-based Health Planning and Service [CHPS], Community-based Maternal and Child Healthand Buruli Ulcer) to understand their specific effects on health outcomes. Three focus groups, involving 26 participants, were held in three districts of the Ashanti region of Ghana. Participants were mainly health service users involving community health committee members/volunteers, residents and health professionals. They were invited to participate based on their roles in the design and implementation of the programmes. Participants focused on each of Rifkin's spider-gram components. Data were transcribed and analysed descriptively using NVIVO 12 Plus. PPE implementation was found to be extensive across the three programmes in specific areas such as organisation and resource mobilisation. PPE was more restricted in relation to community needs assessment, leadershipand management, particularly for the CHPS and Buruli Ulcer programmes. Findings suggest that benefits from community-based health interventions are likely to be greater if PPE can be widely implemented across all dimensions of the spider-gram framework.

Feasibility and acceptability of involving bilingual community navigators to improve access to health and social care services in general practice setting of Australia

BackgroundPatients from culturally and linguistically diverse (CALD) backgrounds often face difficulties in accessing health and social care services. This study explored the feasibility and acceptability of involving community health workers (CHWs) as bilingual community navigators (BCNs) in general practice setting, to help patients from CALD backgrounds access health and social care services in Australia.MethodsThis research was conducted in two general practices in Sydney where most patients are from specific CALD backgrounds (Chinese in one practice and Samoan in other). Three CHWs trained as BCNs were placed in these practices to help patients access health and social care service. A mixed-method design was followed to explore the feasibility and acceptability of this intervention including analysis of a record of services provided by BCNs and post-intervention qualitative interviews with patients, practice staff and BCNs exploring the feasibility and acceptability of the BCNs’ role. The record was analyzed using descriptive statistics and interviews were audio-recorded, transcribed, and thematically analyzed.ResultsBCNs served a total of 95 patients, providing help with referral to other services (52.6%), information about appointments (46.3%), local resources (12.6%) or available social benefits (23.2%). Most patients received one service from BCNs with the average duration of appointments being half an hour. Overall, BCNs fitted in well within the practices and patients as well as staff of participating practices accepted them well. Their role was facilitated by patients’ felt need for and acceptance of BCNs’ services, recruitment of BCNs from the patient community, as well as BCNs’ training and motivation for their role. Major barriers for patients to access BCNs’ services included lack of awareness of the BCNs’ roles among some patients and practice staff, unavailability of information about local culture specific services, and inadequate time and health system knowledge by BCNs. Limited funding support and the short timeframe of the project were major limitations of the project.ConclusionBCNs’ placement in general practice was feasible and acceptable to patients and staff in these practices. This first step needs to be followed by accredited training, development of the workforce and establishing systems for supervision in order to sustain the program. Future research is needed on the extension of the intrevention to other practices and culture groups.

Unlocking the power of communities to achieve Universal Health Coverage in Africa

Africa is at a critical time undergoing demographic, epidemiological, political and socio-economic transitions and faced with repeated outbreaks of emerging and remerging diseases amidst other broader challenges of climate change, environmental degradation and pollution testing the resilience of its health systems and hindering progress to achieve health for all. Five years into the journey towards Sustainable Development Goals (SDGs), the continent – similar to the rest of the world – has been gripped with the Corona virus disease pandemic that has caused significant morbidity and mortality as well as severely disrupted health systems and the underlying socioeconomic determinants of health. One of the most significant SDG targets is the achievement of Universal Health Coverage (UHC) where all people have access to quality health services they need without inflicting a financial hardship on them. However, progress towards this target has been slow on the continent and requires rethinking the current approaches employed. We argue that Africa’s key strength lies in the communities whose potential should be unlocked to build cost effective and sustainable bottom-up health systems founded on Primary Health Care (PHC). Such systems should be founded on community-based services, designed around individuals, families and the community involving community health workers and other actors, and capitalising on health promotion and disease prevention approaches. A strong community health system should be adequately linked to district, regional and national levels working together to empower and serve populations to make health for all a reality.

Improving Self-management of Type 2 Diabetes in Latinx Patients: Protocol for a Sequential Multiple Assignment Randomized Trial Involving Community Health Workers, Registered Nurses, and Family Members

The rate of Type 2 diabetes mellitus (T2DM) among Mexican American individuals is 16.3%, about twice that of non-Hispanic White individuals. While a number of education approaches have been developed and shown to improve diabetes self-management behaviors and glycemic control for Spanish-speaking Latinx patients with T2DM, there is little research to guide health practitioners regarding which interventions to apply and when so that resources are used efficiently, and treatment outcomes are maximized. This study aimed to describe an adaptive intervention that integrates community mental health workers, diabetes nurse educators, family members, and patients as partners in care while promoting diabetes self-management for Mexican American individuals with T2DM. The project incorporates four evidence-based, culturally tailored treatments to determine what sequence of intervention strategies work most efficiently and for whom. Given the increasing prevalence of T2DM, achieving better control of diabetes and lowering the associated medical complications experienced disproportionally by Mexican American individuals is a public health priority. Funded by the National Institute of Nursing Research (National Institutes of Health grant R01 NR015809), this project used a sequential multiple assignment randomized trial and included 330 Spanish-speaking Latinx patients with T2DM. In the first phase of the study, subjects were randomly assigned to an evidence-based diabetes self-management educational program called Tomando Control delivered in a group format for 6, biweekly 1.5-hour sessions, led either by a community health worker or a diabetes nurse educator. In the second phase of the study, those subjects who did not improve their diabetes self-management behaviors were rerandomized to receive either an augmented version of Tomando Control or a multifamily group treatment focused on problem-solving. The primary outcome measure was the "Summary of Diabetes Self-Care Activities." Evaluations were made at baseline and at 3, 6, and 12 months. This study was funded in June 2016 for a period of 5 years. Institutional review board approval was obtained in November 2016. Between March 2017 and September 2020, a total of 330 patients were recruited from the outpatient primary care clinics of Olive View-UCLA Medical Center, with a brief hiatus between May 2020 and July 2020 due to COVID-19 restrictions. The study interventions were completed in December 2020. Data collection began in March 2017 and was completed in December 2021. Data analysis is expected to be completed in Spring 2023, and results will be published in Fall 2023. The results of this trial should help practitioners in selecting the optimal approach for improving diabetes self-management in Spanish-speaking, Latinx patients with T2DM. ClinicalTrials.gov NCT03092063; https://clinicaltrials.gov/ct2/show/NCT03092063. DERR1-10.2196/44793.

S-36-5: TEAM-BASED CARE TO DIAGNOSE, TREAT AND CONTROL HYPERTENSION: FINDINGS FROM RESOLVE TO SAVE LIVES (RTSL)

In order to achieve population-wide control of hypertension, team-based care is essential, especially in low- and middle-income countries (LMIC) where there are insufficient numbers of physicians to diagnose hypertension and prescribe medications. RTSL is a global initiative to dramatically improve hypertension control from 14% to 50% worldwide. One key aspect of our approach to team-based care is generating evidence useful in transforming health care delivery. Types of evidence can broadly be classified as follows: (1) literature synthesis to understand evidence on the types and effects of team-based care for hypertension, and (2) empirical studies of health system changes designed to scale up and improve hypertension care. The empirical studies are typically community-based and involve community health workers (CHWs) who are given greater responsibility beyond basic administrative and clinical tasks. Below are a sample of RTSL studies. Our first study involved understanding the global gap between physician capacity and patient need. We documented that most low- and lower middle income countries did not have the physician capacity to provide 3 annual visit for patients with hypertension (figure). Our principal conclusion is that health system and policy changes are needed, including task-sharing. In a second study, we conducted a meta-analysis and documented that team-based care significantly lowers blood pressure in LMIC, with the extent of blood pressure reduction related to the clinical training of team members. In a third study, we conducted surveys to understand current level of task sharing and barriers to task sharing; few countries allowed non-physicians to conduct advanced clinical tasks, e.g. diagnosing hypertension, initiating treatment, and titrating medications. In a fourth study, MUTU conducted in Nepal, we tested a health system change in which CHWs, under the supervision of a physician, initiated and titrated treatment with amlodipine (MUTU results will be presented at ISH on Oct 16). Currently, we are designing a study in which CHWs, supervised remotely via telemedicine, initiate and titrate medication in persons with untreated hypertension in rural Bangladesh. Other studies involve developing and evaluating training materials for non-physician health care workers and modelling the effects of task shifting on the number of persons treated for hypertension in India, along with associated costs. While these studies are being conducted, many RTSL countries have already implemented health system initiatives that involve team-based care for hypertension. These initiatives studies and RTSL studies hold great promise as a means to improve hypertension control rates in LMIC.

BEYOND HOUSING

Abstract Social isolation and loneliness in older adults are a public health challenge that has been exacerbated during the COVID pandemic. While quarantining although it was necessary to protect individuals from the virus, older adults lost their usual social supports, connectedness, and relationships. Research has shown that loneliness and social isolation have many negative effects on a person’s physical and mental health. This presentation will describe an initiative of Age Friendly RI which addressed the problem of social isolation among older adults living in a congregate housing community who struggled with stress, anxiety, depression, and exacerbation of mental illness. Through a partnership between a state college and a community based mental health center, and supported with grant funding, behavioral health services and supports were embedded in the housing community. The project was multi-faceted involving community health workers and a community support professional who provided outreach and emotional support, the use of technology to help residents connect with medical providers or loved ones or enjoy music, games, movies, and students who provided outreach and taught older adults how to use technology. A social isolation scale was administered to identify residents at high risk of social isolation and targeted intervention. The evaluation of the program will be discussed in terms of the interventions implemented and the outcomes realized, including resident well-being and satisfaction. Finally, it will suggest a pathway for sustaining the integration of behavioral health services in housing to better meet the behavioral health needs of older residents beyond the pandemic.

Implementing the Bloom Trial: Community health nurses’ perceptions of potential barriers

Abstract Background The overall aim of the Bloom Trial is to develop and test a program promoting healthy weight development during infancy within the community health nurse setting in Denmark. Many interventions are poorly implemented, and to ensure adequate implementation support, previous studies have suggested to assess barriers and organizational readiness before intervention start. The aim of the present study is to assess barriers for implementing and sustaining the Bloom Trial among program adopters and implementers. Methods Telephone interviews with managing health nurses (adopters) and health nurses (implementors) from twenty Danish municipalities were carried out (n = 22) in 2017. Moreover, two workshops with health nurses, and continuously meetings with implementation science experts were conducted in 2021-2022. Results Barriers were identified on different levels. Organizational barriers within the work of health nurses included lack of time, economic resources, project fatigue, and political priority. Furthermore, health nurses lacked relevant tools to guide parents about promoting healthy weight development. Interpersonal barriers between health nurses and parents were identified as the difficulties of having conversations about healthy weight development, especially if the parents or health nurses were overweight themselves. Cultural differences including language barriers and different perceptions of for example healthy food choices were also found. Conclusions The findings are central for ensuring that the Bloom Trial is relevant and applicable to the setting of health nurses in Danish municipalities. This is crucial for ensuring successful adoption, implementation, and prolonged sustainability. Key messages • The study pinpoints key barriers (e.g. lack of time, project fatigue and cultural factors) of implementing an intervention promoting healthy weight in the community health nurse setting in Denmark. • Involving community health nurses’ perceptions aim at increasing the chances of producing a relevant and successful implementation strategy.

Empowering health workers and leveraging digital technology to improve access to mental health and epilepsy care: A longitudinal quasi-experimental study in Hlaing Thar Yar Township.

Despite an estimated 8% prevalence of mental disorders in Myanmar, the treatment gap is high, up to 90%. This project aimed to assess the effects of a series of activities implemented by the Myanmar Medical Association over a 2-year period in Hlaing Thar Yar Township involving community health workers (CHWs) and general practitioners (GPs) on the identification, diagnosis and management of people with psychotic disorders, depression and epilepsy. Seventy-six CHWs were trained to raise awareness, identify people with mental disorders and refer them to GPs. Fifty GPs were upskilled to diagnose and manage patients. Prevalence, treatment gap and general population's Knowledge-Attitudes-Practices (KAP) were evaluated through door-to-door surveys, whilst CHWs' and GPs' KAP were measured pre-, and post-training as well as post-intervention. Patient identification, diagnosis and management were analysed through data collected by CHWs and GPs via smartphones and tablets. At baseline, the average treatment gap was 79·7%. During the 2 year-intervention, 1,378 suspected cases were referred by CHWs to GPs and 1,186 (86%) of them saw a GP. Among the 1,088 patients (92%) diagnosed, the concordance between GPs' diagnosis and CHWs' screening was 75·6%. For CHWs, knowledge improved post-training (16·9 vs. 15·3; p=0·0010), whilst attitudes and practices improved post-intervention (17·1 vs. 15·7; p=0·010 and 19·4 vs. 11·2; p<0·0001 respectively). GPs' global KAP score improved post-training (14·6 vs. 12·8; p=0·0010), and remained stable post-intervention. General population's KAP score improved between baseline and end-line (8·3 vs. 12·7; p<0·0001). This project suggests that a 2-year intervention including the training of frontline health workers and raising awareness among the population can have positive outcomes and lead to a greater number of people with mental disorders being diagnosed and managed. This project was implemented as part of a partnership involving the Myanmar Medical Association, the Myanmar Mental Health Society, the World Association of Social Psychiatry, the Université Numérique Francophone Mondiale and Sanofi Global Health. It was funded by Sanofi Global Health, within the framework of the Fight Against STigma (FAST) Program.

Assessment of Community Health Volunteers contribution and factors affecting their health care service delivery in selected urban wards of Puducherry – A mixed-methods operational research study

IntroductionCommunity participation gained its importance from the Alma Ata declaration in 1978. Improving coverage of these services depends on factors like availability, accessibility, and quality of service delivery. Involving Community Health Volunteers to deliver health services would help in decentralizing health care delivery. MethodsA mixed-method approach (Sequential experimental design) was employed to evaluate the contributions of CHVs. The data collection methods included Key Informant Interviews (KII) and a pre-tested semi-structured self-introspection questionnaire to capture both volunteer's and health system side perspectives of the intervention. The study was conducted from October 2017 to May 2018. ResultsAt the end of the intervention, only 33 volunteers (51%) had contributed to health care delivery in their respective anganwadis. We compiled the contributions made by the CHV during the intervention period. We explored the facilitating, hindering factors that influenced the outcome and gathered suggestions for the same. The CHVs felt that they have contributed adequately to the delivery of health care. Discussion and conclusionThe study explores the contributions of CHVs and their evaluation using a mixed-methods design capturing the perspectives of various stakeholders. Our study results highlight the spectrum of contributions that can be rendered through CHV's if adequately trained, who can be utilized as an effective workforce in resource-poor settings.

The Service Quality of Community Health Centers During the COVID-19 Pandemic: Do Governance Practices Benefit?

Research aims: This study aims to examine the role of internal control on the service quality of community health centers in handling the COVID-19 pandemic with transparency and accountability budget management as intervening variables.Design/Methodology/Approach: The population of this study was all community health centers located in the Special Region of Yogyakarta Province. The cluster sampling technique was used in determining the samples. Eighty-two community health centers participated in this study. Data were collected by distributing questionnaires. Partial Least Square (PLS) was employed to test the hypotheses.Research findings: The results revealed that, during the COVID-19 pandemic, internal control implementation was not associated directly with the service quality of the community health center. Instead, the association was mediated by transparency, not accountability. Additionally, transparency independently was associated with service quality.Theoretical contribution/Originality: This study extends the literature by examining the role of good governance mechanisms and principles in the community health center context by positioning transparency and accountability as intervening. In addition, this research was conducted in the context of the COVID-19 pandemic, where the service quality of community health centers has a crucial role in dealing with people exposed to COVID-19.Practitioner/Policy implication: The results of this study can be used as input for the relevant regulator to improve the service quality of community health centers through good governance practices.Research limitation/Implication: This research only involved community health centers in the Special Region of Yogyakarta Province as samples.

Implementing shared decision-making in Australia

Person-centred care (PCC) and shared decision-making (SDM) are part of national clinical standards for an increasing number of areas of health care delivery. In addition to existing standards for accrediting hospitals, day surgery facilities, public dental services and medical education in Australia, new standards governing primary health care and digital mental health services have been added. Implementation and measurement of PCC and SDM to comply with standards, and training of health professionals, remain challenges for the Australian health sector. Consumer involvement in health research, policy and clinical service governance continues to increase and the National Health and Medical Research Council has begun to encourage consumer and community involvement in health and medical research. This increased consumer engagement and moves towards more PCC provision is reflected in a focus on encouraging patients to ask questions during their clinical care and supports improvements in consumer health literacy. SDM support tools are now being culturally adapted whilst a need for more systemic approaches to their development and implementation persists. With increasing resources and tools for all aspects of PCC and SDM challenges to find sustainable solutions to ensure tools are kept up to date with the best available evidence remain.