Effectiveness Of Community Health Workers Research Articles

Perceptions and experiences of a multi-domain preventive health programme: a qualitative study informing future community-based health interventions in singapore

BackgroundDespite global popularity, Community-based Health Intervention (CBHI) programmes have yet to be fully incorporated into Singapore’s public healthcare systems, with most initiatives focusing on specific diseases. This qualitative study aimed to evaluate older adults’ perceptions of the “Get Well, Live Well” multi-domain preventive health programme, explore the effectiveness of Community Health Workers (CHWs) in promoting health literacy and modifying health behaviours, and examine participants’ experiences in the CHW-delivered CBHI programme.MethodsPurposeful sampling was used to recruit study subjects from participants in the “Get Well, Live Well” programme until data saturation was achieved. In-depth, semi-structured, one-to-one telephone interviews were conducted in English or Chinese with participants aged ≥ 40 years. Audio recordings were translated into English as needed and transcribed in full. The collected data were anonymised, and thematic analysis was performed by three trained evaluators using a structured process.ResultsThe final study sample included 19 subjects (median age of 64 years; 84% women; and 95% Chinese). Three key themes emerged regarding the programme’s value, interactions with CHW, also known as Care Connectors, and their facilitation of health services/behaviours. Participants acknowledged that the “Get Well, Live Well” programme provided physical/emotional support, improved health literacy, and enhanced social interaction. The programme’s effectiveness may depend on Care Connector’s personal qualities, service quality beyond expectation, connection with participants, and their proactive and authoritative roles in facilitating health services/behaviours.ConclusionThe findings suggest that future Community-based Health Interventions could benefit from deploying CHWs with strong people skills to enhance the programme’s success.

O25 ARE COMMUNITY HEALTH WORKERS EFFECTIVE IN MANAGING HYPERTENSION AND DIABETES SIMULTANEOUSLY? A SYSTEMATIC REVIEW AND META-ANALYSIS

Background and objective: To evaluate and summarise the effectiveness of community health worker (CHW)-led interventions to manage risk factors for NCDs. We further assessed whether CHWs could simultaneously manage hypertension and diabetes. Methods: We searched six different databases for randomised controlled trials and cluster randomised trials. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. We used random effects models to assess the sample average mean difference between intervention and control groups. The primary outcomes for this review were net mean differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose (HbA1c and fasting blood glucose), blood lipids (low-density lipoprotein (LDL) and triglycerides) and obesity (body mass index (BMI) ≥ 25 kg/m2). Results: Among 10,508 potential articles identified, 68 were included in the systematic review, and 43 for meta-analysis (11223 participants) after excluding studies not meeting the inclusion criteria. Interventions undertaken by CHWs were effective in reducing SBP [-2.94 mmHg (95% CI, -4.28 to -1.59); I2=73%], DBP [-1.63 mmHg (95% CI, -2.60 to -0.66); I2=81%], HbA1c% [-0.30 (95% CI, -0.45 to -0.16), I2=54%], and triglycerides [-8.32 mg/dl (95%. CI, -13.54 to -3.10)]. Greater reductions in SBP were observed in low- and middle-income countries (LMICs) than in high-income countries (HICs). No detectable difference was observed in the change in HbA1c% in LMICs (only three studies). Interventions targeting diabetes as the primary outcome not only reduced HbA1c% but were also effective in reducing SBP by -2.03 mmHg (95% CI, -3.85 to -0.21). There was no evidence that these interventions improved body mass index or LDL Conclusions: We demonstrate that CHW-led interventions are effective in reducing SBP, DBP, HbA1c% and triglycerides, thus reinforcing the importance of engaging CHWs in the management of NCDs. This study represents an important step towards expanding the role of CHWs in addressing multiple risk factors in LMICs and marginalised groups in HICs. Figure 1: Effect of CHW-delivered intervention on primary and secondary outcomes of systolic blood pressure

Reimagining the role of community health workers in SAARC countries.

Following the Alma Ata declaration, SAARC countries have established their workforce of community health workers (CHWs) to address primary healthcare needs. Initially focused on maternal and child health, the countries now confront a changing healthcare landscape characterized by noncommunicable diseases (NCDs), mental health issues, and surgical conditions. These developments have led to the emergence of specialized CHWs tasked with managing NCDs and mental health concerns, prompting a reevaluation of the balance between specialization and maintaining a generalist approach. The effectiveness of CHWs during crises hinges on critical factors such as standardized training, opportunities for career advancement, and equitable compensation. This viewpoint makes a call to introduce a specialist category of CHW to align with evolving healthcare requirements in SAARC countries.

Critical lessons from a pragmatic randomized trial of home-based COVID-19 testing in rural Native American and Latino communities.

Native Americans and Latinos have higher COVID-19 infection and mortality rates and may have limited access to diagnostic testing. Home-based testing may improve access to care in rural and underserved populations. This study tests the effect of community health worker (CHW) support on accessibility, feasibility, and completion of COVID-19 home testing among Native American and Latino adults living on the Flathead Reservation in Montana and in Yakima Valley, Washington. A two-arm, multisite, pragmatic randomized controlled trial was conducted using block randomization stratified by site and participant age. Active arm participants received CHW assistance with online COVID-19 test kit registration and virtual swabbing support. The passive arm participants received standard-of-care support from the kit vendor. Logistic regression modeled the association between study arm and test completion (primary outcome) and between study arm and test completion with return of valid test results (secondary outcome). Responses to posttest surveys and interviews were summarized using deductive thematic analysis. Overall, 63% of participants (n=268) completed COVID-19 tests, and 50% completed tests yielding a valid result. Active arm participants had higher odds of test completion (odds ratio: 1.66, 95% confidence interval [1.01, 2.75]). Differences were most pronounced among adults ≥60years. Participants cited ease of use and not having to leave home as positive aspects, and transportation and mailing issues as negative aspects of home-based testing. CHW support led to higher COVID-19 test completion rates, particularly among older adults. Significant testing barriers included language, educational level, rurality, and test kit issues.

Community Health Workers’ experiences of an intervention to provide them with increased support and supervision: a qualitative study of a home visiting model in rural South Africa

Deploying Community Health Workers (CHWs) is a crucial strategy to improve health at a community level in low- and middle-income countries. While there is substantial evidence for CHW effectiveness, there is a need for more research on the mechanisms through which these programs work. Understanding CHWs experiences of how programmes function is important. This article examines CHW’s experiences of three key programmatic domains; training, logistical support and supervision. Data were gathered using through qualitative descriptive study drawing from semi-structured interviews. The study was embedded within a cluster randomized controlled trial, testing the effectiveness of an enhanced supervision package delivered to government-employed CHWs in the rural Eastern Cape, South Africa, on maternal and child health outcomes We conducted individual semi structured interviews with CHWs (n = 16) and two supervisors. Data were coded deductively and overall, three overarching areas and five sub-themes emerged from our interviews, the overarching teams were; 1) CHW knowledge and confidence increased through additional training, 2) CHW motivation and community acceptance improved because of added logistical support, and 3) CHW supervision led to improved sense of accountability, feelings of respect, and sense of being supported. Our findings highlight the importance of a functional support system within which CHWs can operate, in a context where most CHWs operate in isolation and without support. CHWs receiving supportive supervision reported positive impacts on their motivation and ability to carry out their work effectively. Clinicaltrials.gov, NCT02957799, 2016-11-08.

Challenges to Implementation of Community Health Worker-Led Chronic Obstructive Pulmonary Disease (COPD) Screening and Referral in Rural Uganda: A Qualitative Study using the Implementation Outcomes Framework.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. The burden of COPD is expected to increase in low- and middle-income countries (LMICs). COPD screening and diagnostics tools are often inaccessible in rural settings of LMICs. To contribute to the growing body of evidence on the effectiveness of Community Health Worker (CHW) interventions, this study aims to understand the facilitators and barriers of implementing a CHW-led COPD screening and referral program in rural Uganda. This qualitative study was conducted from September to October 2022 to explore Community Members, CHWs, and Healthcare Providers (HCPs) perceptions on the challenges of CHW-delivered COPD programming in Nakaseke, rural Uganda. In total, we held eight individual in-depth interviews with CHWs, ten in-depth interviews with HCPs and six focus group discussions with 34 Community Members. Research assistants audio-recorded and transcribed interviews verbatim. The implementation outcomes framework guided the thematic analysis. Implementation acceptability was constrained by a lack of COPD awareness, a lack of perceived utility in COPD screening as well as stigma around the diagnostic process. Limited spirometry adoption was also attributed to Community Member accessibility and willingness to participate in the COPD diagnostic referral process. The high patient volume and the complex, time-consuming diagnostic and referral process hindered successful implementation. To enhance program sustainability, all participants suggested increasing CHW support, medication access, decentralizing COPD care and upscaling follow-up of Community Members by CHWs. CHW-led interventions remain a potentially critical tool to alleviate barriers to treatment and self-management in settings where access to care is limited. While community-based interventions can create sustainable infrastructure to improve health outcomes, formative assessments of the potential barriers prior to intervention are required. Evidence-based, localized approaches and sustained funding are imperative to achieve this.

Effects of a Community Health Worker-Led Health Literacy Intervention on Lifestyle Modification Among Patients With Hypertension and Diabetes in the City of Harare, Zimbabwe: Protocol for a Cluster Randomized Controlled Trial.

Hypertension and diabetes are among the most common noncommunicable diseases in Zimbabwe. These 2 conditions are largely prevented and controlled by lifestyle modifications, such as healthy eating habits, physical activity, and avoiding the use of tobacco and alcohol. This study aims to evaluate the effects of a community health worker (CHW)-led health literacy intervention on lifestyle modification among patients with diabetes and hypertension in the City of Harare, Zimbabwe, in terms of (1) adherence to recommended lifestyle changes, (2) blood pressure and blood glucose levels, and (3) medication adherence. This is a 6-month-long cluster randomized controlled trial, which will be conducted in primary health care clinics in the city of Harare. A total of 14 clinics will be randomly allocated into either the intervention or control group. A total of 680 (49 participants per clinic) adult patients with hypertension and diabetes will be enrolled for the trial. Participants in the intervention arm will receive a simple health literacy intervention on lifestyle modification, which will be delivered by trained CHWs, while those in the control arm will receive usual care. The intervention consists of 4 face-to-face interactive educational sessions and monthly support visits by trained CHWs and will be carried out over a period of 6 months. The primary study outcomes will be blood pressure and blood glucose levels and levels of adherence to the recommended lifestyle modifications. Other outcomes will include adherence to medication. Data management and analysis will be done using Epi Info software, and the data will be analyzed using the intention-to-treat principle. Recruitment of study participants commenced on June 1, 2023, and was completed on July 30, 2023. Baseline data are being collected after participants' recruitment, and the final data collection will be completed by January 31, 2024. There is an information dearth regarding the effectiveness of CHW-led interventions for the management and control of hypertension in Zimbabwe. Our study offers an opportunity to show the effectiveness of CHWs in addressing the gaps in the management of hypertension and diabetes. The findings from our study will provide crucial evidence on the effectiveness and feasibility of a simple intervention delivered by CHWs in resource-constrained areas. PRR1-10.2196/47512.

Recruitment and selection of community health workers in Iran; a thematic analysis

BackgroundIn Iran, community health workers (CHWs) are selected and employed according to the instructions of the Ministry of Health (MOH). The present study aimed to investigate the views of different stakeholders regarding the selection criteria, as well as the competency of CHWs.MethodsThis study was conducted using a qualitative thematic analysis in Golestan Province, Iran. Data were collected using semi-structured interviews with managers, supervisors, CHWs, and common people in 2021. The interviews were recorded and then transcribed. To extract key themes, the six-step Brown model was used, which involved becoming acquainted with the data, meaningful organization of transcripts, extracting primary open codes, searching for themes in an iterative approach, theme extraction, defining themes, and preparing a report. The relationships between codes and sub-themes and themes were represented using ATLAS.ti version 8.ResultsData saturation was achieved after interviewing 22 people. The extracted data included 340 open codes, two main sub-themes of “CHW effectiveness” and “CHW sustainability”, and three main themes of “criteria for employing competent people”, “barriers to employing competent people”, and “identifying the barriers to employing competent people”, according to the MOH instructions.ConclusionIn the present study, local hiring was one of the major challenges in the competency-based selection of CHWs. One of the most repeated codes was expanding the local hiring concept and its requirements. Since different regions of Iran have different climatic, economic, cultural, and social conditions, the selection and hiring criteria for CHWs should be tailored to the needs of the community.

Integrating Community Health Workers into Hospital Systems Through a Social Work Partnership: A Report from the Field.

While studies support the effectiveness of community health worker (CHW) services, best approaches for CHW integration in health systems are not well understood. We describe early outcomes from a partnership between a safety-net hospital systems' social work department and CHWs to address adverse social determinants of health of high-risk patients.

Effect of home visits by community health workers on complementary feeding practices among caregivers of children aged 6-23 months in 10 districts of Bangladesh.

Suboptimal complementary feeding contributes to undernutrition in children aged 6-23 months in low- and middle-income countries like Bangladesh. Multifaceted interventions have been taken to improve complementary feeding practices, but there is limited evidence about the effect of home visits by community health workers (CHWs) on complementary feeding practices of the caregivers of children. We collated data from the baseline and the corresponding follow-up survey done as part of an evaluation of Bangladesh Maternal, Infant and Young Child Nutrition (MIYCN) programme. We collected data on complementary feeding practices using a 24-h recall questionnaire. Age-appropriate dietary diversity, minimum meal frequency, and minimum acceptable diet were assessed based on recommended food consumption as per child's age. To understand the effect of CHWs' visits on complementary feeding practices, we performed Generalized Estimating Equation (GEE) procedure for dealing with correlated data and adjusted other covariates. A total of 758 and 745 caregivers of children aged 6-23 months participated in the baseline and follow-up survey, respectively. Complementary feeding practices were improved in 1 year of programme implementation; dietary diversity increased from 46 to 54%, minimum meal frequency from 82 to 91%, and minimum acceptable diet from 41 to 53%. Caregivers of children who had received the visit of CHWs in the last 12 months prior to the day of the follow-up survey were more likely (AOR 1.51; 95% CI 1.10-2.10) to maintain dietary diversity in their children's feeding practices than the caregivers who had not received a CHW visit in the last 12 months. The likelihood of maintaining a minimum acceptable diet in feeding practices was 1.57 times higher (AOR 1.57; 95% CI 1.14-2.17) among the caregivers who were exposed to the visits of the CHWs in the last 12 months compared to the caregivers who were not exposed to the CHW's visits in the last 12 months. Integration of promotional activities of complementary feeding practices into the mainstream nutrition programme can be instrumental in optimizing complementary feeding practices among the caregivers of the under-five children. However, home visits by CHWs should be prioritized in such an integrated programme.

Effect of community-level intervention on antenatal care attendance: a quasi-experimental study among postpartum women in Eastern Uganda

ABSTRACT Background Early Initiation of antenatal care (ANC) and at least four visits during pregnancy allow screening and support for a healthy lifestyle and self-care during pregnancy however, community-directed interventions to improve access to these services are rarely explored. Objective To assess the effect of community health worker (CHW) involvement on utilisation of antenatal services during pregnancy in resource-constrained rural settings in Uganda. Methods We conducted a quasi-experimental evaluation study among mothers from Eastern Uganda. We used Difference in Differences (DiD) analysis to assess the effect of CHW intervention on ANC attendance. Components of the intervention included community dialogues and empowering CHWs to educate pregnant women about using maternal health services. The primary endpoints were early initiation of ANC and completion of at least 4 ANC visits. Results Overall, the intervention significantly improved attendance of ≥ 4 ANC visits (DiD = 5.5%). The increase was significant in both intervention and comparison areas (46.2–64.4% vs. 54.1–66.8%, respectively), with slightly greater gains in the intervention area. Other elements that predicted ≥4 ANC attendance besides the intervention were post-primary education (PR1.14, 95%CI 1.02–1.30), higher wealth quintile (PR1.17, 95%CI 1.06–1.30), and early initiation of ANC (PR1.58, 95%CI 1.49–1.68). The intervention did not significantly improve early initiation of ANC (DiD =-1.3%). Instead, early initiation of ANC was associated with higher husband education (PR1.19,95%CI 1.02–1.39), larger household size (PR = 0.81, 95%CI 0.70–0.95), and higher wealth index (PR1.19,95%CI 1.03–1.37). Conclusions The CHW intervention improved attendance of at least 4 ANC visits but not early initiation of ANC. There is need to promote CHW-led health education to increase attendance at 4+ ANC visits, but other approaches to promote early initiation are urgently required.

Comparing dedicated and designated approaches to integrating task-shared psychological interventions into chronic disease care in South Africa: a three-arm, cluster randomised, multicentre, open-label trial

Community health workers (CHWs) are increasingly providing task-shared psychological interventions for depression and alcohol use in primary health care in low-income and middle-income countries. We aimed to compare the effectiveness of CHWs dedicated to deliver care with CHWs designated to deliver care over and above their existing responsibilities and with treatment as usual for patients with a chronic physical disease. We did a three-arm, cluster randomised, multicentre, open-label trial done in 24 primary health-care clinics (clusters) within the Western Cape province of South Africa. Clinics were randomly assigned (1:1:1) to implement dedicated care, designated care, or treatment as usual, stratified by urban-rural status. Patients with HIV or type 1 or type 2 diabetes were eligible if they were 18 years old or older, taking antiretroviral therapy for HIV or medication to manage their diabetes, had an Alcohol Use Disorders Identification Test (AUDIT) score of eight or more or a Center for Epidemiologic Studies Depression Scale score of 16 or more, and were not receiving mental health treatment. In the intervention arms, all participants were offered three sessions of an evidence-based psychological intervention, based on motivational interviewing and problem-solving therapy, delivered by CHWs. Our primary outcomes were depression symptom severity and alcohol use severity, which we assessed separately for the intention-to-treat populations of people with HIV and people with diabetes cohorts and in a pooled cohort, at 12 months after enrolment. The Benjamini-Hochberg procedure was used to adjust for multiple testing. The trial was prospectively registered with the Pan African Clinical Trials Registry, PACTR201610001825403. Between May 1, 2017, and March 31, 2019, 1340 participants were recruited: 457 (34·1%) assigned to the dedicated group, 438 (32·7%) assigned to the designated group, and 445 (33·2%) assigned to the treatment as usual group. 1174 (87·6%) participants completed the 12 month assessment. Compared with treatment as usual, the dedicated group (people with HIV adjusted mean difference -5·02 [95% CI -7·51 to -2·54], p<0·0001; people with diabetes -4·20 [-6·68 to -1·72], p<0·0001) and designated group (people with HIV -6·38 [-8·89 to -3·88], p<0·0001; people with diabetes -4·80 [-7·21 to -2·39], p<0·0001) showed greater improvement on depression scores at 12 months. By contrast, reductions in AUDIT scores were similar across study groups, with no intervention effects noted. The dedicated and designated approaches to delivering CHW-led psychological interventions were equally effective for reducing depression, but enhancements are required to support alcohol reduction. This trial extends evidence for CHW-delivered psychological interventions, offering insights into how different delivery approaches affect patient outcomes. British Medical Research Council, Wellcome Trust, UK Department for International Development, the Economic and Social Research Council, and the Global Challenges Research Fund.

Determinants of community health workers effectiveness for delivery of maternal and child health in Sub Saharan Africa: A Systematic review protocol.

BackgroundCountries in sub-Sahara African continue to have the highest maternal and under- five child death occurrences in the world and this has become a key health challenge in the region and persists as global public health agenda. Although Community Health Workers (CHWs) are increasingly being acknowledged as crucial members of the healthcare workforce in reducing health disparity, evidence is limited on perspective of community health workers. The objective of this protocol is to outline the methodological process of a systematic review that will gather qualitative data to examine determinants of community health workers effectiveness for delivery of maternal and child health in Sub Saharan Africa. Synthesizing the perspectives of community health workers’ perceived experience is crucial to inform decision makers, policy makers, and practitioners to address barriers to and scaleup facilitators of CHWs program to ensure maternal and child health equity and a resilience community health system.MethodsThe protocol has been registered in the PROSPERO (CRD42020206874). We will systematically conduct a literature search from inception in MEDLINE complete, EMBASE, CINAHL complete and Global Health for relevant studies. Eligible studies will be reports of original research, peer reviewed articles having a qualitative component (i.e., qualitative, mixed, or multi-method studies) on empowerment of CHWs associated with maternal and child health in the sub-Saharan Africa. Eligibility will be restricted to studies published in English. Two reviewers will independently screen all included abstracts and full-text articles. The primary outcome will be CHWs’ perceived barriers to and facilitators of effectiveness of community health workers in maternal and child health in sub-Saharan Africa. Study methodological quality (or bias) will be appraised using appropriate tools. Narrative analysis will be conducted, and narrative summary of findings will be presented. We will use the ‘best fit’ framework method as a systematic approach to analyzing the qualitative data.DiscussionThis study will systematically and comprehensively search literature and integrate evidence on perceived barriers to and facilitators of effectiveness of community health workers led maternal and child health program in sub-Saharan Africa. Our findings will inform policy and practice on maternal and child health equity and a resilient communities health system. The resulting manuscript will be disseminated in a peer-reviewed journal and at international and national conferences.

Improving Community Health Worker Compensation: A Case Study From India Using Quantitative Projection Modeling and Incentive Design Principles.

Although community health workers (CHWs) are effective at mobilizing important health behaviors, there is limited evidence on how financial incentive systems can best be designed to drive their effectiveness. This study intends to bridge this evidence gap by analyzing the compensation model of India's accredited social health activist (ASHA) program and identifying areas of improvement in the system's design and implementation. We analyze the ASHA program in Uttar Pradesh, India. ASHAs receive compensation through a mix of program-linked, performance-based, and routine activity-based incentive structures. Using multiple data sources, including a novel linked household and ASHA survey, we estimate ASHA performance-linked incentive earnings under different scenarios of ASHA actions and household behaviors. Juxtaposing statistical projection models and actual government payments, we identified which incentives promised the highest payments, which were claimed or not, which could be claimed more by increasing ASHA actions, and which were paid despite not meeting payment criteria. We also report findings on ASHA awareness of and experiences with claiming incentives. We find crucial gaps and implementation challenges in the ASHA incentive structure. ASHAs could double their earnings by completing certain tasks within their control. ASHAs may also be paid for partial completion of activities, as incentives are paid in lump sums for a series of activities rather than for each activity. Family planning incentives have the largest gap between potential and actual earnings. Incentivizing ASHAs for achieving certain health outcomes is inefficient, as no clear linkage was found between the achievability of such health outcomes and the claim amounts. There are several opportunities for improving CHW compensation, from improving the incentive claims process to shifting focus to achievable outcomes. Optimizing incentive system designs can further enhance CHW effectiveness globally to affect key health behaviors.

927-P: The Impact of Community Health Worker Interventions on A1C in People of Racial/Ethnic Minority Groups with Type 2 Diabetes: A Systematic Review and Meta-analysis

Objective: Communities of racial/ethnic minority groups experience a higher prevalence of type 2 diabetes (T2DM) with higher rates of diabetes-related complications compared to non-Hispanic Whites. Interventions that utilize community health workers (CHW) are often successful at improving glycemic control. This analysis aimed to examine the effectiveness of CHW interventions on glycemic control in people of racial/ethnic minority groups with T2DM. Methods: A search of electronic databases (PubMed, Scopus, CINAHL, PsycInfo) to identify articles published between 1985 and 20was conducted using broad search terms for diabetes, race/ethnicity, and disparities. To further refine articles to those focusing on CHW-based randomized controlled trials, abstracts were searched for “community workers” and “promotores.” A random effects model was used to calculate the effect of CHW interventions on hemoglobin A1c (HbA1c) with future plans to analyze effects on other cardiovascular risk factors such as body mass index, blood pressure, and cholesterol. Results: A total of 22 RCTs were identified, involving 4996 adults (26% Black, 50% Hispanic, 11% Asian, and 11% Pacific Islander) . CHW interventions among people of racial/ethnic minority groups was associated with a 0.44% (95% confidence interval: -0.56% to -0.31%; p&amp;lt;0.0001) reduction in HbA1c. Conclusion: CHW interventions are an effective means to lower HbA1c among people of racial/ethnic minority groups with T2DM. This finding is important for future healthcare policies, which should work to emphasize culturally sensitive interventions for patients with T2DM while maintaining cost effectiveness through CHWs. Future research should examine the effectiveness of CHWs for diabetes prevention. Disclosure R.Shetty: None. A.Deckard: None. W.Wan: n/a. A.Nathan: None. E.M.Staab: None. A.W.Rodriguez: None. A.Gandhi: None. A.A.Baig: None. N.Laiteerapong: None.

Multilevel determinants of community health workers for an effective maternal and child health programme in sub-Saharan Africa: a systematic review

BackgroundCountries in sub-Saharan Africa (SSA) continue to have the highest maternal and under-five child deaths in the world. The ongoing COVID-19 pandemic is amplifying the problems and overwhelming already fragile...

Effectiveness of community health workers on identification and mobilization of persons living with epilepsy in rural Rwanda using a validated screening tool

IntroductionEngagement and training of community health workers (CHWs) have demonstrated their value in different conditions. Despite repeat epilepsy trainings of CHWs in Northern Rwanda, the treatment gap remained high. We hypothesized that effectiveness of CHWs on mobilization of patients living with epilepsy (PwE) could be improved using a validated tool for epilepsy screening.MethodsCHWs associated with health centers (HCs) of Gataraga, Kimonyi and Karwasa attended a 1-day training on epilepsy and Limoges epilepsy screening questionnaire (Kinyarwanda version). Thereafter, CHWs screened households in their villages for persons with one or more positive answer. CHWs then accompanied positively screened persons to a consultation for clinical evaluation and diagnosis by neurologists, and demographic data were collected. CHW variables were collected retrospectively.ResultsA total of 1308 persons were screened positive by 281 CHWs. Clinical diagnosis of epilepsy was confirmed in 589 and in 93 additional unscreened PwE, presenting voluntarily at the consultation. Pre-intervention number of 48 PwE increased to 682 after, a 14.2-fold increase. The overall treatment gap amounted to 93.0%. The age distribution of male PwE preponderance at younger age inverted to females at older age.CHW characteristics showed non-significant differences within and across HCs. Logistic regression did not relate CHW age, gender, and experience to screening results.DiscussionEquipping CHWs with a validated screening tool was effective in identifying and mobilizing PwE in a short time frame and offers opportunity for future scaling. Nonetheless, barriers to sustainability of care will need to be addressed before.

Scorecard metrics for assessing the extent of integration of community health worker programmes into national health systems.

BackgroundThe effectiveness of community health workers (CHWs) in delivering community-based preventive services is often curtailed by inadequate or complete lack of integration of the CHW programmes into national health systems. Although literature has defined the context and guidelines for integrating CHW programmes into health systems, indicators to quantitatively assess the extent of integration are inadequately addressed.AimThis article presents an integration scale – CHW Programme Integration Scorecard Metrics (CHWP-ISM) – for measuring the extent of CHW programme integration into national health systems.SettingLiterature review and policy documents were focused on sub-Saharan Africa, while interview participants were drawn from six African countries.MethodsA deductive–inductive approach to item and measurement scale development was employed. Information obtained from a combination of diverse literature sources, subject matter expert (SME) interviews and documentary abstraction from publicly available policy documents advised item generation for the proposed CHWP-ISM. The study qualitatively captured the sectoral CHW integration, thematically analysed the data and culminated in the quantitative integration metrics.ResultsAnalysis of the responses from six SMEs and abstraction from policy documents resulted in the compilation of metrics with a total of 100 indicators for the CHWP-ISM scale that could be used to assess the level of CHW programmes integration into national health systems. The indicators were categorised along the six World Health Organization’s (WHO) health systems building blocks. Subject matter expert responses corresponded well with abstracted results from the 18 country CHW programmes, indicating content validity.ConclusionThe proposed scorecard metrics can be used to quantitatively rate the extent of CHW programmes integration into health systems, in an attempt to strengthen health systems to improve health outcomes.

The West Philadelphia asthma care implementation study (NHLBI# U01HL138687)

Asthma is the most common chronic condition among children, with low-income families living in urban areas experiencing significantly higher rates. Evidence based interventions for asthma are routinely implemented in either the home, school, or primary care setting. However, even when caregivers of poor children are engaged in asthma interventions in one setting, they often have to navigate challenges in another setting, such as an under-resourced home, non-supportive school, or disengaged health care provider. The West Philadelphia Asthma Care Implementation Plan aims to compare the effectiveness of a primary care-based intervention, school-based intervention, and combined primary care and school intervention to usual care for improving asthma control in school-age children to explore if the synergistic effect of Community Health Worker (CHW) support in the home, school, and health care environments will result in improved asthma control. Children ages 5–13 with uncontrolled asthma from four West Philadelphia recruitment sites will be eligible for enrollment. The families of school age children interested in participating will be randomized to receive a primary care CHW or usual care. Those identified as attending a participating school will have a CHW-led school intervention or usual care in school. If proven effective, this care coordination program will assist caregivers in assessing resources, improving self-management skills, and ultimately reducing asthma-related ED visits and hospitalizations as well as provide additional information for healthcare systems and policy makers to inform their decisions about how and where to focus additional resources and investments in childhood asthma care to improve health outcomes.

Abstract 2553: Using a “train-the-trainer” approach with urban and rural minority community health workers to implement the cancer-Community Awareness Access Research and Education (c-CARE) Project

Abstract Introduction: Community health workers (CHW) are often a key component to effective implementation of health promotion interventions; training on intervention delivery and self-efficacy enhances CHW effectiveness. The cancer-Community Awareness Access Research and Education (c-CARE) project utilized a train-the-trainer approach to equip CHWs to teach the four-week c-CARE lung cancer module. Project objectives included providing and facilitating: 1) education on risks of lung cancer, 2) low-dose CT (LCDT) screening for eligible participants, 3) smoking cessation, and 4) training CHWs to deliver the educational intervention and thus promote sustainability. Methods: Lay CHWs (n=63, 54 urban, 9 rural, 92% female, 56% having ≥Bachelors degree, 79% healthcare providers) were selected from 16 historically African American (AA) churches (n = 9 urban, 3 rural), Federally-Qualified Health centers (n=3) and one community center, all in Georgia or South Carolina. CHW inclusion criteria included pastor recommendation from the churches' healthcare ministry (primarily nurses and other allied health professionals) or community clinic workers who were public health practitioners, nurses, and paraprofessionals. CHWs participated in a 2-day implementation training. Training topics included: their role as a c-CARE facilitator, knowledge of cancer risk factors and lung cancer screening, and using the c-CARE materials to teach the sessions. Pre and post surveys assessed knowledge, satisfaction with the training, and self-efficacy regarding teaching the content. Responses were summarized; all significance tests were two-tailed using a significance level of 0.05. Result: Improvement in each of the six items was strongly significant (p &amp;lt; 0.001), with a mean improvement of at least 2 points on the 0-10 scale in: 1) understanding of their roles as c-CARE facilitators, 2) knowledge of cancer risk factors, 3) knowledge of lung cancer screening, 4) confidence in conducting a c-CARE group, 5) confidence in their abilities to implement a policy change, and 6) confidence in using c-CARE materials to teach participants. Participants also reported satisfaction with the c-CARE training they received. There were no significant differences between urban and rural CHW participants. CHWs conducted 64 sessions for 586 participants as a part of the c-CARE project. Discussion: Use of lay CHWs to deliver culturally competent cancer education and screening navigation was an important component of the c-CARE project. Increases in knowledge regarding cancer risk factors, screening requirements, and self-efficacy in leading the sessions were reported by the CHWs. Use of local lay CHWs ensures sustainability, positively affecting community knowledge, attitude and beliefs regarding lung cancer, prevention, and screening behaviors. Citation Format: Marlo M. Vernon, Ghadeer Albashir, Samantha J. Sojourner, Justin X. Moore, Stephen W. Looney, Martha S. Tingen. Using a “train-the-trainer” approach with urban and rural minority community health workers to implement the cancer-Community Awareness Access Research and Education (c-CARE) Project [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2553.