Local Community Health Workers Research Articles

Harlem Health Advocacy Partners: A Local Health Department's Place-Based Community Health Worker Program.

In January 2015, the New York City Department of Health and Mental Hygiene launched Harlem Health Advocacy Partners (HHAP), a place-based initiative to demonstrate the capacity of a CHW workforce to improve the health of residents of public housing. The long-term goal of HHAP is to improve the population health of residents of public housing in East and Central Harlem and to close racial gaps in health and social outcomes. A variety of evaluation approaches have been used to assess the initiative. This paper describes the HHAP model and methods for evaluating the program.

Exploring Crop Choices: Benefits, Challenges, and Rationale Among Rwandan Farmers

Farming decisions on crop choices are guided by different factors including natural conditions, household needs, traditions, stakeholder recommendations, and productivity. The best decision varies for each farmer based on specific circumstances. There are both benefits and challenges in farmers’ crop growing experience. In Rwanda, agriculture employs 70% of the population, contributing 33% to the GDP across three main agricultural seasons. However, food and nutritional insecurity remain pressing issue affecting both human and economic progress. This study explored the rationale, benefits, and challenges of farmers’ choices. This study used a qualitative descriptive approach, conducting six focus group discussions (FGDs) in each participating district. Each FGD comprised 10 participants, ensuring gender balance. Recruitment was facilitated by local community health workers (CHWs), with participants providing informed consent. Trained data collectors utilized voice recorders to collect the data. The researchers transcribed the data verbatim, anonymized the data, and translated the same data into English. Data analysis revealed four key themes: reasons for cultivation, factors influencing crop choice, farmers’ livelihoods, and farming challenges. Findings highlight the need for holistic and context-specific solutions in Rwandan agricultural development, emphasizing stakeholder collaboration to support informed decision-making and sustainable agriculture.

Abstract P446: Community-Engaged Strategies for Recruitment of Black Men at Risk for Hypertension: The CLIP Study

Background: Recruitment of Black participants in research studies is challenging. Mistrust of academic and medical institutions due to historic mistreatment, medical racism, and lack of culturally tailored strategies to engage Black communities as partners, has led to under-representation of Black participants in studies. Black men have higher prevalence of hypertension (HTN) and worse outcomes than other groups. Yet, Black men are underrepresented in HTN clinical trials. The Community-to-Clinic Linkage Program to Prevent Hypertension (CLIP) is a community-engaged cluster randomized trial to test barbershop facilitation to prevent HTN among Black men residing in Staten Island (SI), New York City. Objective: To describe recruitment strategies to engage Black men in CLIP via an academic-community partnership. Methods and Results: Approximately 10% of SI residents identify as Black, of which ~ 90% live in 3 census tracts with the highest prevalence of HTN in the borough. The study team collaborates with Community Health Action of Staten Island (CHASI), a grassroots health organization with > 30 years of community focus on addressing the root causes of health disparities on SI, the Director of Health in SI, a community advisory council (CAC) comprised of local leaders and residents, and the New York American Heart Association providing HTN education materials in an academic-community partnership to implement CLIP. Our recruitment goal is to enroll 84 men across 4-5 Black-owned barbershops over 5 cycles (12 weeks each), total N=418. We did not meet recruitment goals for cycles 1 and 2, (~60% enrolled). In consultation with CHASI and the CAC we adjusted our recruitment strategies to: 1) host bi-monthly community events in or around participating barbershops; 2) offer study incentives at the time of enrollment; 3) leverage existing relationships with faith-based organizations and other stakeholders to promote CLIP; and 4) distribute co-branded promotional flyers with CHASI and other stakeholders to publicize events. Subsequently we exceeded recruitment goals in our last cycle (113% enrolled); current cycle recruitment is ongoing. Several strategies have been successful in improving recruitment of Black men for CLIP: 1) deep community ties of our community health partner; 2) enlisting local community health workers representative of the study population; 3) flexibility and open communication between academic and community staff; 4) trust in the competence of each partner; 5) mutual commitment to the mission of the study. Conclusion: Partnering with engaged and trusted community partners, stakeholders, and local leaders positively impacts recruitment of Black men participants in HTN research studies. Organizations with deep community ties are crucial for establishing trust and identifying flexible solutions to recruitment challenges.

FEASIBILITY OF A COMMUNITY-BASED NAVIGATOR SUPPORT PROGRAM FOR CARE PARTNERS OF SERIOUSLY ILL VETERANS

Abstract We examined the feasibility and satisfaction of a short-term Veterans Health Administration (VHA)-based care partner support intervention delivered by trained navigators during COVID-19 through a single-arm interventional cohort feasibility study of a telephone-based care partner navigation intervention. Navigators (n=9) received the standard state curriculum online from a local community health worker training program plus an additional eight weeks of online role-specific training by the study team. Subsequently, navigators contacted care partners (n=30) of seriously ill veterans weekly via telephone over a 12-week period to assess social and practical needs, and connect care partners to appropriate community-based or VHA resources. All navigators (9 female; 1 male) and 17% of care partners were African-American (83% were Caucasian or other). Care partners were 90% female and 10% male; age range 41 to 80. In this telephone-based support program delivered to care partners by standard-trained navigators across 12 counties, care partners were overall very satisfied (x̄=4.69 out of 5, sd =.77) with their navigator’s responsiveness and social support throughout the 12-week course of the study. Navigators’ confidence increased over time (x̄=8.2 out of 10 (sd=1.14) to x̄=8.78 (sd=.97)), while their self-assessed effectiveness ratings lowered over time as they encountered real-life scenarios (x̄=8.5 (sd=1.43) to x̄=7.89 (sd=.93)). Navigators documented successful connections to services in the VHA and in care partners’ communities. Using remote navigators with minimal but standard training is a feasible and acceptable model of care partner support.

Strengths, weaknesses, opportunities and threats of a community-based egg program in rural Honduras

Abstract Background Young children living in poor rural areas in Honduras are susceptible to suffering from undernutrition. About 1 in every 4 children under age 5 have stunting. Stunting during early childhood has negative consequences on an individual's life that can have short-term and lasting effects. This study's purpose was to explore the perceptions of the mothers of children that participate in a community-based nutrition-agriculture program that offers 1 egg daily to all children ages 6 to 24 months in 13 communities. Methods Using community-engaged methods, we implemented a SWOT analysis to identify strengths, weaknesses, opportunities, and threats using a semi-structured guide to conduct in-depth interviews in n = 14 participating mothers in the Hens Hatching Hope project (ClinicalTrials.gov Identifier: NCT04721197). Interviews were performed by a local community health worker in Spanish, translated to English, and analyzed via content analysis by a researcher. Main themes were identified and synthesized. Results Some of the identified strengths were the “improved community access to eggs” and “financial assistance that offset burdening household expenses”. For weaknesses “expansion of program age eligibility to accommodate multi-child households” and “no control over parent's use of eggs”. For opportunities “Implementation of external community resources” and “improve water and sanitation initiatives”, for threats “changes in political climate” and “frail farm infrastructure”. Conclusions Perception of the program is positive among all mother participants. This analysis identified multiple strengths and opportunities to 1) improve the program locally, and 2) expand the program's scope and reach. Further, this analysis identified weaknesses and potential threats that will serve to modify and improve the delivery and uptake of the intervention. Key messages • Explore program strengths, weaknesses, opportunities, and threats perceived by particpating mothers of a community-based nutrition agriculture program that provides 1 egg a day to their child's diet. • The swot analysis of participating mothers’ interviews serves in the developing contingency plans to continue the Hens Hatching Hope program.

THU254 VICTOR-Pilot Study Of A Virtual Dietary Intervention To Improve Diabetes And Cardiovascular Risk In Rural Communities - Primary Results

Abstract Disclosure: C.C. Low Wang: Research Investigator; Self; Dexcom, Virta Health. R.O. Estacio: None. S. Coronel-Mockler: None. N. Flattery: None. A. McKenzie: Employee; Self; Virta Health. Stock Owner; Self; Virta Health. D. Harrison: Employee; Self; Virta Health. Stock Owner; Self; Virta Health. M.P. Bonaca: Consulting Fee; Self; Audentes. Research Investigator; Self; Abbott Laboratories, Agios Pharmaceuticals, Alexion Pharmaceuticals, Inc., Alnylam, Amgen Inc, Angionetics, Anthos Therapeutics, ARCA Biopharma Inc, Array, AstraZeneca, Atentiv, Better Therapeutics, Bayer, Inc., Bristol-Myers Squibb, Cardiol Therapeutics, CellResearch Corp, CSL Behring, Eidos Therapeutics, EP Trading Company, Esperion Therapeutics, EveryWell, Faraday Pharmaceuticals, Fortress Biotech, HeartFlow, Insmed, Jansen Pharmaceuticals, Lexicon Pharmaceuticals, Inc., Kowa Research, Merck & Co., Moderna, Novo Nordisk, Pfizer, Inc., PhaseBio, PPD Development, Prothena Biosciences, Regeneron Pharmaceuticals, Regio Biosciences, Sanifit Therapeutics, Sanofi, Stealth Biotherapeutics, Wraser, Cambrian Biopharma, Cook Regentech, EPG Communications, Epizon Pharma, Exicon Consulting, Medtronic, Silence Therapeutics, VarmX. Stock Owner; Self; Pfizer, Inc., Medtronic. Introduction: Individuals in rural communities face challenges accessing healthcare. Innovative strategies combining local Community Health Workers (CHW) and virtual digital solutions may be beneficial for improving type 2 diabetes (T2D) care and cardiovascular (CV) risk. Hypothesis: A virtually delivered digitally based intervention will improve glycemic control in individuals with diabetes in rural communities. Methods: The Virta Intervention in CommuniTies in cOloRado (VICTOR)-Pilot Study is designed to examine whether referral to the Virta Intervention (VINT) while integrated into the CHW program Colorado Heart Healthy Solutions (CHHS), a health education program designed to improve cardiovascular risk factors, is feasible, acceptable, and improves hemoglobin A1c (HbA1c). VINT is a low-carbohydrate approach to T2D treatment which is delivered through a continuous remote care platform via a smartphone application; patients receive care from a dedicated Health Coach and Medical Provider to boost efficacy and ensure safety. Adults with T2D age 18-79 yr in rural Colorado enrolled in CHHS and taking one or more antihyperglycemic medications for at least 3 months, with BMI >25 kg/m2, and HbA1c >7.5% were randomized to VINT + CHHS vs CHHS alone. The primary outcome is change in HbA1c from baseline to 3 months. Secondary outcomes include change in body weight, number of diabetes medications, and patient-reported outcomes. The Intervention arm undergoes VINT + CHHS for 6 months, then CHHS alone for 3 months. The Control arm starts with CHHS alone for 3 months, then VINT + CHHS for 3 months, and finally CHHS alone for 3 months. Both groups are assessed at baseline (0), 3, 6 and 9 months. Enrollment for the trial is complete, and the study is ongoing. Results: A total of 48 individuals are enrolled from 2 rural Colorado communities, 25 in the Intervention arm and 23 in the Control arm. Of these, 65% are female, mean age 59.4 years (range 36-77, SD 10.1), 92% white, 4% Hispanic, mean body mass index (BMI) 34.3 kg/m2 (range 25-62, SD 7.0), mean HbA1c 9.0% (range 7.5-14.1%, SD 1.3), mean weight 216.6 lb (range 148-364, SD 46.9), median number of diabetes medications: 2, with 36% of participants on insulin. The primary outcome of change in HbA1c from baseline to 3 months will be assessed in March 2023 and available for reporting at the 2023 Endocrine Society meeting. Conclusion: The VICTOR-Pilot study is evaluating the effect on HbA1c, medication burden, feasibility, and acceptability of a virtual digital dietary intervention to improve glycemic control and risk factor management in patients with type 2 diabetes living in rural communities. The trial has fully enrolled, and the primary end point as well as other key secondary endpoints will be reported. Presentation: Thursday, June 15, 2023

Oral health education for school children and capacity building of local community health workers in cleft care: An experience of student-led community service in a West Java village


 
 
 This article presents a program that seeks to establish partnerships between universities and rural villages in West Java provinces, with a focus on health-related activities. The program involves undergraduate students participating in field studies in the community through three activities: educating school children about oral health, providing capacity building for community health workers in managing infants with cleft, and assisting community health workers at Integrated Service Post (Posyandu). The program was developed by scholars at Universitas Padjadjaran and West Bandung Regency of West Java Province to contribute to the development of neighbouring regions. The program has had two significant impacts. First, the undergraduate students are directly involved in the community and can reflect on what they have learned in the context of the community, while also earning credits towards their transcripts. Second, the program has had a positive impact on healthcare by educating various community groups on topics ranging from oral health to early management of infants with orofacial clefts. This program serves as an example of how academic study and community service can be successfully combined to produce positive outcomes for both the students and the community.
 
 

Community engagement among forest goers in a malaria prophylaxis trial: implementation challenges and implications

BackgroundMalaria transmission in Southeast Asia is increasingly confined to forests, where marginalized groups are exposed primarily through their work. Anti-malarial chemoprophylaxis may help to protect these people. This article examines the effectiveness and practical challenges of engaging forest-goers to participate in a randomized controlled clinical trial of anti-malarial chemoprophylaxis with artemether-lumefantrine (AL) versus a control (multivitamin, MV) for malaria in northeast Cambodia.MethodsThe impact of engagement in terms of uptake was assessed as the proportion of people who participated during each stage of the trial: enrolment, compliance with trial procedures, and drug intake. During the trial, staff recorded the details of engagement meetings, including the views and opinions of participants and community representatives, the decision-making processes, and the challenges addressed during implementation.ResultsIn total, 1613 participants were assessed for eligibility and 1480 (92%) joined the trial, 1242 (84%) completed the trial and received prophylaxis (AL: 82% vs MV: 86%, p = 0.08); 157 (11%) were lost to follow-up (AL: 11% vs MV: 11%, p = 0.79); and 73 (5%) discontinued the drug (AL-7% vs MV-3%, p = 0.005). The AL arm was associated with discontinuation of the study drug (AL: 48/738, 7% vs 25/742, 3%; p = 0.01). Females (31/345, 9%) were more likely (42/1135, 4%) to discontinue taking drugs at some point in the trial (p = 0.005). Those (45/644, 7%) who had no previous history of malaria infection were more likely to discontinue the study drug than those (28/836, 3%) who had a history of malaria (p = 0.02). Engagement with the trial population was demanding because many types of forest work are illegal; and the involvement of an engagement team consisting of representatives from the local administration, health authorities, community leaders and community health workers played a significant role in building trust. Responsiveness to the needs and concerns of the community promoted acceptability and increased confidence in taking prophylaxis among participants. Recruitment of forest-goer volunteers to peer-supervise drug administration resulted in high compliance with drug intake. The development of locally-appropriate tools and messaging for the different linguistic and low-literacy groups was useful to ensure participants understood and adhered to the trial procedures. It was important to consider forest-goers` habits and social characteristics when planning the various trial activities.ConclusionsThe comprehensive, participatory engagement strategy mobilized a wide range of stakeholders including study participants, helped build trust, and overcame potential ethical and practical challenges. This locally-adapted approach was highly effective as evidenced by high levels of trial enrolment, compliance with trial procedures and drug intake.

Involving hard-to-reach populations is pivotal for the tailoring and implementation of an epidemiological study in cross-border communities of French Guiana and Suriname.

Hard-to-reach, vulnerable and cross-border populations are often disproportionately affected by communicable diseases. Epidemiological data on viral hepatitis in French Guiana and Suriname are available for urban areas, but not for remote communities. The Maroni River, which separates FG and Suriname, is home to Tribal and Indigenous communities. Reaching these populations is challenging due to logistical constraints, cultural and language barriers, and mistrust of outsiders. We aimed to conduct an epidemiological study of viral hepatitis [Maroni Hepatites Virales (MaHeVi)] in this remote and complex area. Here, we describe the operational hurdles and solutions required to achieve this. We undertook a preliminary assessment of the area with local community leaders and health workers to gain approval of MaHeVi, acceptance of blood sampling, and suggestions for adapting the study to cultural and logistical constraints. Anthropological assessments were conducted through focus groups and interviews with key individuals to assess knowledge, beliefs and risk factors for VH. MaHeVi was well received by the local communities. The approval of the community leaders was crucial for the implementation and acceptance of the study. The main adaptations were hiring community health mediators to overcome cultural and language differences, using blotting paper instead of venipuncture for logistical and acceptability reasons, and adapting communication materials. Careful preparation and tailoring of the communication materials and research protocol have enabled the successful implementation of the study. This process could be replicated in this area and transferred to other complex contexts combining borders, logistical hurdles and populations requiring cultural adaptations.

Organizational trust, usability, and inclusivity are key implementation facilitators for a proposed assets-based mobile health intervention.

Assets-based interventions can address child health disparities by connecting families to existing community resources. Community collaboration when designing interventions may identify barriers and facilitators to implementation. The objective of this study was to identify crucial implementation considerations during the design phase of an asset-based intervention to address disparities in childhood obesity, Assets for Health. We conducted focus groups and semi-structured interviews with caregivers of children (<18 years) (N = 17) and representatives of community-based organizations (CBOs) which serve children and families (N = 20). Focus group and interview guides were developed based on constructs from the Consolidated Framework for Implementation Research. Data were analyzed using rapid qualitative analysis and matrices were used to identify common themes within and across groups of community members. Desired intervention characteristics included an easy-to-use list of community programs that could be filtered based on caregiver preferences and local community health workers to promote trust and engagement among Black and Hispanic/Latino families. Most community members felt an intervention with these characteristics could be advantageous versus existing alternatives. Key outer setting characteristics which were barriers to family engagement included families' financial insecurity and lack of access to transportation. The CBO implementation climate was supportive but there was concern that the intervention could increase staff workload beyond current capacity. Assessment of implementation determinants during the intervention design phase revealed important considerations for intervention development. Effective implementation of Assets for Health may depend on app design and usability, fostering organizational trust and minimizing the costs and staff workload of caregivers and CBOs, respectively.

Does the Nae Umeed group intervention improve mental health and social participation? A pre-post study in Uttarakhand, India.

There are few evidence-based interventions to support caregiver mental health developed for low- and middle-income countries. Nae Umeed is a community-based group intervention developed with collaboratively with local community health workers in Uttarakhand, India primarily to promote mental wellbeing for caregivers and others. This pre-post study aimed to evaluate whether Nae Umeed improved mental health and social participation for people with mental distress, including caregivers. The intervention consisted of 14 structured group sessions facilitated by community health workers. Among 115 adult participants, 20% were caregivers and 80% were people with disability and other vulnerable community members; 62% had no formal education and 92% were female. Substantial and statistically significant improvements occurred in validated psychometric measures for mental health (12-Item General Health Questionnaire, Patient Health Questionnaire-9) and social participation (Participation Scale). Improvements occurred regardless of caregiver status. This intervention addressed mental health and social participation for marginalised groups that are typically without access to formal mental health care and findings suggest Nae Umeed improved mental health and social participation; however, a controlled community trial would be required to prove causation. Community-based group interventions are a promising approach to improving the mental health of vulnerable groups in South Asia.

Assessing Social Needs and Engaging Community Health Workers in Underserved Kansas Counties: Insights From Primary Care Providers and Clinic Managers.

Rural and under-resourced urban communities face unique challenges in addressing patients' social determinants of health needs (SDoH). Community health workers (CHWs) can support patients experiencing social needs, yet little is known about how rural and under-resourced primary care clinics are screening for SDoH or utilizing CHWs. Interviews were conducted with primary care clinic providers and managers across a geographically large and predominately rural state to assess screening practices for SDoH and related community resources, and perspectives on using CHWs to address SDoH. Interviews were conducted by phone, recorded, and transcribed. Data were analyzed using thematic analysis. We completed interviews with 27 respondents (12 providers and 15 clinic managers) at 26 clinics. Twelve (46.1%) clinics had a standardized process for capturing SDoH, but this was primarily limited to Medicare wellness visits. Staffing and time were identified as barriers to proper SDoH screening. Lack of transportation and affordable medication were the most cited SDoH. While respondents were all aware of CHWs, only 8 (30.8%) included a CHW on their care team. Perceived barriers to engaging CHWs included cost, space, and availability of qualified CHWs. Perceived benefits of engaging CHWs in their practice were: assisting patients with navigating resources and programs, relieving clinical staff of non-medical tasks, and bridging language barriers. Rural and under-resourced primary care clinics need help in identifying and addressing SDoH. CHWs could play an important part in addressing social needs and promoting preventive care if financial constraints could be addressed and local CHWs could be trained.

Adapting Attachment and Biobehavioral Catch-up for infants and young children with intellectual disabilities and developmental delays in South Africa: Reflections and recommendations from local stakeholders.

Attachment and Biobehavioral Catch-up (ABC) is an intervention targeted at enhancing the socioemotional and regulatory functioning of at-risk infants. However, to use the ABC for infants/toddlers with intellectual disabilities/developmental delays (ID/DD) and in novel cultural contexts, such as South Africa, adaptations may be required. This study aimed, therefore, to explore the opinions of clinical experts and perceptions of caregivers regarding the use of ABC for children with ID/DD in South Africa. It also sought to incorporate the experiences of families of children with ID/DD who received, and intervenors who delivered, ABC in its first implementation in South Africa. Semi-structured interviews were conducted with 18 participants. Thematic analysis explicated 12 main themes: Intervention Strengths, Points of Concern, and Recommendations (Experts); Focus on Caregiver-child Relationship, and Intervention Targets and Duration (Caregivers); Benefits of ABC, and Cultural Considerations (ABC Recipients); Focused and Targeted, Value of Feedback, Supportive Supervision, Working Alliance, and Challenges Experienced (ABC Intervenors). Practice and training recommendations include psychoeducation for parents and training for intervenors that is ID/DD-specific, expanding supervision capacity, building intervenors' cultural/linguistic sensitivity and competence, accessing referral networks, including local Community Health Workers as intervenors, and greater flexibility in how the sessions are organized.

Assessing knowledge, attitudes and belief toward HPV vaccination of parents with children aged 9–14 years in rural communities of Northwest Cameroon: a qualitative study

BackgroundHuman papilloma virus (HPV) vaccination is essential for the WHO cervical cancer elimination initiative. In Cameroon, HPV vaccine uptake is currently 5%. To assess the knowledge, beliefs and attitudes of...

Implementation barriers and remedial strategies for community-based health insurance in Bangladesh: insights from national stakeholders

BackgroundCommunity-based health insurance (CBHI) is a part of the health system in Bangladesh, and overcoming the obstacles of CBHI is a significant policy concern that has received little attention. The purpose of this study is to analyze the implementation barriers of voluntary CBHI schemes in Bangladesh and the strategies to overcome these barriers from the perspective of national stakeholders.MethodsThis study is exploratory qualitative research, specifically case study design, using key informant interviews to investigate the barriers of CBHI that are faced during the implementation. Using a topic guide, we conducted thirteen semi-structured in-depth interviews with key stakeholders directly involved in the CBHI implementation process. The data were analyzed using the Framework analysis method.ResultsThe implementation of CBHI schemes in Bangladesh is being constrained by several issues, including inadequate population coverage, adverse selection and moral hazard, lack of knowledge about health insurance principles, a lack of external assistance, and insufficient medical supplies. Door-to-door visits by local community-health workers, as well as regular promotional and educational campaigns involving community influencers, were suggested by stakeholders as ways to educate and encourage people to join the schemes. Stakeholders emphasized the necessity of external assistance and the design of a comprehensive benefits package to attract more people. They also recommended adopting a public–private partnership with a belief that collaboration among the government, microfinance institutions, and cooperative societies will enhance trust and population coverage in Bangladesh.ConclusionsOur research concludes that systematically addressing implementation barriers by including key stakeholders would be a significant reform to the CBHI model, and could serve as a foundation for the planned national health protection scheme for Bangladesh leading to universal health coverage.

Hand hygiene practices in Caribbean and Latin American countries: An integrative review.

To explore what is known about knowledge, attitudes and beliefs that influence hand hygiene practices in in low- and middle-income Caribbean and Latin American countries. With the emergence of infectious diseases such as the recent COVID-19 pandemic, handwashing is key to preventing communicable diseases as they disproportionately affect populations in low-income countries. While hand hygiene is known to be the single most effective method for avoiding the transmission of infection, little is known about the beliefs and practices of individuals in these regions. Following PRISMA 2020 Checklist, an integrative review of studies published from 2008-2020 was conducted (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Whittemore and Knafl's method was used to review the literature. Six databases were searched, and the Johns Hopkins Evidence Based Rating Scale was used for study appraisal. The review yielded 18 studies conducted across Latin America. Poor handwashing practices are influenced by various factors including inadequate education and training, cultural beliefs, lack of resources and substandard government regulations. Communicable diseases and other diarrheal illnesses were highly prevalent, especially after a major disease outbreak. Future post-disaster campaigns aimed at improving hand hygiene and handwashing practices should focus on beliefs and attitudes to affect behaviour change since there was a higher disease susceptibility during those times. Barriers to proper hand hygiene include false attitudes such as, washing hands only after touching bodily fluids/patient contact or not washing hands at all after open defecation. Researchers working with populations in Latin America and the Caribbean should partner with local community health workers to improve compliance to recommended hand hygiene practices.

Cost of primary care approaches for hypertension management and risk-based cardiovascular disease prevention in Bangladesh: a HEARTS costing tool application

ObjectiveTo estimate the costs of scaling up the HEARTS pilot project for hypertension management and risk-based cardiovascular disease (CVD) prevention at the full population level in the four subdistricts (upazilas)...

Acceptability of Telemedicine for Early Surgical Site Infection Diagnosis after Cesarean Section

Introduction: While telemedicine is a plausible tool for scaling up access to healthcare, such innovations must be feasible and acceptable for real-world application. This qualitative study describes the acceptability of a telemedicine intervention which used photos of surgical incisions taken by community health workers (CHWs) to detect surgical site infections (SSIs) among women after cesarean section in rural Rwanda. Methods: Twenty-five semi-structured interviews (13 patients, 12 CHWs) were conducted in the local dialect (Kinyarwanda) among women who participated in the telemedicine intervention. The interviews were transcribed verbatim and translated into English, and parallel inductive coding processes were done to create English and Kinyarwanda codebooks. Results from the 2 methodologies were merged to create a master codebook for the final coding process. Results: The overwhelming majority of participants reported that this photo-based telemedicine was acceptable, with only 1 patient concerned about the reliability of photos to detect SSIs. Faster healing, improved access to home-based postoperative care, and saving out-of-pocket expenditures were reported perceived advantages of the intervention. Trust in CHWs was reported by all as essential to the acceptance of this intervention. All but 1 of the CHWs believed that it was acceptable to implement this intervention during the COVID-19 period. Conclusion: Photo-based telemedicine procedures were feasible and acceptable by the majority of patients and CHWs, even during the COVID-19 pandemic. Trust in CHWs was described as a key factor in patients' acceptance of this program. Given this, local CHWs should be involved early in the development and implementation of such interventions.

Evaluation of a First Responders Course in Rural North India

BackgroundMost mortality in trauma occurs in prehospital settings when the golden hour is spent accessing healthcare facilities rather than resuscitating and stabilizing. Assessments performed in the rural community of Nanakpur, India demonstrated a significant paucity of, and limited access to healthcare facilities. To address deficiencies in prehospital care, the All-India Institute of Medical Sciences (AIIMS) constructed the Basic Emergency Care Course (BECC). This study evaluated the BECCs efficacy in Nanakpur. MethodsThe first responder courses took place in 2017 in Nanakpur. Local community health workers, known as Accredited Social Health Activists (ASHAs) were recruited as participants. Participants completed both a pre- and post-course evaluation to assess baseline knowledge and improvement. Participants then took a one-year post-course assessment to evaluate retention. ResultsThe course included 204 individuals, and over half (109/204) were ASHAs. Pre- and post-course test results were available for 70 participants and demonstrated a significant improvement in knowledge (P < 0.0001). The one-year knowledge retention assessment was completed by 48.6% (n = 53/109) of the original ASHAs. Comparisons between both the pre- and post-course assessment tests with the 12-mo retention assessment revealed a significant decay in knowledge (P < 0.0001). ConclusionsThis study demonstrates the feasibility of utilizing BECC to train ASHAs in Nanakpur as first responders. Participants demonstrated a significant improvement in knowledge immediately after the course. After one year, there was a significant loss in knowledge, highlighting the need for refresher courses. These data suggest potential for the use of BECC for training ASHAs countrywide to strengthen India's prehospital care system.

Estimated total cardiovascular risk in a rural area of Bangladesh: a household level cross-sectional survey done by local community health workers

ObjectiveThe aim of this study was to estimate 10-year cardiovascular disease (CVD) risk among Bangladeshi rural community residents, using the 2014 WHO/International Society of Hypertension (WHO/ISH) risk prediction charts.Study designCross-sectional...