Use Of Community Health Workers Research Articles

Patient-perceived barriers to early initiation of prenatal care at a large, urban federally qualified health center: a mixed-methods study

BackgroundEarly initiation of prenatal care is widely accepted to improve the health outcomes of pregnancy for both mothers and their infants. Identification of the various barriers to entry into care that patients experience may inform and improve health care provision and, in turn, improve the patient’s ability to receive necessary care.AimThis study implements a mixed-methods approach to establish methods and procedures for identifying barriers to early entry to prenatal care in a medically-vulnerable patient population and areas for future quality improvement initiatives.MethodsAn initial chart review was conducted on obstetrics patients that initiated prenatal care after their first trimester at a large federally qualified health center in Brooklyn, NY, to determine patient-specified reasons for delay. A thematic analysis of these data was implemented in combination with both parametric and non-parametric analyses to characterize the population of interest, and to identify the primary determinants of delayed entry.ResultsThe age of patients in the population of interest (n = 169) was bimodal, with a range of 15 – 43 years and a mean of 28 years. The mean gestational age of entry into prenatal care was 19 weeks. The chart review revealed that 8% recently moved to Brooklyn from outside of NYC or the USA. Nine percent had difficulty scheduling an initial prenatal visit within their first trimester. Teenage pregnancy accounted for 7%. Provider challenges with documentation (21%) were noted. The most common themes identified (n = 155) were the patient being in transition (21%), the pregnancy being unplanned (17%), and issues with linkage to care (15%), including no shows or patient cancellations. Patients who were late to prenatal care also differed from their peers dramatically, as they were more likely to be Spanish-speaking, to be young, and to experience a relatively long delay between pregnancy confirmation and entry into care. Moreover, the greatest determinant of delayed entry into care was patient age.ConclusionOur study provides a process for other like clinics to identify patients who are at risk for delayed entry to prenatal care and highlight common barriers to entry. Future initiatives include the introduction of a smart data element to document reasons for delay and use of community health workers for dedicated outreach after no show appointments or patient cancellations.

Group-based Education and monitoring program delivered by community health workers to improve control of high blood pressure in island districts of lake victoria, Uganda

BackgroundIndividuals living in communities with poor access to healthcare may be unaware of their high blood pressure (BP). While the use of community health workers (CHWs) can address gaps in human resources for health, CHWs in Uganda have not been used previously for BP screening and management. We report the results of an initiative to train CHWs to evaluate BP and to administer group-based education in Kalangala and Buvuma Island Districts of Lake Victoria, Uganda.MethodsWe randomly selected 42 of 212 villages. We trained CHWs based in island districts on measuring BP. CHWs visited all households in the selected villages and invited all adults ≥ 18 years to be screened for high BP. We used the World Health Organization’s STEPwise tool to collect data on demographic and behavioral characteristics and BP measurements. High blood pressure was defined as systolic BP (SBP) ≥ 140 mm Hg and/or diastolic BP (DBP) ≥ 90 mm Hg over three readings. CHWs created and led fortnight support groups for individuals identified with high blood pressure at baseline. At each group meeting, CHWs re-measured BP and administered an intervention package, which included self-management and lifestyle education to participants. The paired t-test was used to compare mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after the intervention. Generalized estimating equations (GEE) were used to model longitudinal changes in BP.ResultsWe trained 84 CHWs to measure BP and deliver the intervention package. Among 2,016 community members, 570 (28.3%) had high blood pressure; of these, 63 (11.1%) had a previous diagnosis of hypertension. The comparison of SBP and DBP before and after the intervention revealed significant reductions in mean SBP from 158mmHg (SD = 29.8) to 149 mmHg (SD = 29.8) (p < 0.001) and mean DBP from 97mmHg (SD = 14.3) to 92mmHg (p < 0.001). GEE showed decreases of -1.133 (SBP) and − 0.543 mmHg (DBP)/fortnight.ConclusionHigh BP was common but previously undiagnosed. The CHW-led group-based self-management and education for controlling high BP was effective in the island districts in Uganda. Scaling up the intervention in other hard-to-reach districts could improve control of high BP on a large scale.

Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review.

Ethnic minority groups in high income countries in North America, Europe, and elsewhere are disproportionately affected by T2DM with a higher risk of mortality and morbidity. The use of community health workers and peer supporters offer a way of ensuring the benefits of self-management support observed in the general population are shared by those in minoritized communities. The major databases were searched for existing qualitative evidence of participants' experiences and perspectives of self-management support for type 2 diabetes delivered by community health workers and peer supporters (CHWPs) in ethnically minoritized populations. The data were analysed using Sekhon's Theoretical Framework of Acceptability. The results are described within five domains of the framework of acceptability collapsed from seven for reasons of clarity and concision: Affective attitude described participants' satisfaction with CHWPs delivering the intervention including the open, trusting relationships that developed in contrast to those with clinical providers. In considering Burden and Opportunity Costs, participants reflected on the impact of health, transport, and the responsibilities of work and childcare on their attendance, alongside a lack of resources necessary to maintain healthy diets and active lifestyles. In relation to Cultural Sensitivity participants appreciated the greater understanding of the specific cultural needs and challenges exhibited by CHWPs. The evidence related to Intervention Coherence indicated that participants responded positively to the practical and applied content, the range of teaching materials, and interactive practical sessions. Finally, in examining the impact of Effectiveness and Self-efficacy participants described how they changed a range of health-related behaviours, had more confidence in dealing with their condition and interacting with senior clinicians and benefitted from the social support of fellow participants and CHWPs. Many of the same barriers around attendance and engagement with usual self-management support interventions delivered to general populations were observed, including lack of time and resource. However, the insight of CHWPs, their culturally-sensitive and specific strategies for self-management and their development of trusting relationships presented considerable advantages.

Public health surveillance through community health workers: a scoping review of evidence from 25 low-income and middle-income countries

BackgroundThe last 3 years have witnessed global health challenges, ranging from the pandemics of COVID-19 and mpox (monkeypox) to the Ebola epidemic in Uganda. Public health surveillance is critical for...

Use of Community Health Workers Among U.S. Male Latino Population: A Scoping Review.

Community Health Workers (CHWs) are an effective strategy to address the health needs of specified communities. The purpose of this scoping review was to explore the use of CHWs to address the health needs of the Latino male population. This project used specific search terms to identify relevant articles from PubMed, PsycINFO, and Google Scholar. Eligible articles included studies, conducted in the U.S. and in English from 2010 to 2022, that assessed the use of CHWs among a predominantly male (≥ 50%) Latino population. Twenty articles consisting of 13 interventions were identified for review and were further categorized into male-only participant samples (n = 10) and mixed-gender but predominantly-male participant samples (n = 10) for synthesis. Male-only participant samples focused on occupational health and participant's social support and networks. Predominantly-male, mixed-gender participant sample interventions were disease-centered and emphasized the longitudinal support of CHWs as well as social networks. Of the 13 interventions reviewed, almost all (n = 10) utilized existing social networks for engagement and nearly half (n = 6) employed community-based participatory research (CBPR) principles. Findings suggest that recruiting CHWs from within existing social networks and using CBPR are important factors for successful health promotion among male Latinos.

Community Partnership to Co-Develop an Intervention to Promote Equitable Uptake of the COVID-19 Vaccine Among Pediatric Populations

Community Partnership to Co-Develop an Intervention to Promote Equitable Uptake of the COVID-19 Vaccine Among Pediatric Populations

WORKFORCE CHALLENGES DURING COVID-19

Abstract As of October, 2022 nearly 1.1 million individuals in the United States died of COVID-19 with approximately 790,000 being individuals ages 65 and older. This age group accounts for 16% of the total US population but 75% of all COVID deaths to date. Covid-19 has taxed the United States public health system resulting in clinician burnout and a lack of trust in the public health system. The demands of the pandemic physically, psychologically, and logistically overwhelmed many clinicians resulting insomnia, anxiety, depression, and increased risk for substance use and misuse. Burnout at the institutional level is associated with increased medical errors, lower quality of care, and hospital-acquired infections. Compounding the issue of burnout was the lack of public trust that subsequently developed. Facts about COVID-19 competed with misinformation of the disease, false medical cures, contradictory health messages, an overwhelmed health care system in many areas, and conspiracy theories. One solution to these concerns is to increase the use of Community Health Workers (CHC). CHCs are trusted members of the communities they serve and play an essential role in assisting in care, providing factual information, and dispelling misinformation related to health topics such as COVID-19 infection, symptoms, and vaccination. Augmenting this workforce may help the system prepare for future emergencies. This presentation will discuss the recommendations of the Federal Advisory Committee on Interdisciplinary, Community-Based Linkages’ latest report “Building Trust, Addressing Burning, and Expanding the Direct Care Workforce”.

Strengthening community health worker program in Belize

Community health workers (CHWs) have been identified as effective workforce that can improve access to primary health care particularly for underserved and hard to reach populations. The contributions of CHWs have not been limited to low-income countries. More recently, the use of CHWs has attracted attention in some high-income countries where despite more developed health systems there are large inequities in healthcare access and outcomes amongst different population groups. Belize is an upper middle-income country located in Central America and its health system is based on a primary health care model with community health workers actively involved in health service delivery. A descriptive study through review of grey literature detailing the process for strengthening the community health worker program in the country using the Community Health Worker Assessment and Improvement Matrix (CHW AIM) tool. The results were thematically analysed based on Community Health Worker Assessment and Improvement Matrix (CHW AIM) conceptual framework on factors influencing the performance of community health worker program. Community health workers in Belize are recognized as part of the formal health system with policy and strategy in place that define their roles, tasks, relationship to the health system. They are provided with monthly financial incentives, opportunities for further studies, career advancement and employment opportunities within the health system. The study contributes to the existing literature on strengthening of community health worker program to enhance the primary health care system and build a more resilient health system for better preparedness and response for future pandemics with focus on an upper middle income country.

Use of Community Health Workers to Help End the Epidemic of Sexually Transmitted Infections.

Use of Community Health Workers to Help End the Epidemic of Sexually Transmitted Infections.

Feasibility of screening for cognitive impairment among older persons and referral by community health workers in Wakiso district, Uganda.

In Uganda, cognitive impairment in older persons aged ≥ 60 years is often undiagnosed due to inadequate appreciation of the condition compounded with limitations of trained human resource able to conduct appropriate cognitive evaluations. Use of Community Health Workers (CHWs) especially in hard-to-reach communities can be an important link for older persons to the health facilities where they can receive adequate evaluations and interventions for cognitive challenges. The aim of the study was to assess the feasibility of screening for cognitive impairment among older persons and referral by CHWs in Wakiso district, Uganda. This was a sequential explanatory mixed methods study. The CHWs received a one-day training on causes, signs and symptoms, and management of cognitive impairment and screened older persons ≥ 60 years for cognitive impairment using the Alzheimer's Disease scale 8 (AD8). Psychiatric clinical officers (PCOs) administered the AD8 and the Mini Mental State Examination to the older persons after assessment by the CHWs who then referred them for appropriate clinical care. We conducted Kappa statistic for agreement between the CHWs and PCOs and compared raw scores of the CHWs to Experts scores using Bland Altman and pair plots and corresponding analyses. We also conducted focus group discussions for the older persons, caregivers and CHWs. We collected data from 385 older persons. We involved 12 CHWs and 75% were females, majority were married (58.3%) with at least a secondary education (66.7%). There was 96.4% (CI 94.5-98.2%) agreement between PCOs and CHWs in identifying cognitive impairment with the PCOs identifying 54/385 (14.0: 95%CI 10.7-17.9%) older persons compared to 58/385 (15.1: 95%CI 11.6-19.0%) identified by CHWs. Of the 58 identified to have cognitive impairment by the CHWs, 93.1% were referred for care. The average difference between the score of the expert and that of the CHW was - 0.042 with a 95% CI of -1.335 to 1.252. Corresponding Bland Altman and pair plots showed high agreement between the measurements although CHWs scored higher values with increasing scores. CHWs can be trained to identify and refer older persons with cognitive impairment in the communities.

Assessing Implementation of Social Screening Within US Health Care Settings: A Systematic Scoping Review.

Though a growing crop of health care reforms aims to encourage health care-based social screening, no literature has synthesized existing social screening implementation research to inform screening practice and policymaking. Systematic scoping review of peer-reviewed literature on social screening implementation published 1/1/2011-2/17/2022. We applied a 2-concept search (health care-based screening; social risk factors) to PubMed and Embase. Studies had to explore the implementation of health care-based multi-domain social screening and describe 1+ outcome related to the reach, adoption, implementation, and/or maintenance of screening. Two reviewers extracted data related to key study elements, including sample, setting, and implementation outcomes. Forty-two articles met inclusion criteria. Reach (n = 7): We found differences in screening rates by patient race/ethnicity; findings varied across studies. Patients who preferred Spanish had lower screening rates than English-preferring patients. Adoption (n = 13): Workforce education and dedicated quality improvement projects increased screening adoption. Implementation (n = 32): Time was the most cited barrier to screening; administration time differed by tool/workforce/modality. Use of standardized screening tools/workflows improved screening integration. Use of community health workers and/or technology improved risk disclosure and facilitated screening in resource-limited settings. Maintenance (n = 1): Only 1 study reported on maintenance; results showed a drop in screening over 21 months. Critical evidence gaps in social screening implementation persist. These include gaps in knowledge about effective strategies for integrating social screening into clinical workflows and ways to maximize screening equity. Future research should leverage the rapidly increasing number of screening initiatives to elevate and scale best practices.

Child feeding practices of mothers of rural coastal area of Navsari district

Poor feeding habits are one of the most serious barriers to achieving and preserving health of children under the age of five, as they pose a significant challenge to social and economic growth. To know the socio-demographic profile and to study the prevalence of Infant and young child feeding practices of mothers A cross-sectional study in rural areas of Navsari district, Gujarat, included 243 women, who had one child aged 12 to 23 months preceding data collection. Data were analyzed using statistical software Epi Info 6. About 32% of the infants had received pre-lacteals feeds, most common feed was Gripe water (44.9%). The colostrum was fed by 90 % mothers. Half of mothers had initiated breast-feeding within 1 hour after delivery. Only 88 mothers (36.2%) had given exclusive breast-feeding for 6 months. About half of children had received complementary feeding during 6–9 months of age. Most of the mothers (96.7%) were washing their hands before each feeding of the child whereas 61.7 % were cooking special meal for the child. Majority of mothers (93.8%) think that breast-feeding should be continued for 1 to 2 years. Continuing to emphasise nutrition education could go a long way toward empowering mothers to avoid using pre-lacteal feeds, to sustain exclusive breastfeeding for a prescribed period, to incorporate complementary foods at the appropriate time, and to enhance overall child-care through optimum use of community health workers.

Pivotal role of CHWs in prevention, early detection and control of outbreaks: neglected key primary players; a call to action

Pivotal role of CHWs in prevention, early detection and control of outbreaks: neglected key primary players; a call to action

Incidence of HIV disclosure among HIV affected heterosexual partners using a community health worker led mechanism in rural Uganda; a quasi-experimental study

BackgroundHIV disclosure is vital in HIV management. Community Health Workers (CHW) were reported to support partner disclosure among HIV affected heterosexual partners with disclosure difficulties. However, time to disclosure attributed to use of CHW led disclosure support mechanism was not documented. This study compared the incidence of sexual partner disclosure among adults living with HIV (ALHIV) with CHW support and those without in the greater Luwero region, Uganda.MethodsWe conducted a quasi-experimental study with two arms allocated by geographically determined clusters and adjusted for between-group differences; among ALHIV in the greater Luwero region of Uganda who had never disclosed to their current primary sexual partners. We allocated study clusters to either a CHW-led intervention or control arm. In both arms, we consecutively recruited participants; those in the intervention arm received CHW disclosure support in addition to routine care. The overall follow-up was six months, and the primary outcome was disclosure to the partner. We used survival analysis with proportional hazard ratios to determine the time to partner disclosure in both arms.ResultsA total of 245 participants were enrolled, and 230 (93.9%) completed the study; of these, 112 (48.7%) were in the intervention and 118 (51.3%) in the control arm. The mean age was 31 ± 8 years with a range of 18 to 55 years; the majority were females, 176 (76.5%). The cumulative incidence of disclosure was higher in the intervention arm, 8.76 [95% CI: 7.20–10.67] per 1,000 person-days versus 5.15 [95%CI: 4.85–6.48] per 1,000 person-days in the control arm, log-rank test, X2 = 12.93, P < 0.001.Male gender, aHR = 1.82, tertiary education, aHR = 1.51, and relationship duration of > six months, aHR = 1.19 predicted disclosure. Prior disclosure to a relative, aHR = 0.55, and having more than one sexual partner in the past three months, aHR = 0.74, predicted non-disclosure.ConclusionCHW-led support mechanism increased the rate of sexual partner disclosure among ALHIV with disclosure difficulties. Therefore, to achieve the global targets of ending HIV, near location CHW-led disclosure support mechanism may be used to hasten HIV disclosure in rural settings.

Knowledge, attitude and practices of community health workers on managing and preventing childhood malaria and diarrhea in Fako Division, South West Region, Cameroon; A mixed method study.

In developing countries, childhood malaria and diarrhea are among the 5 leading causes of death among children under five years; the use of community health workers (CHWs) to manage these diseases has shown some degree of success. A descriptive cross-sectional study was conducted to assess knowledge, attitude and practices (KAP) of CHWs on the management and prevention of childhood malaria and diarrhea in Fako Division, South-West Region, Cameroon. A pretested questionnaire was administered to eighty CHWs in Fako Division. Three focus group discussions (FGDs) were conducted with 29 CHWs. The Chi-Square and Spearman Correlation tests were used to investigate the association between socio-demographic characteristics with CHWs' KAP on childhood malaria and diarrhea management and prevention. A total of 52.5% of the participants had good knowledge, negative attitudes (65.0%), and carried out poor practices (60.0%) on the management and prevention of childhood malaria. Up to 8.75% CHWs did not know the first-line antimalarial drug used in Cameroon. More than half (57.5%) of participants had poor knowledge, 70.0% had a negative attitude and 82.25% carried out good practices on the management and prevention of childhood diarrhea. 47.6% of CHWs used a mixture of guava leaves and 'masepo' (Ocimum gratissimum) as treatment for childhood diarrhea. Level of education (p = 0.028) and Health District (p = 0.026) were significantly associated with practices on management and prevention of childhood diarrhea. CHWs had inadequate knowledge, poor attitude, and practices on childhood malaria management. Even though a majority of CHWs carried out good practices for diarrhea management, their knowledge and attitude were poor. Therefore, there is a need for training to improve CHWs' knowledge, attitude and practices on childhood malaria and diarrhea management.

Understanding the Public Health Role, Motivations, and Perceptions of Community Health Workers Deployed to Low-Income Housing in Richmond, Virginia.

For the US health indicators to improve to the level of other developed countries, the use of Community Health Workers (CHWs) in vulnerable populations has been indicated as a possible long-term intervention. There are few models of long-term deployment of CHWs as part of the district level public health system in the US. In this study we interviewed CHWs who served as neighborhood-integrated health district staff assigned to low-income housing in Richmond, Virginia for 10years. Qualitative analyses of their taped and transcribed interviews resulted in 5 themes from the interviews. The themes were Activities, Satisfaction, Strengths, Facilitation/Resources and Challenges. We highlighted quotes from the CHWs interviews for themes and summarized the findings from each theme. CHWs carried out a variety of activities daily and these were described. The CHWs were generally satisfied with their job because it enabled them to assist others. The strength of their communities was resilience, and the resources they needed more included physical resources, human resources, political support, and more comprehensive programming. Their client's challenges include transportation, mental health, and physical safety and the CHWs challenge to effectively carrying out their work with clients was trust by community members. The information garnered from the CHWs would be useful in designing CHW programs at other health districts.

Integration of patient experience factors improves readmission prediction.

Many readmission prediction models have marginal accuracy and are based on clinical and demographic data that exclude patient response data. The objective of this study was to evaluate the accuracy of a 30-day hospital readmission prediction model that incorporates patient response data capturing the patient experience. This was a prospective cohort study of 30-day hospital readmissions. A logistic regression model to predict readmission risk was created using patient responses obtained during interviewer-administered questionnaires as well as demographic and clinical data. Participants (N = 846) were admitted to 2 inpatient adult medicine units at Massachusetts General Hospital from 2012 to 2016. The primary outcome was the accuracy (measured by receiver operating characteristic) of a 30-day readmission risk prediction model. Secondary analyses included a readmission-focused factor analysis of individual versus collective patient experience questions. Of 1754 eligible participants, 846 (48%) were enrolled and 201 (23.8%) had a 30-day readmission. Demographic factors had an accuracy of 0.56 (confidence interval [CI], 0.50-0.62), clinical disease factors had an accuracy of 0.59 (CI, 0.54-0.65), and the patient experience factors had an accuracy of 0.60 (CI, 0.56-0.64). Taken together, their combined accuracy of receiver operating characteristic = 0.78 (CI, 0.74-0.82) was significantly more accurate than these factors were individually. The individual accuracy of patient experience, demographic, and clinical data was relatively poor and consistent with other risk prediction models. The combination of the 3 types of data significantly improved the ability to predict 30-day readmissions. This study suggests that more accurate 30-day readmission risk prediction models can be generated by including information about the patient experience.

Determinants of periodic health examination uptake among adults in Al-Jouf Region, Saudi Arabia.

Periodic Health Examinations (PHEs) typically occur annually and provide an important opportunity for providers to screen their patients for undiagnosed health conditions and monitor existing conditions, such as diabetes and hypertension. Unfortunately, PHEs are reported to be low in Saudi Arabia. This study's aim was to assess the regular uptake of PHEs by adults residing in Al-Jouf region, Saudi Arabia. A cross-sectional survey was conducted among adults (aged ≥ 20 years) residing in five communities in the Al-Jouf Region on sociodemographic characteristics, self-reported chronic conditions, knowledge of PHEs, and their regular uptake. Chi-square tests and multivariate logistic regression analysis were performed to determine the factors associated with regular uptake of PHEs. A total of 624 participants completed the survey questionnaire. Of the participants, 27.7% reported a regular uptake of PHEs. The odds of regular uptake of PHEs were higher among older respondents (odds ratio [OR] =1.98; P = 0.002), those who reported that they had diabetes (OR = 3.25; P < 0.001), hypertension (OR = 4.11; P = 0.001), hyperlipidemia (OR = 2.66; P = 0.003), and those with a higher PHEs knowledge score (OR = 1.35; P < 0.001). However, the odds regular uptake of PHEs among respondents residing in the three governorates and Skaka city were significantly lower (OR = 0.27; P = 0.001 and OR = 0.30; P = 0.002, respectively) than their counterparts. Low rates of PHEs uptake were observed among the survey participants in the Al-Jouf Region of Saudi Arabia. The characteristics of individuals associated with low uptake of PHEs were identified. Tailored interventions, such as the use of community health workers and clinic communications, could target these individuals to increase the uptake of PHEs.

Exploring cancer care needs for Latinx adults: a qualitative evaluation

Latinx adults with cancer, as compared with non-Latinx White adults, are diagnosed with more advanced stages and experience worse quality of life. Identifying barriers in cancer care among low-income Latinx adults is crucial to designing and implementing culturally appropriate interventions. The objective of this study was to explore the specific barriers encountered by Latinx adults after a cancer diagnosis and perspectives on the use of community health workers (CHWs) to address these barriers. We conducted semi-structured qualitative interviews with low-income Latinx adults with a past or current history of cancer and/or their caregivers in a community oncology clinic located in an agricultural community in California. Analysis was based in grounded theory and performed using the constant comparative method. Sixteen interviews were conducted with patients alone (n = 11), a caregiver alone (n = 1), and patient-caregiver pairs (n = 4 patients; n = 4 caregivers). Four major themes emerged: (1) low cancer health literacy including cancer diagnosis and treatment, cancer fatalism, navigating next steps after diagnosis, advance directives, and precision medicine; (2) challenges in communicating and receiving supportive services due to language barriers; (3) stress and anxiety regarding financial hardships related to job loss, insurance barriers, and the COVID-19 pandemic; (4) the need for supportive, bilingual, and bicultural personnel to assist in overcoming these challenges. Low-income Latinx adults with cancer and their caregivers experience health literacy, communication, and financial barriers that impede quality cancer care delivery. Embedding CHWs in the care team could be one way to address these barriers to culturally concordant, accessible care.

Increasing and sustaining diabetic retinopathy screening in Fiji by leveraging community health workers (CHWs) services: A qualitative study

IntroductionInequities in access to diabetic retinopathy (DR) services particularly in rural and remote Fiji is concerning. This is because DR when left undiagnosed and untreated for long, can lead to vision loss and permanent blindness. Appropriate channels must be explored to strengthen services and ensure equitable access to healthcare for everyone. This study describes the development and implementation of DR awareness training for community health workers (CHWs) and their subsequent engagement to raise awareness and scale-up DR screening for communities throughout Fiji. Materials and methodAs part of a programme to reduce the incidence of avoidable blindness due to diabetes amongst people living in the Pacific, DR training for primary level nurses was developed and implemented. As these primary level nurses were already inundated by clinical duties and competing health priorities, a shifting of the task was proposed to engage the CHWs who would instead educate communities on diabetes and DR and make referrals for DR screening. A one-day DR awareness training was developed and implemented by the Pacific Eye Institute with funding from the Fred Hollows Foundation New Zealand. ResultsAt the end of the DR programme in 2019, the team had achieved their target and trained a total of 823 CHWs giving an 81.32% coverage of the total 1012 registered CHW in the MHMS register. Anecdotal evidence showed a spike in DR referrals and screenings recorded at health facilities. Three key themes emerged related to the involvement of CHWs which include engagement of CHWs, benefits of the engagement, and health system-related challenges. ConclusionThe use of CHWs who are already integrated into the health system was considered a sustainable intervention to strengthen diabetes and DR services at the primary level of care, particularly if it involves community awareness, health education, and health services facilitation The future of the CHWs will depend on their being integrated more systematically into local health services with strengthened management and supervision.