Risk Factors During Pregnancy and Early Childhood in Rural West Bengal, India: A Feasibility Study Implemented via Trained Community Health Workers Using Mobile Data Collection Devices

Abstract Background The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC’s catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC’s staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). Results A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. Conclusion The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.

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An Innovative Approach to Improve the Detection and Treatment of Risk Factors in Poor Urban Settings: A Feasibility Study in Argentina

10.21203/rs.3.rs-131798/v1 ◽

2021 ◽

Author(s):

Rosana Poggio ◽

Goodarz Danaei ◽

Laura Gutierrez ◽

Ana Cavallo ◽

María Lopez ◽

...

Keyword(s):

Risk Factors ◽

Primary Care ◽

Community Health ◽

Community Health Workers ◽

Feasibility Study ◽

Health Workers ◽

Public Healthcare ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Clinical Visit

Abstract Background The effective management of cardiovascular (CVD) prevention among the uninsured population in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were being uninsured, age ≥ 40 years, residence in the PCC´s catchment area and 10-year CVD risk ≥ 10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC´s staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs).Results A total of 185 participants were included in the study. Of the total number of the eligible participants, 82.2% of eligible participants attended to at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21% to 32.6% in hypertensive participants, 7.4% to 33.3% in high CVD risk and 1.4% to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP<140/90 mmHg) increased from 20.3% to 35.5%.Conclusion The proposed CHWs-led intervention was feasible and well accepted in improving the detection and treatment of risk factors in the uninsured and poor population with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs not only stimulated teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.

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Smart Phones As a Viable Data Collection Tool in Low-resource Settings: Case Study of Rwandan Community Health Workers

Neuroscience and Biomedical Engineering ◽

10.2174/2213385204666160711155116 ◽

2016 ◽

Vol 4 (2) ◽

pp. 132-139 ◽

Cited By ~ 2

Author(s):

Suzana Brown ◽

Alan Mickelson

Keyword(s):

Data Collection ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Smart Phones ◽

Data Collection Tool ◽

Low Resource Settings ◽

Low Resource

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Perceived cardiovascular disease risk and tailored communication strategies among rural and urban community dwellers in Rwanda: A qualitative study

10.21203/rs.3.rs-799333/v1 ◽

2021 ◽

Author(s):

Jean Berchmans NIYIBIZI ◽

Kufre Joseph OKOP ◽

Jean Pierre NGANABASHAKA ◽

Ghislaine UMWALI ◽

Stephen RULISA ◽

...

Keyword(s):

Risk Factors ◽

Qualitative Study ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Urban Community ◽

Communication Strategies ◽

Cvd Risk ◽

Rural And Urban ◽

Community Dwellers

Abstract Background In Rwanda, cardiovascular diseases (CVDs) are the third leading cause of death, and hence constitute an important public health issue. Like worldwide, most CVDs are due to lifestyle and preventable risk factors. Prevention interventions are based on risk factors for CVD risk, yet the outcome of such interventions might be limited by the lack of awareness or misconception of CVD risk. This study aimed to explore how rural and urban population groups in Rwanda perceive CVD risk and tailor communication strategies for estimated total cardiovascular risk. Methods An exploratory qualitative study design was applied using focus group discussions to collect data from rural and urban community dwellers. Thematic analysis with Atlas ti 7.5.18 was used and main findings for each theme reported as a narrative summary. Results Participants thought that CVD risk is due to either financial stress, psychosocial stress, substance abuse, noise pollution, unhealthy diets, diabetes or overworking. Participants did not understand CVD risk presented in quantitative format, but preferred qualitative formats or colors to represent low, moderate and high CVD risk through in-person communication. Participants preferred to be screened for CVD risk by community health workers using mobile health technology. Conclusion Rural and urban community members in Rwanda are aware of their CVD risk. Community health workers are preferred by local communities for CVD risk screening. Quantitative formats to present the total CVD risk appear inappropriate to the Rwandan population and qualitative formats are therefore advisable. Thus, operational research on the use of qualitative formats to communicate CVD risk is recommended to improve decision-making on CVD risk communication in the context of Rwanda.

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Building the capacity of community health workers to support health and social care for dependent older people in Latin America: a pilot study in Fortaleza, Brazil

BMC Geriatrics ◽

10.1186/s12877-021-02477-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

João Bastos Freire Neto ◽

Gerídice Lorna Andrade de Moraes ◽

Janaína de Souza Aredes ◽

Karla Cristina Giacomin ◽

Luciane Ponte de Melo ◽

...

Keyword(s):

Risk Factors ◽

Older People ◽

Community Health ◽

Community Health Workers ◽

Health Care Services ◽

Health Workers ◽

Training Intervention ◽

Care Givers ◽

Health And Social Care ◽

Before And After

Abstract Background Brazil is seeing rapid population ageing, which is leading to new demands on primary health care services. There is a need to develop and assess the effectiveness of new interventions to build the capacity of staff, including community health workers, to meet the needs of groups such as care-dependent older people and their care-givers. This study examines the feasibility of a small training intervention piloted in the Brazilian city of Fortaleza. Methods The study evaluated participants’ own assessments of key knowledge and skills related to the needs of care-dependent older people, both before and after the training intervention. It also assessed their capacity to implement a simple screening tool of geriatric risk factors. Results The participant self-assessments indicate significant improvements in their perceived knowledge and capacity in responding to the health needs of care-dependent older people. Additionally, participants were able to successfully conduct the home visits and screening for risk factors. Conclusions The study demonstrates the feasibility of developing interventions to enhance the capacity of community health workers to meet the needs of dependent older people in countries like Brazil. The evidence of effectiveness, though limited and subjective, provides justification for a larger, formally evaluated intervention. The experience of Fortaleza provides valuable lessons for other cities and countries in the region which are facing similar challenges.

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Community health workers’ involvement in the prevention and control of non-communicable diseases in Wakiso District, Uganda

Globalization and Health ◽

10.1186/s12992-020-00653-5 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

David Musoke ◽

Edwinah Atusingwize ◽

Deborah Ikhile ◽

Sarah Nalinya ◽

Charles Ssemugabo ◽

...

Keyword(s):

Risk Factors ◽

Community Health ◽

Community Health Workers ◽

Prevention And Control ◽

Health Workers ◽

Communicable Diseases ◽

Community Mobilisation ◽

Community Members ◽

Non Communicable Diseases ◽

And Control

Abstract Background Community health workers (CHWs) are an important cadre of the global health workforce as they are involved in providing health services at the community level. However, evidence on the role of CHWs in delivering interventions for non-communicable diseases (NCDs) in Uganda is limited. This study, therefore, assessed the involvement of CHWs in the prevention and control of NCDs in Wakiso District, Uganda with a focus on their knowledge, attitudes and practices, as well as community perceptions. Methods A cross-sectional study using mixed methods was conducted which involved a structured questionnaire among 485 CHWs, and 6 focus group discussions (FGDs) among community members. The study assessed knowledge, perceptions including the importance of the various risk factors, and the current involvement of CHWs in NCDs, including the challenges they faced. Quantitative data were analysed in STATA version 13.0 while thematic analysis was used for the qualitative data. Results The majority of CHWs (75.3%) correctly defined what NCDs are. Among CHWs who knew examples of NCDs (87.4%), the majority mentioned high blood pressure (77.1%), diabetes (73.4%) and cancer (63.0%). Many CHWs said that healthy diet (86.2%), physical activity (77.7%), avoiding smoking/tobacco use (70.9%), and limiting alcohol consumption (63.7%) were very important to prevent NCDs. Although more than half of the CHWs (63.1%) reported being involved in NCDs activities, only 20.9 and 20.6% had participated in community mobilisation and referral of patients respectively. The majority of CHWs (80.1%) who were involved in NCDs prevention and control reported challenges including inadequate knowledge (58.4%), lack of training (37.6%), and negative community perception towards NCDs (35.1%). From the FGDs, community members were concerned that CHWs did not have enough training on NCDs hence lacked enough information. Therefore, the community did not have much confidence in them regarding NCDs, hence rarely consulted them concerning these diseases. Conclusions Despite CHWs having some knowledge on NCDs and their risk factors, their involvement in the prevention and control of the diseases was low. Through enhanced training and community engagement, CHWs can contribute to the prevention and control of NCDs, including health education and community mobilisation.

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Risk factors for childhood illness and death in rural Uttar Pradesh, India: perspectives from the community, community health workers and facility staff

BMC Public Health ◽

10.1186/s12889-021-12047-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kanchan Srivastava ◽

Ranjana Yadav ◽

Lorine Pelly ◽

Elisabeth Hamilton ◽

Gaurav Kapoor ◽

...

Keyword(s):

Risk Factors ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Uttar Pradesh ◽

Childhood Illness ◽

Severe Illness ◽

Community Members ◽

Vulnerable Children ◽

Facility Staff

Abstract Background Uttar Pradesh (UP), India continues to have a high burden of mortality among young children despite recent improvement. Therefore, it is vital to understand the risk factors associated with under-five (U5) deaths and episodes of severe illness in order to deliver programs targeted at decreasing mortality among U5 children in UP. However, in rural UP, almost every child has one or more commonly described risk factors, such as low socioeconomic status or undernutrition. Determining how risk factors for childhood illness and death are understood by community members, community health workers and facility staff in rural UP is important so that programs can identify the most vulnerable children. Methods This qualitative study was completed in three districts of UP that were part of a larger child health program. Twelve semi-structured interviews and 21 focus group discussions with 182 participants were conducted with community members (mothers and heads of households with U5 children), community health workers (CHWs; Accredited Social Health Activists and Auxiliary Nurse Midwives) and facility staff (medical officers and staff nurses). All interactions were recorded, transcribed and translated into English, coded and clustered by theme for analysis. The data presented are thematic areas that emerged around perceived risk factors for childhood illness and death. Results There were key differences among the three groups regarding the explanatory perspectives for identified risk factors. Some perspectives were completely divergent, such as why the location of the housing was a risk factor, whereas others were convergent, including the impact of seasonality and certain occupational factors. The classic explanatory risk factors for childhood illness and death identified in household surveys were often perceived as key risk factors by facility staff but not community members. However, overlapping views were frequently expressed by two of the groups with the CHWs bridging the perspectives of the community members and facility staff. Conclusion The bridging views of the CHWs can be leveraged to identify and focus their activities on the most vulnerable children in the communities they serve, link them to facilities when they become ill and drive innovations in program delivery throughout the community-facility continuum.

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Knowledge of Non-communicable Disease Risk Factors among Community Health Workers in South Africa

The Open Public Health Journal ◽

10.2174/1874944502013010430 ◽

2020 ◽

Vol 13 (1) ◽

pp. 430-437

Author(s):

Sunday O. Onagbiye ◽

Lungiswa P. Tsolekile ◽

Thandi Puoane

Keyword(s):

Risk Factors ◽

South Africa ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Statistical Tests ◽

Communicable Diseases ◽

Poor Knowledge ◽

Non Communicable Diseases ◽

Education Levels

Introduction: Community Health Workers play an important role in supporting patients with chronic non-communicable diseases (NCDs), therefore they need to be constantly updated with current knowledge to enable them to perform their activities effectively. The purpose of this study was to assess the knowledge of NCDs risk factors among Community Health Workers (CHWs) in South Africa. Methodology: A triple “A” approach (assessment, analysis, and action) was used among 40 CHWs working with patients with chronic non-communicable diseases. All CHWs gave voluntary, informed consent in writing and verbally before they were allowed to participate in the study. For the initial assessment, CHWs completed a questionnaire to assess knowledge about the knowledge of NCDs. The questionnaire was analysed to determine their baseline performance. The findings of the assessment identified shortcomings in the knowledge of CHWs, specifically on diabetes and hypertension knowledge. Feedback was given to the CHWs followed by a short training on healthy living, focusing on the risk factors associated with NCDs (diabetes and hypertension). Training of CHWs was conducted using an adapted national training programme together with CHW prevention of healthy lifestyle modules designed by experts from the School of Public Health, University of the Western Cape. All statistical tests were two-tailed, and p<.05 was considered statistically significant. Results: The majority (97.5%) of the CHWs who had their knowledge assessed were women. Fifty-five percent (55%) were within age 30-45 years, while 45% were between the ages 46-60 years. The majority of the participants had secondary school education (92.5%) and 1-15 years of experience (97.5%) as CHWs. The results of the post-training assessment revealed that 48.5%, 63.6%, 42.4%, 72.7%, 42.5%, 57.6%, and 18.2% had poor knowledge of diabetes, hypertension, diabetes complications, hypertension complications, advice for diabetic patient, advice for hypertension, and nutrition advice of NCDs, respectively. Regression analysis showed that those with higher education levels were significantly highly likely to be knowledgeable about hypertension complications (OR=19.6, CI=1.14, 336.0). Conclusion: There was poor knowledge of risk factors for NCDs among CHWs. An association exists between the knowledge of risk factors for NCDs and education levels among the participants. There is a need for regular refresher training programs for CHWs to upscale their knowledge about NCDs, coupled with frequent review of CHWs program and curriculum.

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