Using mobile technologies to support the training of community health workers in low-income and middle-income countries: mapping the evidence

IntroductionThis paper maps the evidence published between 2000 and 2018 on the use of mobile technologies to train community health workers (CHWs) in low- and middle-income countries (LMICs) across nine areas of global healthcare, including the neglected areas of disability and mental health.MethodsWe used an evidence mapping methodology, based on systematic review guidelines, to systematically and transparently assess the available evidence-base. We searched eight scientific databases and 54 grey literature sources, developed explicit inclusion criteria, and coded all included studies at full text for key variables. The included evidence-base was visualised and made accessible through heat mapping and the development of an online interactive evidence interface.ResultsThe systematic search for evidence identified a total of 2530 citations of which 88 met the full inclusion criteria. Results illustrate overall gaps and clusters of evidence. While the evidence map shows a positive shift away from information dissemination towards approaches that use more interactive learner-centred pedagogies, including supervision and peer learning, this was not seen across all areas of global health. Areas of neglect remain; no studies of trauma, disability, nutrition or mental health that use information dissemination, peer learning or supervision for training CHWs in LMICs were found.ConclusionThe evidence map shows significant gaps in the use of mobile technologies for training, particularly in the currently neglected areas of global health. Significant work will be needed to improve the evidence-base, including assessing the quality of mobile-based training programmes.

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Scoping review assessing the evidence used to support the adoption of mobile health (mHealth) technologies for the education and training of community health workers (CHWs) in low-income and middle-income countries

BMJ Open ◽

10.1136/bmjopen-2017-019827 ◽

2018 ◽

Vol 8 (7) ◽

pp. e019827 ◽

Cited By ~ 12

Author(s):

Niall Winters ◽

Laurenz Langer ◽

Anne Geniets

Keyword(s):

Systematic Reviews ◽

Scoping Review ◽

Low Income ◽

Health Workers ◽

Education And Training ◽

Evidence Base ◽

Mobile Technologies ◽

Middle Income ◽

And Training ◽

Formal Theories

ObjectivesUndertake a systematic scoping review to determine how a research evidence base, in the form of existing systematic reviews in the field of mobile health (mHealth), constitutes education and training for community health workers (CHWs) who use mobile technologies in everyday work. The review was informed by the following research questions: does educational theory inform the design of the education and training component of mHealth interventions? How is education and training with mobile technology by CHWs in low-income and middle-income countries categorised by existing systematic reviews? What is the basis for this categorisation?SettingThe review explored the literature from 2000 to 2017 to investigate how mHealth interventions have been positioned within the available evidence base in relation to their use of formal theories of learning.ResultsThe scoping review found 24 primary studies that were categorised by 16 systematic reviews as supporting CHWs’ education and training using mobile technologies. However, when formal theories of learning from educational research were used to recategorise these 24 primary studies, only four could be coded as such. This identifies a problem with how CHWs’ education and training using mobile technologies is understood and categorised within the existing evidence base. This is because there is no agreed on, theoretically informed understanding of what counts as learning.ConclusionThe claims made by mHealth researchers and practitioners regarding the learning benefits of mobile technology are not based on research results that are underpinned by formal theories of learning. mHealth suffers from a reductionist view of learning that underestimates the complexities of the relationship between pedagogy and technology. This has resulted in miscategorisations of what constitutes CHWs’ education and training within the existing evidence base. This can be overcome by informed collaboration between the health and education communities.

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The burgeoning role of global health diplomacy to alleviate suffering of cancer patients in low- and middle-income countries

International Health ◽

10.1093/inthealth/ihaa004 ◽

2020 ◽

Vol 12 (3) ◽

pp. 231-233

Author(s):

Melissa Adomako ◽

Alaei Kamiar ◽

Abdulla Alshaikh ◽

Lyndsay S Baines ◽

Desiree Benson ◽

...

Keyword(s):

Global Health ◽

Evidence Base ◽

International Affairs ◽

Global Health Diplomacy ◽

Middle Income ◽

Middle Income Countries ◽

Health Diplomacy ◽

Health Practitioners ◽

And Control ◽

Low And Middle Income

Abstract The science of global health diplomacy (GHD) consists of cross-disciplinary, multistakeholder credentials comprised of national security, public health, international affairs, management, law, economics and trade policy. GHD is well placed to bring about better and improved multilateral stakeholder leverage and outcomes in the prevention and control of cancer. It is important to create an evidence base that provides clear and specific guidance for health practitioners in low- and middle-income countries (LMICs) through involvement of all stakeholders. GHD can assist LMICs to negotiate across multilateral stakeholders to integrate prevention, treatment and palliative care of cancer into their commercial and trade policies.

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Much research, but little learned to date: A scoping review on mental health of health workers in low- and lower-middle income countries and roadmap for future research

10.21203/rs.3.rs-215108/v1 ◽

2021 ◽

Author(s):

Julia Lohmann ◽

Denny John ◽

Aso Dzay

Keyword(s):

Mental Health ◽

Scoping Review ◽

Health Workers ◽

Tertiary Care ◽

Psychological Wellbeing ◽

Future Research ◽

Measurement Tool ◽

High Quality ◽

Middle Income ◽

Middle Income Countries

Abstract BackgroundSARS-CoV-2 has resulted in unprecedented research efforts on health workers’ work realities and their potential mental health impacts. To understand the latter, high-quality evidence on the baseline situation is paramount. With the aim of providing a comprehensive overview of existing evidence and to inform future research, we undertook a scoping review of the quantitative literature on mental health and psychological wellbeing of clinical skilled healthcare personnel working in all settings of care in low- and lower-middle income countries (LLMIC).MethodsWe performed a systematic search of the literature up to the end of 2019, in English or French language, in MEDLINE, EMBASE, PsychINFO, Global Health, and CAIRN. We included both studies estimating levels of mental health and studies investigating associations with other factors. We extracted data on study characteristics and methodology, and assessed the methodological quality of the included studies along nine criteria.ResultsWe found 143 relevant studies, 135 including data on mental health levels and 126 including data on associations with other factors. The studies covered 26 of the world’s 78 LLMICs, with most studies conducted in India, Nigeria, Pakistan, or Egypt, in urban secondary- and tertiary-care settings. 67% of studies assessed burnout, 25% general psychological wellbeing, and 20% other mental health outcomes. Only 19% of studies were of high quality due to shortcomings particularly in regards to sample representativeness, context-specific measurement tool validity, and reporting of methodological detail. We found much heterogeneity in investigated associated factors. Studies focused almost exclusively on potential determinants of mental health, while none linked mental health to objectively measured performance outcomes.ConclusionWe conclude that despite its impressive size, we can learn comparatively little from the current body of literature. Based on our findings, we outline areas for expansion, methodological improvement, and standardization of reporting in future research on mental health of health workers.Systematic review registrationPROSPERO no. CRD42019140036

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Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020000864 ◽

2020 ◽

Vol 29 ◽

Author(s):

W. A. Tol ◽

M. C. Greene ◽

M. E. Lasater ◽

K. Le Roch ◽

C. Bizouerne ◽

...

Keyword(s):

Mental Health ◽

Exclusive Breastfeeding ◽

Home Visiting ◽

Health Workers ◽

Maternal Mental Health ◽

Meta Analysis ◽

Middle Income ◽

Middle Income Countries ◽

Child Height ◽

Low And Middle Income

Abstract Aims Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). Methods We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. Results We identified 21 trials with 28 284 mother–child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13–1.71, ten trials, N = 4749 mother–child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02–0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. Conclusions These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.

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Prevalence and factors associated with poor mental health among healthcare professionals in low- and lower-middle-income countries: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-019-1201-7 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Julia Lohmann ◽

Denny John ◽

Aso Dzay

Keyword(s):

Mental Health ◽

Healthcare Professionals ◽

Health Workers ◽

Poor Mental Health ◽

Psychological Wellbeing ◽

Health Issues ◽

Middle Income ◽

Factors Associated ◽

Middle Income Countries ◽

Mental Health Issues

Abstract Background A healthy and productive health workforce is central to a well-functioning health system. However, health workers are at high risk of poor psychological wellbeing due to their particularly strenuous work demands. While mental health of health workers is a well-researched issue in high-income countries, research from low- and lower-middle-income countries (LLMIC) has begun to emerge only recently. The review aims to synthesize this body of research, specifically to assess the prevalence of mental health issues among health workers in LLMIC, to identify factors associated with good or poor mental health, and to highlight gaps in knowledge. Methods We will perform a systematic search of the published English and French language literature (from inception onwards) in MEDLINE, EMBASE, and PsycINFO. Eligible for inclusion are observational studies (e.g., cross-sectional, case-control, or cohort) and control arms of randomized controlled trials reporting investigations on the nature, prevalence, and factors associated with mental health or psychological wellbeing among formally trained health professionals and health associate professionals delivering health services in formal healthcare facilities in LLMIC. The primary outcomes will be burnout, depression, and general psychological wellbeing. Secondary outcomes include other specific mental health diagnoses, as well as general psychological stress, distress and/or trauma if work-related and explicitly framed as a mental health issue. Two authors will independently examine the studies against the eligibility criteria in the stages of title, abstract, and full-text study selection, as well as assess the risk of bias in included studies using standard checklists depending on study design. Disagreements will be resolved in discussion with the third author. Data will be extracted from included studies using a predefined and piloted coding framework. Given the anticipated heterogeneity of studies, we do not expect to be able to conduct meta-analysis and plan to summarize the extracted data in narrative form. The framework method will be used to organize narrative data by subthemes and explore patterns. Discussion In assessing the prevalence of mental health issues among healthcare professionals in LLMIC and identifying factors associated with positive or poor mental health, the review aims to synthesize all possible available information for policy makers and health system managers on a potentially highly important but not yet much-discussed issue and to highlight gaps in currently available knowledge. Systematic review registration International Prospective Register of Systematic Reviews PROSPERO (registration number CRD42019140036)

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US NCI's Center for Global Health Regional Centers for Research Excellence Program to Support Research Infrastructure on Non-Communicable Diseases, Mental Health and Injuries (NCDs)

Journal of Global Oncology ◽

10.1200/jgo.2016.003723 ◽

2016 ◽

Vol 2 (3_suppl) ◽

pp. 44s-44s

Author(s):

Shannon L. Silkensen ◽

John S. Flanigan

Keyword(s):

Mental Health ◽

Global Health ◽

Conflicts Of Interest ◽

Communicable Diseases ◽

Research Infrastructure ◽

Collaborative Partnerships ◽

Middle Income ◽

Non Communicable Diseases ◽

Middle Income Countries ◽

Population Science

Abstract 78 In many low and middle-income countries (LMICs) there is a marked need to build or enhance research infrastructure to support basic, translational, clinical, and population science on non-communicable diseases, mental health and injuries (NCDs). To support this growing need, the NCI's Center for Global Health recently invited investigators throughout the world to apply for Planning Grants for Regional Infrastructure Centers (RCREs) for the coordination of research on NCDs in LMICs. The purpose of the funding opportunity (FOA) is to facilitate the planning and designing of RCRE that will build on collaborative partnerships among investigators from institutions in high-income countries (HICs)/ Upper Middle Income Countries (UMIC) and LMICs. The presentation will provide details of the opportunity for funding from the NCI, how partnerships can be created, the requirements for the application to the program and its multiple funding timelines, and early information about the program's global reach. The NCI Center for Global Health encourages the CUGH community to examine and become involved in this this opportunity as primary or partner applicants. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from either author.

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Where there is no psychiatrist: A mental health programme in Sierra Leone

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v20i3.498 ◽

2014 ◽

Vol 20 (3) ◽

pp. 6

Author(s):

Pino Alonso ◽

Brian Price ◽

Abdul R Conteh ◽

Carmen Valle ◽

Patrick E Turay ◽

...

Keyword(s):

Public Health ◽

Mental Health ◽

Mental Disorders ◽

Sierra Leone ◽

Health Workers ◽

Middle Income ◽

Middle Income Countries ◽

Mental Health Programme ◽

Drug Use Disorders ◽

Health Programme

Background. For most low- and middle-income countries, mental health remains a neglected area, despite the recognised burden associated with neuropsychiatric conditions and the inextricable link to other public health priorities.Objectives. To describe the results of a free outpatient mental health programme delivered by non-specialist health workers in Makeni, Sierra Leone between July 2008 and May 2012. Methods. A nurse and two counsellors completed an 8-week training course focused on the identification and management of seven priority conditions: psychosis, bipolar disorder, depression, mental disorders due to medical conditions, developmental and behavioural disorders, alcohol and drug use disorders, and dementia. The World Health Organization recommendations on basic mental healthcare packages were followed to establish treatment for each condition. Results. A total of 549 patients was assessed and diagnosed as suffering from psychotic disorders (n=295, 53.7%), manic episodes (n=69, 12.5%), depressive episodes (n=53, 9.6%), drug use disorders (n=182, 33.1%), dementia (n=30, 5.4%), mental disorders due to medical conditions (n=39, 7.1%), and developmental disorders (n=46, 8.3%). Of these, 417 patients received pharmacological therapy and 70.7% were rated as much or very much improved. Of those who could not be offered medication, 93.4% dropped out of the programme after the first visit. Conclusions. The identification and treatment of mental disorders must be considered an urgent public health priority in low- and middle-income countries. Trained primary health workers can deliver safe and effective treatment for mental disorders as a feasible alternative to ease the scarcity of mental health specialists in developing countries.

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Community Health Workers Can Provide Psychosocial Support to the People During COVID-19 and Beyond in Low- and Middle- Income Countries

Frontiers in Public Health ◽

10.3389/fpubh.2021.666753 ◽

2021 ◽

Vol 9 ◽

Author(s):

Sabuj Kanti Mistry ◽

Ben Harris-Roxas ◽

Uday Narayan Yadav ◽

Sadia Shabnam ◽

Lal Bahadur Rawal ◽

...

Keyword(s):

Mental Health ◽

Health Services ◽

Community Health ◽

Community Health Workers ◽

Health Systems ◽

Health Workers ◽

Psychosocial Support ◽

Middle Income ◽

Middle Income Countries ◽

The People

The COVID-19 pandemic has been the most challenging public health issue which not only affected the physical health of the global population but also aggravated the mental health conditions such as stress, anxiety, fear, depression and anger. While mental health services are seriously hampered amid this COVID-19 pandemic, health services, particularly those of Low- and Middle- Income Countries (LMICs) are looking for alternatives to provide psychosocial support to the people amid this COVID-19 and beyond. Community Health Workers (CHWs) are an integral part of the health systems in many LMICs and played significant roles such as health education, contact tracing, isolation and mobilization during past emergencies and amid COVID-19 in many LMICs. However, despite their potentials in providing psychosocial support to the people amid this COVID-19 pandemic, they have been underutilized in most health systems in LMICs. The CHWs can be effectively engaged to provide psychosocial support at the community level. Engaging them can also be cost-saving as they are already in place and may cost less compared to other health professionals. However, they need training and supervision and their safety and security needs to be protected during this COVID-19. While many LMICs have mental health policies but their enactment is limited due to the fragility of health systems and limited health care resources. CHWs can contribute in this regard and help to address the psychosocial vulnerabilities of affected population in LMICs during COVID-19 and beyond.

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A realist review of community engagement with health research

Wellcome Open Research ◽

10.12688/wellcomeopenres.15298.1 ◽

2019 ◽

Vol 4 ◽

pp. 87 ◽

Cited By ~ 3

Author(s):

Bipin Adhikari ◽

Robin Vincent ◽

Geoff Wong ◽

Claire Duddy ◽

Emma Richardson ◽

...

Keyword(s):

Global Health ◽

Community Engagement ◽

Health Research ◽

Evidence Synthesis ◽

Realist Review ◽

Evidence Base ◽

Programme Theory ◽

Middle Income ◽

Middle Income Countries ◽

Registration Number

Introduction: Community engagement is increasingly recognized as a critical aspect of global health. Recent years have seen an expansion of community engagement activities linked to health research, but debates and inconsistencies remain about the aims of different types of engagement, mechanisms underpinning their implementation and impact, and influential contextual factors. Greater commitment to and consistency around community engagement by health research programs, implementers and funders requires a more coherent evidence base. This realist review is designed to improve our understanding of how and why community engagement contributes to intended and unintended outcomes (including research and ethical outcomes) in different contexts. Given the breadth and diversity of the literature on community engagement in health research, the review will initially focus on malaria research in low- and middle-income countries (LMICs) and draw on wider global health literature where needed. Methods and analysis: Community engagement in practice is often a complex set of interventions. We will conduct a realist review – a theory driven approach to evidence synthesis – to provide explanations for how and why community engagement with health research produces the pattern of outcomes observed across different contexts of application. We will consolidate evidence from a range of documents, including qualitative, quantitative and mixed method studies. The review will follow several stages: devising an initial programme theory, searching evidence, selecting appropriate documents, extracting data, synthesizing and refining the programme theory, and reiteration of these steps as needed. Ethics and dissemination: A formal ethics review is not required for this literature review. Findings will be disseminated in a peer reviewed journal, through national and international conferences, and through a set of short briefings tailored for audiences with an interest in community engagement. Outputs and presentations will be informed by and feed into our network of community engagement experts. PROSPERO registration number: CRD42019125687

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Review of layperson screening tools and model for a holistic mental health screener in lower and middle income countries

10.1101/763045 ◽

2019 ◽

Author(s):

Aderibigbe Oluwakemi Olanike ◽

Christopher M Perlman

Keyword(s):

Mental Health ◽

Substance Use ◽

Human Resource ◽

Health Workers ◽

Health Screening ◽

Mental Health Screening ◽

Screening Tools ◽

Community Based ◽

Middle Income ◽

Middle Income Countries

AbstractBackgroundThe needs of people diagnosed with Mental Neurological and Substance-Use (MNS) conditions are complex including interactions physical, social, medical and environmental factors. Treatment requires a multidisciplinary approach including health and social services at different levels of care. However, due to inadequate assessment, services and scarcity of human resource for mental health, treatment of persons diagnosed with MNS conditions in many LMICs is mainly facility-based pharmacotherapy with minimal non-pharmacology treatments and social support services. In low resource settings, gaps in human resource capacity may be met using layperson health workers. A layperson health working is one without formal mental health training and may be equivalent to community health worker (CHW) or less cadre in primary health care system.ObjectivesThis study reviewed layperson mental health screening tools for use in supporting mental health in developing countries, including the content and psychometric properties of the tools. Based on this review this study proposes recommendations for the design and effective use of layperson mental health screening tools based on the Five Pillars of global mental health.MethodsA systematic review was used to identify and examine the use of mental health screening tools among laypersons supporting community-based mental health programs. PubMed, Scopus, CINAHL and PsychInfo databases were reviewed using a comprehensive list of keywords and MESH terms that included mental health, screening tools, lay-person, lower and middle income countries. Articles were included if they describe mental health screening tools used by laypersons for screening, delivery or monitoring of MNS conditions in community-based program in LMICs. Diagnostic tools were not included in this study. Trained research interviewers or research assistants were not considered as lay health workers for this study.ResultsThere were eleven studies retained after 633 were screened. Twelve tools were identified covering specific disorders (E.g. alcohol and substance use, subcortical dementia associated with HIV/AIDS, PTSD) or common mental disorders (mainly depression and anxiety). These tools have been tested in LMICs including South Africa, Zimbabwe, Haiti, Malaysia, Pakistan, India, Ethiopia and Brazil. The included studies show that simple screening tools can enhance the value of laypersons and better support their roles in providing community-based mental health support. However, most of the layperson MH screening tools used in LMICs do not provide comprehensive information that can inform integrated comprehensive treatment planning and understanding of the broader mental health needs of the community.ConclusionDeveloping a layperson screening tools is vital for integrated community-based mental health intervention. This study proposed a holistic framework which considers the relationship between individual’s physical, mental and spiritual aspect of mental health, interpersonal as well as broader contextual determinants (community, policy and different level of the health system) that can be consulted for developing or selecting a layperson mental health screening instrument. More research are needed to evaluate the practical application of this framework.

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