Evaluating the Impact of Telehealth-Based, Diabetes Medication Training for Community Health Workers on Glycemic Control

Background: Diabetes is a major contributor to morbidity and mortality. Community Health Workers (CHWs) have been instrumental in improving patient outcomes. However, CHW training largely focuses on general diabetes concepts rather than medications. Providing accessible, diabetes medication training for CHWs has the potential to increase patient understanding, personalized care, and adherence, thereby improving outcomes. Objective: To evaluate the impact of a telehealth-based diabetes medication training for CHWs on patient outcomes as measured by HbA1c changes. Methods: We provided a 12-month weekly, telehealth (videoconference) medication training for CHWs who led 6-month diabetes programs for low-income Latino(a)s in community clinics. We measured participant HbA1c (primary outcome), blood pressure, and body mass index (BMI) changes. We evaluated CHW knowledge via two pre/post-tests: medication adverse events/side effects (TEST-1, months 1–6) and dosing, titration, and emergencies (TEST-2, months 7–12). We assessed CHW training application by their ability to identify patient, provider, and healthcare system medication barriers. Results: Participants’ (n = 55) HbA1c improved (9.0% (75 mmol/mol) to 7.8% (62 mmol/mol) (p = 0.001)). Blood pressure and BMI changes were not significant. CHWs improved their knowledge: TEST-1: 10.5-18.2/20.0 (p = 0.002), TEST-2: 10.3–17.3/19.0 (p = 0.0019). CHWs identified 984 patients (n = 610), providers (n = 151), and healthcare systems (n = 223) medication barriers during the 12-month training. Conclusions: Providing a telehealth-based, diabetes medication training program for CHWs allowed a personalized approach to identify barriers to care at several levels, which was associated with significant participant HbA1c reductions and improved CHW knowledge. This is a promising cost-effective, culturally sensitive strategy to improve diabetes care. Larger longitudinal evaluations are needed to fully understand the impact of CHW medication training.

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The impact of community health workers on the self-determination, self-sufficiency, and decision-making ability of low-income women and mothers of young children

Journal of Community Psychology ◽

10.1002/jcop.20006 ◽

2004 ◽

Vol 32 (3) ◽

pp. 343-356 ◽

Cited By ~ 5

Author(s):

Andrea Crivelli Kovach ◽

Julie Becker ◽

Heidi Worley

Keyword(s):

Decision Making ◽

Young Children ◽

Community Health ◽

Community Health Workers ◽

Low Income ◽

Health Workers ◽

The Self ◽

Self Determination ◽

Self Sufficiency ◽

The Impact

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Impact of Different Levels of Supervision on the Recovery of Severely Malnourished Children Treated by Community Health Workers in Mali

Nutrients ◽

10.3390/nu13020367 ◽

2021 ◽

Vol 13 (2) ◽

pp. 367

Author(s):

Pilar Charle-Cuéllar ◽

Noemí López-Ejeda ◽

Mamadou Traore ◽

Adama Balla Coulibaly ◽

Aly Landouré ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Low Income ◽

Community Intervention ◽

Health Workers ◽

Acute Malnutrition ◽

Control Group ◽

Supportive Supervision ◽

Supervision Group ◽

Different Levels

(1) Background: The Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated community case management (iCCM). This paper evaluates the most effective model of supervision for treating SAM using community health workers (CHWs). Methods (2): This study was a prospective non-randomized community intervention trial with two intervention groups and one control group with different levels of supervision. It was conducted in three districts in rural areas of the Kayes Region. In the high supervision group, CHWs received supportive supervision for the iCCM package and nutrition-specific supervision. In the light supervision group, CHWs received supportive supervision based on the iCCM package. The control group had no specific supervision. (3) Results: A total of 6112 children aged 6–59 months with SAM without medical complications were included in the study. The proportion of cured children was 81.4% in those treated by CHWs in the high supervision group, 86.2% in the light supervision group, and 66.9% in the control group. Children treated by the CHWs who received some supervision had better outcomes than those treated by unsupervised CHWs (p < 0.001). There was no difference between areas with light and high supervision, although those with high supervision performed better in most of the tasks analyzed. (4) Conclusions: Public policies in low-income countries should be adapted, and their model of supervision of CHWs for SAM treatment in the community should be evaluated.

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Abstract P303: Use of Community Health Workers for Community-based Hypertension Screening in Urban Haiti

Circulation ◽

10.1161/circ.141.suppl_1.p303 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Caleigh Smith ◽

Vanessa Rivera ◽

Jean Joscar Victor ◽

Lookens Pierre ◽

Fabyola Preval ◽

...

Keyword(s):

Blood Pressure ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Linkage To Care ◽

Median Number ◽

Population Based ◽

Age Group ◽

Cvd Risk ◽

Blood Pressure Screening

Background: Cardiovascular disease is the leading cause of mortality among Haitian adults, and hypertension (HTN) is the most important CVD risk factor, as in other resource-poor countries. The majority of Haitians have never been screened for hypertension and access to clinic-based services is limited. Methods: Twenty-eight Haitian community health workers (CHW) conducted household-based HTN screening within a population-based longitudinal cohort study of 3,000 adults in metropolitan Port-au-Prince. Randomly selected GPS locations across census blocks were selected in proportion to the estimated population of each block. One household at each waypoint was selected systematically and CHW collected household information and conducted three blood pressure measurements the same day on all adult household members (≥ 18 years) present at the time of the survey using AHA guidelines. Adults with HTN were referred to the GHESKIO clinic for repeat BP measurement and treatment. Results: Between March and September 2019, 585 households provided verbal consent for surveys and BP screening (97% response rate). These households had a total of 2542 people (1777 adults) with the median number of adults per household being 3 (IQR 2-4; range 1-9). A total of 913 adults (51%) were present at the time of survey, and all agreed to blood pressure screening. The majority were women (70%) with a median age of 36 years (IQR 27-52). Hypertension prevalence (SBP > 140 and/or DBP > 90) was 25.3% (15.5% Stage I, 9.8% Stage II). Figure 1 reports HTN prevalence by age group (18-30, 31-45, 46-60, >60) and by sex, with HTN increasing by age group but without significant variation by sex. Conclusion: Community blood pressure screening is feasible and highly acceptable in Port-au-Prince, Haiti. Preliminary results show high rates of HTN among a population with limited access to screening, diagnosis and treatment. Further research is urgently needed to design linkage to care strategies and effective treatment interventions to curb the HTN epidemic in Haiti.

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Abstract 242: Evaluating the Impact and Barriers to a Collaborative Physician-pharmacist Care Model to Control Hypertension in a Low-income Population

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.242 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Kerrilynn C Hennessey ◽

Carolyn Hickman ◽

Brianne Krawczyk ◽

Michelle Opare ◽

Leslie Churchwell ◽

...

Keyword(s):

Blood Pressure ◽

Side Effects ◽

Blood Pressure Control ◽

Low Income ◽

Health Workers ◽

Pressure Control ◽

Low Income Population ◽

Early Results ◽

Patient Reported ◽

The Impact

Objectives: Physician-pharmacist collaborative practice models have emerged as an effective model for managing hypertension (HTN). We implemented this model in a low-income, hospital-based cardiology clinic and sought to identify programmatic features necessary to control HTN in this vulnerable population. Methods: Patients with persistently elevated blood pressure (>130/80) were referred by their primary cardiologist. Patients were excluded if they were pregnant, had acute kidney injury, or acute cardiovascular complaints including anginal chest pain, decompensated heart failure, or unstable arrhythmia. The initial pharmacist appointment occurred within 2 weeks of referral, with the goal of bi-weekly visits for 6 weeks or until blood pressure was controlled. Patients were prescribed home blood pressure cuffs and given specific instructions for home-based monitoring. Telehealth visits were made available to interested patients. During each encounter, pharmacists assessed response and side effects to medication, adherence, lifestyle behaviors, stressors, and social barriers to blood pressure control. Clinical management and barriers to HTN control were reviewed at standing weekly staff meetings that included cardiologists and pharmacists. Early results: Among 35 people referred, 22 patients attended at least one pharmacist visit. A total of 139 reminder or follow-up calls were made for these 22 patients. Among the first 35 referrals (mean age 58; 57% male; 65% African American or Latinx), 26% have documented substance use disorders, 34% have a mental health comorbidity, 20% were not taking their medications as prescribed on intake, and 17% had side effects from 2 or more prior antihypertensive medications. Medications adjustments were made in 21/43 patient visits (49% of visits). In 8/43 visits more than 1 medication change was made. The most common patient reported barriers to care include transportation (20%) and language barriers (11%). Discussion and Future Direction: Managing HTN in a low-income population requires attention to the social and contextual factors impacting blood pressure control. We plan to: 1) support the uptake of telehealth to address issues of transportation and access; 2) pilot blue-tooth connected blood pressure cuffs to facilitate home monitoring and management; and 3) partner with community health workers to assess best practices for capturing and addressing social determinants of health in the clinical setting.

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Ongoing training of community health workers in low-income andmiddle-income countries: a systematic scoping review of the literature

BMJ Open ◽

10.1136/bmjopen-2017-021467 ◽

2018 ◽

Vol 8 (4) ◽

pp. e021467 ◽

Cited By ~ 23

Author(s):

James O’Donovan ◽

Charles O’Donovan ◽

Isla Kuhn ◽

Sonia Ehrlich Sachs ◽

Niall Winters

Keyword(s):

Community Health ◽

Community Health Workers ◽

Scoping Review ◽

Low Income ◽

Health Workers ◽

Review Of The Literature ◽

Ongoing Training

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Community Health Workers (CHWs) as Innovators

International Journal of Healthcare Information Systems and Informatics ◽

10.4018/ijhisi.2018010102 ◽

2018 ◽

Vol 13 (1) ◽

pp. 15-28

Author(s):

Tyler Prentiss ◽

John Zervos ◽

Mohan Tanniru ◽

Joseph Tan

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Underserved Populations ◽

Low Cost ◽

Cost Effective ◽

Well Being ◽

Grant Writing ◽

Multiple Sources ◽

Context Of Learning

Community health workers (CHWs) have a longstanding role in improving the health and well-being of underserved populations in resource-limited settings. CHWs are trusted in the communities they serve and are often able to see through solutions on community challenges that outside persons cannot. Notwithstanding, such solutions often must be low-cost, easily implementable, and permit knowledge gaps among CHWs to be filled via appropriate training. In this sense, use of cost-effective information technology (IT) solutions can be key to increasing access to knowledge for these community agents. This paper highlights insights gleaned from a pilot study performed in Detroit, Michigan with a group of CHWs in basic grant-writing training via an e-platform, the Community Health Innovator Program (CHIP). The results are discussed within the context of learning theory. It is concluded that e-platforms are necessary for CHWs to leverage knowledge from multiple sources in an adaptive environment towards addressing ever-evolving global health challenges.

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Strategies Used By Community Health Workers to Influence Adoption of Maternal Nutrition Behaviors in Rural Bangladesh: A Focused Ethnographic Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa059_076 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1359-1359

Author(s):

Gargi Wable Grandner ◽

Katherine Dickin ◽

Purnima Menon ◽

Tiffany Yeh ◽

John Hoddinott

Keyword(s):

Community Health ◽

Community Health Workers ◽

Low Income ◽

Maternal Nutrition ◽

Health Workers ◽

Ethnographic Study ◽

Low Income Countries ◽

Cultural Congruence ◽

Healthy Tree ◽

Diet Diversity

Abstract Objectives Efforts to integrate nutrition into antenatal health promotion in low income countries have led to increased involvement of community health workers (CHWs) in counseling on maternal nutrition. Little is known about how CHWs “package” messages in resource-poor communities to increase adoption of recommended maternal nutrition behaviors. We developed focused ethnographic techniques to explore this. Methods We interviewed 35 randomly selected CHWs providing monthly counseling to pregnant women and their families in 7 ‘Alive & Thrive’ intervention sites in Bangladesh. Two sorting exercises explored CHW strategies for promoting and perceptions of adoption of messages on micronutrient supplements, maternal dietary adequacy, and rest during pregnancy. In-depth probing on messages identified as “difficult” to deliver or adopt revealed how CHWs addressed barriers. Analysis of quantitative sorting data complemented thematic coding of qualitative textual data using grounded theory. Results CHW communication strategies involved 3 themes: feasibility (attitudes, norms, agency, poverty), audience (influence, motivators, support), and linguistic choice (emotional appeals, metaphors, logic, sellable but inaccurate arguments). CHWs viewed micronutrient messages as least difficult to adopt, requiring minimal “packaging”. Dietary messages were moderately difficult to adopt, prompting CHWs to leverage cultural congruence to target family members with different strategies. For example, messaging on diet diversity targeted husbands—the primary food-buyers—with logical arguments highlighting costs of inaction. When mothers-in-law held beliefs restricting gestational food intake, CHWs used metaphors (‘healthy tree, healthy fruit’) or faith-based appeals. Some CHWs used inaccurate messages (‘mother rests, baby rests’) to promote rest during pregnancy because it was seen as the least feasible behavior to adopt. Conclusions Where behavior change is viewed as feasible, CHWs use culturally resonant strategies to enhance adoption of maternal nutrition behaviors. Cultural congruence, or shared beliefs, language and cultural identity, is key to CHW effectiveness, but unhelpful for contextually infeasible behaviors. BCC programs co-designed with CHWs could improve messaging and effectiveness. Funding Sources Cornell AWARE Travel Grant.

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Effectiveness of service models and organisational structures supporting tuberculosis identification and management in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review

BMJ Open ◽

10.1136/bmjopen-2017-019642 ◽

2018 ◽

Vol 8 (9) ◽

pp. e019642 ◽

Cited By ~ 1

Author(s):

Charlotte C Heuvelings ◽

Patrick F Greve ◽

Sophia G de Vries ◽

Benjamin Jelle Visser ◽

Sabine Bélard ◽

...

Keyword(s):

Systematic Review ◽

European Union ◽

Cost Effectiveness ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Cost Effective ◽

Service Models ◽

Hard To Reach Populations ◽

Organisational Structures

ObjectiveTo determine which service models and organisational structures are effective and cost-effective for delivering tuberculosis (TB) services to hard-to-reach populations.DesignEmbase and MEDLINE (1990–2017) were searched in order to update and extend the 2011 systematic review commissioned by National Institute for Health and Care Excellence (NICE), discussing interventions targeting service models and organisational structures for the identification and management of TB in hard-to-reach populations. The NICE and Cochrane Collaboration standards were followed.SettingEuropean Union, European Economic Area, European Union candidate countries and Organisation for Economic Co-operation and Development countries.ParticipantsHard-to-reach populations, including migrants, homeless people, drug users, prisoners, sex workers, people living with HIV and children within vulnerable and hard-to-reach populations.Primary and secondary outcome measuresEffectiveness and cost-effectiveness of the interventions.ResultsFrom the 19 720 citations found, five new studies were identified, in addition to the six discussed in the NICE review. Community health workers from the same migrant community, street teams and peers improved TB screening uptake by providing health education, promoting TB screening and organising contact tracing. Mobile TB clinics, specialised TB clinics and improved cooperation between healthcare services can be effective at identifying and treating active TB cases and are likely to be cost-effective. No difference in treatment outcome was detected when directly observed therapy was delivered at a health clinic or at a convenient location in the community.ConclusionsAlthough evidence is limited due to the lack of high-quality studies, interventions using peers and community health workers, mobile TB services, specialised TB clinics and improved cooperation between health services can be effective to control TB in hard-to-reach populations. Future studies should evaluate the (cost-)effectiveness of interventions on TB identification and management in hard-to-reach populations and countries should be urged to publish the outcomes of their TB control systems.PROSPERO registration numberCRD42015017865.

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Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines

BMC Health Services Research ◽

10.1186/s12913-020-05699-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Eunice Mallari ◽

Gideon Lasco ◽

Don Jervis Sayman ◽

Arianna Maever L. Amit ◽

Dina Balabanova ◽

...

Keyword(s):

Qualitative Study ◽

Community Health ◽

Community Health Workers ◽

Financial Incentives ◽

Lived Experiences ◽

Health Workers ◽

The Philippines ◽

Community Members ◽

Cross Sectional ◽

The Impact

Abstract Background Community health workers (CHWs) are an important cadre of the primary health care (PHC) workforce in many low- and middle-income countries (LMICs). The Philippines was an early adopter of the CHW model for the delivery of PHC, launching the Barangay (village) Health Worker (BHW) programme in the early 1980s, yet little is known about the factors that motivate and sustain BHWs’ largely voluntary involvement. This study aims to address this gap by examining the lived experiences and roles of BHWs in urban and rural sites in the Philippines. Methods This cross-sectional qualitative study draws on 23 semi-structured interviews held with BHWs from barangays in Valenzuela City (urban) and Quezon province (rural). A mixed inductive/ deductive approach was taken to generate themes, which were interpreted according to a theoretical framework of community mobilisation to understand how characteristics of the social context in which the BHW programme operates act as facilitators or barriers for community members to volunteer as BHWs. Results Interviewees identified a range of motivating factors to seek and sustain their BHW roles, including a variety of financial and non-financial incentives, gaining technical knowledge and skill, improving the health and wellbeing of community members, and increasing one’s social position. Furthermore, ensuring BHWs have adequate support and resources (e.g. allowances, medicine stocks) to execute their duties, and can contribute to decisions on their role in delivering community health services could increase both community participation and the overall impact of the BHW programme. Conclusions These findings underscore the importance of the symbolic, material and relational factors that influence community members to participate in CHW programmes. The lessons drawn could help to improve the impact and sustainability of similar programmes in other parts of the Philippines and that are currently being developed or strengthened in other LMICs.

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