The effect of community health worker–led education on women’s health and treatment–seeking: A cluster randomised trial and nested process evaluation in Gujarat, India

BackgroundOral anticoagulants reduce the risk of stroke in patients with atrial fibrillation (AF), but are underused. AURAS-AF (AUtomated Risk Assessment for Stroke in AF) is a software tool designed to identify eligible patients and promote discussions within consultations about initiating anticoagulants.AimTo investigate the implementation of the software in UK general practice.Design and settingProcess evaluation involving 23 practices randomly allocated to use AURAS-AF during a cluster randomised trial.MethodAn initial invitation to discuss anticoagulation was followed by screen reminders appearing during consultations until a decision had been made. The reminders required responses, giving reasons for cases where an anticoagulant was not initiated. Qualitative interviews with clinicians and patients explored acceptability and usability.ResultsIn a sample of 476 patients eligible for the invitation letter, only 159 (33.4%) were considered suitable for invitation by their GPs. Reasons given were frequently based on frailty, and risk of falls or haemorrhage. Of those invited, 35 (22%) started an anticoagulant (7.4% of those originally identified). A total of 1695 main-screen reminders occurred in 940 patients. In 883 instances, the decision was taken not to initiate and a range of reasons offered. Interviews with 15 patients and seven clinicians indicated that the intervention was acceptable, though the issue of disruptive screen reminders was raised.ConclusionAutomated risk assessment for stroke in atrial fibrillation and prompting during consultations are feasible and generally acceptable, but did not overcome concerns about frailty and risk of haemorrhage as barriers to anticoagulant uptake.

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Improving Community Health Worker Treatment for Malaria, Diarrhoea and Pneumonia in Uganda Through inSCALE Community and Mhealth Innovations: A Cluster Randomised Controlled Trial

SSRN Electronic Journal ◽

10.2139/ssrn.3786005 ◽

2021 ◽

Author(s):

Karin Elena Källander ◽

Seyi Soremekun ◽

Daniel LL Strachan ◽

Zelee Hill ◽

Frida Kasteng ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Community Health ◽

Health Worker ◽

Community Health Worker ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Cluster Randomised ◽

Randomised Controlled

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Process evaluation of a workplace-based health promotion and exercise cluster-randomised trial to increase productivity and reduce neck pain in office workers: a RE-AIM approach

BMC Public Health ◽

10.1186/s12889-020-8208-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Alyssa Welch ◽

Genevieve Healy ◽

Leon Straker ◽

Tracy Comans ◽

Shaun O’Leary ◽

...

Keyword(s):

Health Promotion ◽

Neck Pain ◽

Process Evaluation ◽

Randomised Trial ◽

Office Workers ◽

Cluster Randomised Trial ◽

Cluster Randomised ◽

Increase Productivity

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Process evaluation protocol for a cluster randomised trial of a complex, nurse-led intervention to improve hypertension management in India

BMJ Open ◽

10.1136/bmjopen-2018-027841 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027841 ◽

Cited By ~ 1

Author(s):

Nikhil Srinivasapura Venkateshmurthy ◽

Kevin Mc Namara ◽

Harriet Koorts ◽

Sailesh Mohan ◽

Vamadevan S Ajay ◽

...

Keyword(s):

Mixed Methods ◽

Process Evaluation ◽

Randomised Trial ◽

Intervention Development ◽

Health Department ◽

Uncontrolled Hypertension ◽

Cluster Randomised Trial ◽

Care Coordinator ◽

Cluster Randomised ◽

Number Of Patients

IntroductionIndia has high prevalence of hypertension but low awareness, treatment and control rate. A cluster randomised trial entitled ‘m-Power Heart Project’ is being implemented to test the effectiveness of a nurse care coordinator (NCC) led complex intervention to address uncontrolled hypertension in the community health centres (CHCs). The trial’s process evaluation will assess the fidelity and quality of implementation, clarify the causal mechanisms and identify the contextual factors associated with variation in the outcomes. The trial will use a theory-based mixed-methods process evaluation, guided by the Consolidated Framework for Implementation Research.Methods and analysisThe process evaluation will be conducted in the CHCs of Visakhapatnam (southern India). The key stakeholders involved in the intervention development and implementation will be included as participants. In-depth interviews will be conducted with intervention developers, doctors, NCCs and health department officials and focus groups with patients and their caregivers. NCC training will be evaluated using Kirkpatrick’s model for training evaluation. Key process evaluation indicators (number of patients recruited and retained; concordance between the treatment plans generated by the electronic decision support system and treatment prescribed by the doctor and so on) will be assessed. Fidelity will be assessed using Borrelliet al’s framework. Qualitative data will be analysed using the template analysis technique. Quantitative data will be summarised as medians (IQR), means (SD) and proportions as appropriate. Mixed-methods analysis will be conducted to assess if the variation in the mean reduction of systolic blood pressure between the intervention CHCs is influenced by patient satisfaction, training outcome, attitude of doctors, patients and NCCs about the intervention, process indicators etc.Ethics and disseminationEthical approval for this study was obtained from the ethics committees at Public Health Foundation of India and Deakin University. Findings will be disseminated via peer-reviewed publications, national and international conference presentations.Trial registration numberNCT03164317; Pre-results.

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Village-Integrated Eye Worker trial (VIEW): rationale and design of a cluster-randomised trial to prevent corneal ulcers in resource-limited settings

BMJ Open ◽

10.1136/bmjopen-2018-021556 ◽

2018 ◽

Vol 8 (8) ◽

pp. e021556 ◽

Cited By ~ 1

Author(s):

Kieran S O’Brien ◽

Raghunandan Byanju ◽

Ram Prasad Kandel ◽

Bimal Poudyal ◽

Mariya Gautam ◽

...

Keyword(s):

Community Health ◽

San Francisco ◽

Negative Binomial ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

Corneal Ulceration ◽

Resource Limited Settings ◽

Corneal Ulcers ◽

Cluster Randomised ◽

Resource Limited

IntroductionCorneal opacity is a leading cause of blindness worldwide. In resource-limited settings, untreated traumatic corneal abrasions may result in infection and ultimately, opacity. Although antimicrobial treatment of corneal ulcers may successfully cure infections, the scarring that accompanies the resolution of infection can still result in visual impairment. Prevention may be the optimal approach for reducing corneal blindness. Studies have employed community health workers to provide prompt administration of antimicrobials after corneal abrasions to prevent infections, but these studies were not designed to determine the effectiveness of such a programme.Methods and analysisThe Village-Integrated Eye Worker trial (VIEW) is a cluster-randomised trial designed to assess the effectiveness of a community health worker intervention to prevent corneal ulcers. Twenty-four Village Development Committees (VDCs) in Nepal were randomised to receive a corneal ulcer prevention programme or to no intervention. Female Community Health Volunteers (FCHVs) in intervention VDCs are trained to diagnose corneal abrasions, provide antimicrobials and to refer participants when needed. An annual census is conducted over 3 years in all study VDCs to assess the incidence of corneal ulceration via corneal photography (primary outcome). Masked outcome assessors grade corneal photographs to determine the presence or absence of incident corneal opacities. The primary analysis is negative binomial regression to compare the incidence of corneal ulceration by study arm.Ethics and disseminationThe University of California San Francisco Committee on Human Research, Nepal Netra Jyoti Sangh and the Nepal Health Research Council have given ethical approval for the trial. The results of this trial will be presented at local and international meetings and submitted to peer-reviewed journals for publication.Trial registration numberNCT01969786; Pre-results.

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