Search

At the onset of the COVID-19 pandemic, neither government officials nor members of the news media fully grasped what was happening in the Latino community. Underreporting of COVID-19 cases led to a systematic neglect of the Latino population and resulted in disproportionately high rates of infection, hospitalization, and death. Illinois Unidos was formed to engage in community mobilization, health communication, advocacy, and policy work in response to inequalities exacerbated by COVID-19 in Latino communities in Illinois. (Am J Public Health. 2021;111(S3):S204–S207. https://doi.org/10.2105/AJPH.2021.306407 )

BACKGROUND: Chinese immigrant for-hire vehicle (FHV) drivers who smoke or smoked are at high risk for lung cancer due to the combined impact of tobacco use and air pollution exposure yet underutilize lung cancer screening (LCS). Community Health Worker (CHW) programs have been effective at improving cancer screening rates. This study describes a community needs assessment to inform the adaptation of an existing CHW intervention to facilitate LCS among Chinese FHV drivers. METHODS: Interviews were conducted until saturation with 13 Chinese-serving health professionals to determine the community’s needs, priorities, and preferences. Transcripts were qualitatively analyzed using Atlas.ti. RESULTS: Seven frequently occurring themes were identified: Knowledge of Guidelines/Access to LCS, Acceptability of CHW Program, CHW Role in Screening Process, Qualities of an Ideal CHW, Barriers to LCS, Challenges to Implementing a CHW Program, and Adaptations to CHW Program. DISCUSSION: The adapted CHW intervention should include culturally tailored health education to increase LCS knowledge for patients and providers.

Domestic violence creates multiple harms for women's health and is a ‘wicked problem’ for health professionals and public health systems. Brazil recently approved public policies to manage and care for women victims of domestic violence. Facing these policies, this study aimed to explore how domestic violence against women is usually managed in Brazilian primary health care, by investigating a basic health unit and its family health strategy. We adopted qualitative ethnographic research methods with thematic analysis of emergent categories, interrogating data with gender theory and emergent Brazilian collective health theory. Field research was conducted in a local basic health unit and the territory for which it is responsible, in Southern Brazil. The study revealed: 1) a yawning gap between public health policies for domestic violence against women at the federal level and its practical application at local/decentralized levels, which can leave both professionals and women unsafe; 2) the key role of local community health workers, paraprofessional health promotion agents, who aim to promote dialogue between women experiencing violence, health care professionals and the health care system. Resumo A violência doméstica (VD) cria múltiplos agravos à saúde das mulheres e é um desafio para profissionais e para os sistemas de saúde. O Brasil aprovou recentemente políticas públicas (PP) para manejo e cuidado de mulheres em situação de VD. Considerando essas PP, este estudo objetivou explorar como a VD contra mulheres é usualmente manejada na atenção primária à saúde brasileira, por meio da investigação de uma unidade básica de saúde e de sua estratégia de saúde da família. Foi adotada metodologia de pesquisa qualitativa de cunho etnográfico, com análise temática de categorias emergentes, interrogando os dados com teoria de gênero e com a produção teórica do campo da saúde coletiva brasileira. A pesquisa de campo foi conduzida em uma unidade básica de saúde e em seu território adscrito, localizado na região sul do Brasil. O estudo revelou: 1) um hiato entre PP direcionadas à VD contra mulheres implantadas a nível federal e sua aplicação prática a nível local/descentralizado, que pode deixar tanto profissionais quanto mulheres em risco; 2) o papel chave de agentes comunitários de saúde, profissionais de promoção da saúde, que objetivam promover o diálogo entre as mulheres experienciando violência, profissionais de saúde e o sistema de saúde.

BACKGROUND Social determinants of health (SDOH) contribute to racial disparities in asthma outcomes. Community health worker (CHW) programs represent a promising way to screen for SDOH and connect patients to resources, but the impact of CHW programs in the inpatient pediatric setting has been examined in few studies. In this study, we aimed to evaluate a CHW program for children hospitalized with asthma in a predominantly Hispanic community by examining rates of SDOH and social resource navigation. METHODS This pilot study involved a CHW intervention to improve pediatric asthma care. Patients were included if they were hospitalized with asthma over an 18-month period and enrolled in the CHW program during their hospitalization. In an intake interview, CHWs screened caregivers for SDOH and provided tailored social resource navigation. Descriptive statistics were used to assess rates of social risk factors and social resource navigation. RESULTS Eighty patients underwent SDOH screening. The majority of patients were Hispanic (81.3%, n = 65). Half of caregivers reported food or housing insecurity over the past 12 months (50.0%, n = 40), and most reported inadequate housing conditions (63.8%, n = 51). CHWs coordinated social resources for the majority of families (98.8%, n = 79), with the most common being food resources (42.5%, n = 34), housing resources (82.5%, n = 66), and appointment navigation (41.3%, n = 33). CONCLUSIONS CHWs identified a high burden of unmet social needs and provided associated social resource navigation in a largely Hispanic pediatric population hospitalized for asthma. CHW programs have potential to improve asthma outcomes by linking high-risk patients with social resources.

Involvement of community health workers (CHWs) within task-sharing to bridge the mental health treatment gap has been proven to be efficacious in randomized controlled trials. The impact of mental health programs based on task-sharing paradigm greatly depends on the performance of CHWs which, in-turn, is influenced by their readiness for change. However, there is dearth of literature assessing the role of readiness for change as an important predicator of CHW performance. The aim of this study is to examine the applicability of the readiness for change model and investigate its cultural and contextual nuances among Accredited Social Health Activists (ASHAs), a cadre of CHWs in India, to understand their engagement in mental health task-sharing. We conducted in-depth, semi-structured interviews with a purposive sample of n = 12 key informants including ASHAs and other healthcare professionals in Sehore district, India. The interview guide consisted of open-ended questions based on the readiness for change factors including ASHAs' attitudes towards their role in mental health care, perception of capability to implement mental health task-sharing, of support from the public health system, etc. Framework analysis with a combined inductive-deductive approach was employed to code the data and generate themes. Participants endorsed three readiness for change themes relevant to task-sharing among ASHAs including change valence or value ascribed to task-sharing, change-efficacy or the perceived ability to implement task-sharing, and job valence or value ascribed to their regular job role. In addition, they provided insights into the culturally and contextually salient aspects of these factors. Themes of personal empowerment, gaining respect and trust from community, professional duty, relationship with supervisors, and lack of resources availability were majorly highlighted. This is the first study to qualitatively investigate the applicability of the readiness for change model and its culture- and context-specific nuances among a cadre of non-specialist health workers in India. Our findings posit that implementation science models should strongly consider the culture and context within which they are being applied to enhance fit and relevance. Further, our results should be taken into consideration to adapt and validate measurement tools and build readiness for change in this population.

The purpose of this mixed methods study was to solicit information from Community Health Workers (CHWs) in order to further understand reasons for Healthy Start participants becoming lost to follow-up after delivery. Four CHWs from a local Healthy Start Program completed questionnaires for participants in their caseloads who had become lost to follow-up from the program (n = 146) between Sep 2018 and Jan 2020. The questionnaire included open ended items about ease of contact before and after delivery, changes in contact information, compliance with prenatal care visits, other life challenges (such as housing, legal, transportation, and family support), family size, living arrangements, working/student status, and substance use. Participants were categorized by ease of contact throughout participation into Easy (28.8%), Easy then Difficult (11%) and Difficult (60.3%). Responses to questions were reviewed and coded to identify common themes. Groups differed on: having a change in contact information, having challenges with transportation, having lots of help, having other children between 6 and 10 years old, compliance with prenatal care, and race being non-Black. Areas where groups differed may indicate possible reasons for participants becoming lost to follow up after delivery. The descriptive results from this study can help CHWs address these issues with participants during prenatal care, when they are easier to contact, to develop contingency plans for remaining in contact after delivery.

Background This is the sixth of our 11-paper supplement entitled “Community Health Workers at the Dawn of New Era”. Expectations of community health workers (CHWs) have expanded in recent years to encompass a wider array of services to numerous subpopulations, engage communities to collaborate with and to assist health systems in responding to complex and sometimes intensive threats. In this paper, we explore a set of key considerations for training of CHWs in response to their enhanced and changing roles and provide actionable recommendations based on current evidence and case examples for health systems leaders and other stakeholders to utilize. Methods We carried out a focused review of relevant literature. This review included particular attention to a 2014 book chapter on training of CHWs for large-scale programmes, a systematic review of reviews about CHWs, the 2018 WHO guideline for CHWs, and a 2020 compendium of 29 national CHW programmes. We summarized the findings of this latter work as they pertain to training. We incorporated the approach to training used by two exemplary national CHW programmes: for health extension workers in Ethiopia and shasthya shebikas in Bangladesh. Finally, we incorporated the extensive personal experiences of all the authors regarding issues in the training of CHWs. Results The paper explores three key themes: (1) professionalism, (2) quality and performance, and (3) scaling up. Professionalism: CHW tasks are expanding. As more CHWs become professionalized and highly skilled, there will still be a need for neighbourhood-level voluntary CHWs with a limited scope of work. Quality and performance: Training approaches covering relevant content and engaging CHWs with other related cadres are key to setting CHWs up to be well prepared. Strategies that have been recently integrated into training include technological tools and provision of additional knowledge; other strategies emphasize the ongoing value of long-standing approaches such as regular home visitation. Scale-up: Scaling up entails reaching more people and/or adding more complexity and quality to a programme serving a defined population. When CHW programmes expand, many aspects of health systems and the roles of other cadres of workers will need to adapt, due to task shifting and task sharing by CHWs. Conclusion Going forward, if CHW programmes are to reach their full potential, ongoing, up-to-date, professionalized training for CHWs that is integrated with training of other cadres and that is responsive to continued changes and emerging needs will be essential. Professionalized training will require ongoing monitoring and evaluation of the quality of training, continual updating of pre-service training, and ongoing in-service training—not only for the CHWs themselves but also for those with whom CHWs work, including communities, CHW supervisors, and other cadres of health professionals. Strong leadership, adequate funding, and attention to the needs of each cadre of CHWs can make this possible.

INTRODUCTION: Hazardous drinking imposes a major public health burden worldwide, especially in low-income countries like Mozambique. Implementing Screening, Brief Intervention, Referral to Treatment (SBIRT) to address problem drinking is recommended; evidence regarding the best strategies to implement SBIRT at scale are needed. METHODS: Guided by the Reach Effectiveness Adoption Implementation Maintenance model, we will conduct a two-year, cluster-randomized, hybrid type 2 implementation-effectiveness trial in 12 districts in Mozambique evaluating implementation (reach, adoption, fidelity, and maintenance), clinical effectiveness (symptoms, functioining, co-morbidities) outcomes, and cost (ClinicalTrials.Gov: NCT03610815). Eight districts will be randomized to an application-based, mobile SBIRT condition and four to SBIRT Conventional Training and Supervision. Study arms will be delivered by clinic-based community health workers. The Consolidated Framework for Implementation Research will guide our mixed-methods assessments throughout the study. RESULTS: The arm showing the better cost-effectiveness, will be scaled up in the other arms’ districts. During this 12-month scale-up phase, Ministry of Health personnel will be charged with trainings, clinical activities, and supervision in all 12 districts without research team support. The scale-up phase is critical to identify real-world facilitators and barriers tracking internal and external factors in clinics that continue using the superior arm and those that switch to that condition. NEXT STEPS: Working in a multi-step process with stakeholders from multiple sectors, outcomes and lessons learned from our study will inform development of an implementation tool-kit to guide scaling-up SBIRT for community hazardous drinking services to other low-and middle-income countries and low resource settings in high income countries.

Objectives: To explore the acceptability of a novel, outreached‐based approach to improve primary and primordial prevention of Strep A skin sores, sore throats and acute rheumatic fever in remote Aboriginal communities. Methods: A comprehensive prevention program delivered by trained Aboriginal Community Workers was evaluated using approximately fortnightly household surveys about health and housing and clinical records. Results: Twenty‐seven primary participants from three remote Aboriginal communities in the Northern Territory consented, providing 37.8 years of retrospective baseline data and 18.5 years of prospective data during the study period. Household members were considered to be secondary participants. Five Aboriginal Community Workers were trained and employed, delivering a range of supports to households affected by acute rheumatic fever including environmental health support and education. Clinical record audit and household self‐report of Strep A infections were compared. No association between clinical‐ and self‐report was identified. Conclusions: Ongoing participation suggests this outreach‐based prevention program was acceptable and associated with improved reporting of household maintenance issues and awareness of prevention opportunities for Strep A infections. Implications for public health: Biomedical, clinic‐based approaches to the management of Strep A infections in remote communities can be usefully augmented by outreach‐based supports delivered by Aboriginal Community Workers responding to community needs.

Introduction Community Health Worker (CHW) programs have long been used to provide acute care for children and women in healthcare shortage areas, but their provision of comprehensive longitudinal care for chronic problems is rare. The Village Health Worker (VHW) program, initiated in 2007, is an example of a long standing “horizontal” CHW program in rural Southwestern Uganda that has delivered village-level care for chronic disease based on a biannual village health census that identifies individual and family health risks. To facilitate continuity of care for problems identified, health census data were electronically transformed into family-specific Family Health Sheets (FHS) in 2016 which summarize the pertinent demographic and health data for each family, as well as health topics the family would like to learn more about. The FHS, evaluated and discussed here, serves as an epidemiologically-informed “bedside” tool to help VHWs provide longitudinal care in their villages. Methods 48 VHWs in the program completed a survey on the utility of the FHS and 24 VHWs participated in small discussion groups. Responses were analyzed using both quantitative and standard conceptual content analysis models Results 46 out of 48 VHWs reported that the FHS made them a “much better VHW.” In addition to helping target interventions in child health, women’s health, and sanitation, the FHS assisted follow-up of non-communicable diseases in the community. In discussion groups, VHWs reported that the FHS helped them understand risks for future disease, facilitated earning stipends, and increased credibility and trust in the community. Limitations cited were the infrequent updates of the FHS, only biannually with the census, and the lack of cross-reference capability by health problem. Discussion The FHS supports VHWs in providing longitudinal and comprehensive healthcare of chronic diseases in their villages. Limitations, potential solutions, and future directions are discussed.

An effective approach to engaging populations who face health care access barriers is support from community health workers (CHWs). There is little research, however, on specific barriers and facilitators related to two key areas of CHW practice: outreach, defined as the ability to make any initial contact with the priority population, and engagement, defined as the ability to continue to work with the priority population after initial contact is made. The current qualitative study is ancillary to a randomized evaluation of a CHW-led program for Medicaid Health Plan enrollees. Implementation experiences with outreach and engagement led the evaluators to develop the current study in which health plan and nonhealth plan CHWs (n = 12) serving low-income, predominantly Black populations in Detroit participated in qualitative semistructured interviews to elucidate barriers and facilitators to outreach and engagement. All audio recordings were transcribed verbatim. The study team used inductive qualitative data analysis techniques. Barriers to outreach included inaccurate contact information and mistrust. Barriers to engagement included lack of ability to provide needed resources, leading to hopelessness and diminished trust, and discontinuity of services due to eligibility changes and terminated programs. Facilitators included adapting outreach schedules and strategies to community needs, availability of resources, and relational strategies that leveraged CHW social proximity. Further research should systematically investigate the relative success of different CHW-led outreach and engagement strategies for specific populations so as to better design and implement CHW programs.

Background. Inappropriate anthropometric measurements of infants and toddlers lead to a misclassification in nutritional status and loss of important interventions. Considering the practice conducted in this program within a country, its impact on millions of children must be considered. This study assesses the ability of community health volunteers (CHVs) before and after anthropometric training on infants and toddlers. Methods. This study used a quantitative approach with a quasiexperimental and pretest-posttest design. The pre- and posttraining assessments of CHVs were conducted by standardized trainers using instruments developed according to WHO standards. There were 11 and 13 statement items for infants’ and toddlers’ indicators of assessment in anthropometric measurements, respectively. The result of the assessment was then analyzed using Rasch modeling with stacking and racking data analysis techniques. Results. The CHVs’ skills before training were far from adequate. Although widely varied, all trainees improved their abilities. Stacking analysis showed that the skills of all CHVs in measuring infants and toddlers increased by 2.68 and 3.34 logits ( p < 0.01 ), respectively. Racking analysis showed a decrease in the perceived difficulty of all items by 2.61 and 3.07 logits for infant and toddler measurements, respectively ( p < 0.01 ). The results of the racking analysis showed that the difficulty in measuring the anthropometrics of infants decreased more than that of toddlers. Conclusions. CHVs’ capacity to monitor child growth must be refreshed regularly. Standardized and proper training and assessment were developed to make CHVs reliable in taking anthropometric measurements of infants and toddlers.

Introduction Strategies are needed to increase implementation of evidence-based tobacco dependence treatment (TDT) in health care systems in low-and middle-income countries (LMICs). Aims and Methods We conducted a two-arm cluster randomized controlled trial to compare the effectiveness of two strategies for implementing TDT guidelines in community health centers (n = 26) in Vietnam. Arm 1 included training and a tool kit (eg, reminder system) to promote and support delivery of the 4As (Ask about tobacco use, Advise to quit, Assess readiness, Assist with brief counseling) (Arm 1). Arm 2 included Arm 1 components plus a system to refer smokers to a community health worker (CHW) for more intensive counseling (4As + R). Provider surveys were conducted at baseline, 6 months, and 12 months to assess the hypothesized effect of the strategies on provider and organizational-level factors. The primary outcome was provider adoption of the 4As. Results Adoption of the 4As increased significantly across both study arms (all p < .001). Perceived organizational priority for TDT, compatibility with current workflow, and provider attitudes, norms, and self-efficacy related to TDT also improved significantly across both arms. In Arm 2 sites, 41% of smokers were referred to a CHW for additional counseling. Conclusions The study demonstrated the effectiveness of a multicomponent and multilevel strategy (ie, provider and system) for implementing evidence-based TDT in the Vietnam public health system. Combining provider-delivered brief counseling with opportunities for more in-depth counseling offered by a trained CHW may optimize outcomes and offers a potentially scalable model for increasing access to TDT in health care systems like Vietnam. Implications Improving implementation of evidence-based TDT guidelines is a necessary step toward reducing the growing burden of noncommunicable diseases and premature death in LMICs. The findings provide new evidence on the effectiveness of multilevel strategies for adapting and implementing TDT into routine care in Vietnam and offer a potentially scalable model for meeting Framework Convention on Tobacco Control Article 14 goals in other LMICs with comparable public health systems. The study also demonstrates that combining provider-delivered brief counseling with referral to a CHW for more in-depth counseling and support can optimize access to evidence-based treatment for tobacco use. Clinical trials number: NCT01967654.

Introduction: Community health workers (CHW) or volunteers are health workers who are trained but do not possess a professional certificate. They are community members who live and work in that particular community. The Ministry of Health Malaysia had initiated a community-based intervention programme, Healthy Community Empowers the Nation or ‘Komuniti Sihat Pembina Negara’ (KOSPEN) in October 2013. In this programme, CHWs main task is to conduct non-communicable diseases (NCD) risk factor screening. Methods: Data from the “Evaluation of the implementation of KOSPEN programme in Malaysia 2016” was used. It is a cross-sectional study which was carried out in randomly selected KOSPEN localities throughout Malaysia. Logistic regression analysis was applied to determine factors associated with not performing KOSPEN screening activities by the volunteers. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 20. Results: A total of 700 volunteers were included in this study. Most of the volunteers were female (65.7%) and were aged 50-59 years (30.9%), followed by those aged 40-49 (27.1%). Majority had secondary education (65.3%), employed (55.7%.) and were married (80.4%). Multivariate logistic regression showed that volunteers who never attended training (aOR 2.79; 95% CI:1.66, 4.67) and who felt the content of the training module was inadequate (aOR 2.693; 95% CI: 1.46, 4.98) were more likely to not perform screening activities in the community. Conclusion: Attendance of the training should be a pre-requisite to qualify as a volunteer. Improvement to the training module should done to increase comprehensibility of the modules among the volunteers. Keywords: KOSPEN-community health workers-NCD screening-community-based intervention Word count (249)

We propose a randomized controlled trial to evaluate the effectiveness of a community health worker-led decision-coaching program to facilitate shared decision-making for prostate cancer screening decisions by Black men at a primary care federally qualified health center.

Since 2009, a community-based, collaborative exemplar in Richmond, Virginia, involving 8 satellite clinics of the state health department, has been implemented within public housing units to focus on prevention and access to care. These satellite centers, known a resource center (RCs), are staffed by public health nurses, community health workers, and nurse practitioners working in complementary roles. The RCs have provided education to 2609 clients on family planning, safe sex practices, safe car seat use, and screening for sexually transmitted infections and have made 9591 patient referrals to health, social, and community services.

Introduction: Kenya adopted the World Health Organization’s recommendation of community case management of malaria (CCMM) in 2012. Trained community health volunteers (CHVs) provide CCMM but information on quality of services is limited. This study aimed to establish determinants of quality of service of CCMM conducted by CHVs. Methodology: A cross-sectional survey was conducted in November 2016 in Bungoma County, Kenya. Data were collected through observing CHVs perform routine CCMM and through interviews of CHVs using structured questionnaires. A ≥ 75% score was considered as quality provision. Descriptive statistics were performed to describe basic characteristics of the study, followed by Chi-Square test and binary logistic regression to examine the differences and associations between the categorical variables. Results: A total of 147 CHVs participated; 62% of CHVs offered quality services. There was a direct association between quality of services and stock-outs of artemether-lumefantrine (AL), stock-outs of malaria rapid diagnostic tests (RDT) and support supervision. CHVs who were supervised during the year preceding the assessment were four times more likely to perform better than those not supervised (uOR 4.2, 95% CI: 1.38-12.85). CHVs with reliable supplies of AL and RDT kits performed three times better than those who experienced stock outs (uOR = 3.2, 95% CI: 1.03-10.03 and 3.3, 95% CI: 1.63-6.59 respectively). Biosafety and documentation were the most poorly performed. Conclusions: The majority of CHVs offered quality CCMM services despite safety gaps. Safety, continuous supplies of RDT, AL and supervision are essential for quality performance by CHV in delivering CCMM.

Addressing Latino childhood obesity requires effective health promotion programs and culturally resonant health professionals. The current profiles of public health professionals and registered dietitians point to the need to increase the number of Latino students trained in community-based participatory research and engagement of underserved populations. To address this workforce gap, the Center for Latino Community Health, Evaluation, and Leadership Training developed the Sanos y Fuertes: Healthy & Strong Graduate Research Fellowship to provide Latino graduate students with research training, professional development, and mentorship. Five cohorts of seven graduate students participated in a yearlong experiential learning program. Graduate research fellows received monthly research and professional development training from faculty, staff, and community health workers. Furthermore, fellows engaged in mentored research through the development and implementation of a Latino childhood obesity prevention curriculum and intervention. A mixed-method evaluation approach was used to assess the effectiveness of the program. Fellows completed baseline, posttraining, and follow-up assessments. Assessment surveys measured training experiences (e.g., research methods, community engagement), confidence (e.g., research methods, health education), and knowledge and skills (e.g., community health program skills). The training resulted in significant increases in skills and confidence between pre- and postassessments that were sustained at follow-up. Based on these findings, we recommend that student training programs include research as experiential learning with multidisciplinary, interprofessional teams and that community-based, community-engaged, or translational research teams include community health workers as integral members for research with marginalized, underserved populations.

BACKGROUND Sepsis is a leading cause of neonatal mortality globally. The home-based neonatal care (HBNC) field trial (1995-1998) in rural Gadchiroli demonstrated a reduction in the incidence of neonatal sepsis. The current study examines the trend of neonatal sepsis during the twenty-one years (1998-2019) following the trial's completion. METHODS We conducted a retrospective cohort study based on the HBNC program data in rural Gadchiroli, India, from April 1998 to March 2019. All live-born neonates who spent all or part of the neonatal period in the 39 study villages and received HBNC were eligible for inclusion. Sepsis was diagnosed during regular home visits by trained village health workers if pre-specified clinical criteria were present. Sepsis incidence was computed for seven 3-year periods. Trend analyses were conducted using the Mann-Kendall test. RESULTS Of the total 17,289 live births, 16,339 (94.5%) home visited were included. In this cohort, 1069 (65 per 1000 live births) neonates were diagnosed with sepsis. The incidence of neonatal sepsis declined from 111 per 1000 live births in 1998 to 2001 to 19 per 1000 live births in 2016 to 2019, an 82.9% decrease (P < 0.0001), mean 4% decrease per year. The incidence of neonatal sepsis declined for early-onset sepsis (P < 0.0001), late-onset sepsis (P < 0.0001), home births (P = 0.006), facility births (P < 0.0001), preterm neonates (P < 0.0001) and full-term neonates (P < 0.0001). CONCLUSIONS The incidence of neonatal sepsis in rural Gadchiroli has continued to decline during the past twenty-one years. We hypothesize that the decline is due to the ongoing practice of HBNC, improved socioeconomic conditions, and new governmental health policies.

Introduction South Asian women in Hong Kong have low cervical cancer screening uptake because of multiple barriers to utilizing health resources. Interventions that effectively modify the cancer screening behaviors of this population are warranted. This study evaluates the effects of a community health worker–led multicomponent intervention on improving cervical cancer screening uptake among South Asian women in Hong Kong. Study Design This study was an assessor-blind, cluster RCT that included a waitlist control group. Setting/participants Recruitment of eligible subjects took place in 6 nongovernmental organizations; these organizations were randomized into intervention and control groups with a 1:1 allocation ratio. Intervention Participants in the intervention group received a 3-month multicomponent intervention comprising health education, monthly telephone follow-ups, and navigation assistance. Main outcome measures Participants’ cervical cancer screening utilization and beliefs were assessed at baseline, after intervention, and 3 months after intervention. A longitudinal outcome comparison between the 2 groups was performed with generalized estimating equation analysis. Data were collected between September 2018 and January 2020 and were analyzed in 2019–2020. Results A total of 387 participants completed the intervention. A significantly higher cervical cancer screening uptake was observed among participants in the intervention group (97.9%, 191 of 195) than among participants in the control group (52.6%, 101 of 192) at 3 months after intervention (p=0.005). Significantly greater decrements in perceived barriers to cervical cancer screening were found in the intervention group after intervention (−0.68, 95% CI= −1.35, −0.01, p=0.047) and 3 months after intervention (−0.86, 95% CI= −1.69, −0.04, p=0.041). Conclusions A community health worker–led multicomponent intervention is effective in promoting cervical cancer screening uptake and in reducing barriers to cancer screening utilization among South Asian women in Hong Kong. Combining a community health worker–led intervention with multiple intervention components could be an effective strategy for developing interventions to increase cervical cancer screening in underserved populations. Trial registration This study was registered at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn ) ChiCTR1800017227 on July 18, 2018.

Background In recent years, there has been greater recognition of the important role of community health volunteers in many countries and their important role informs many health programs. This include health education, provision of services such as screening, monitoring and referral to health facilities. Their roles are better understood in the areas of communicable diseases like HIV infection, Tuberculosis and Malaria however little is known about their role in non-communicable diseases. This study seeks to explore perception of CHVs’ functions, tasks, and their fulfilment in identifying people with elevated blood pressure for diagnosis and monitoring of hypertension in Lilongwe, Malawi. Methods This was a qualitative naturalistic research design utilizing observation and semi-structured interviews with community health volunteers working in Lilongwe, Malawi. Interviews were carried out with the researcher. Participants were recruited from the ZaMaC project. An interview guide was developed with a category-guided deductive approach. The interviews were recorded through note taking. Data analysis was performed using content analysis approach. Results Community health volunteers have multiple roles in prevention and monitoring of hypertension. They act as health educators and provide lifestyle counselling. They screened for hypertension and monitored blood pressure and assisted community members to navigate the health system such as linkage to health facilities. These roles were shaped in response to community needs. Conclusion This study indicates the complexities of the roles of community health volunteer in identifying people with elevated BP for diagnosis and monitoring of hypertension. Understanding community health volunteers’ roles provides insight into their required competencies in provision of their daily activities as well as required training to fill in their knowledge gaps.

Background Chronic care management (CCM) and community health worker (CHW) interventions hold promise for managing complex chronic conditions such as diabetes and related comorbidities. This qualitative study examines facilitators and barriers to the implementation of an expanded CCM intervention that explicitly incorporated program staff, clinic staff, CHWs, and partnerships with community-based organizations to enhance diabetes management among Mexican-origin adults. Method Grounded theory was used to analyze interviews conducted in 2018 with 24 members of the CCM team, including program staff, clinic staff, and community-based program partner staff. Results Three themes emerged that characterize perceived facilitators and barriers to CCM implementation, based on analysis of interviews: (1) understanding roles and responsibilities across organizations, (2) building relationships across organizations, and (3) coordinating delivery of the model among different organizations. First, structured meetings and colocated workspaces enhanced understanding of CCM roles for each team member and across organizations. Barriers to understanding CCM roles were more common during the early stages of CCM implementation and amongst staff who did not participate in regular meetings. Second, regular meetings facilitated development of relationships across organizations to enhance implementation of the CCM model. In contrast, limited relationship building among some CCM team members served as a barrier to implementation. Third, CHWs and case review meetings fostered communication and coordination across the CCM model. Conclusions Results suggest the importance of understanding roles and building relationships among multidisciplinary teams to ensure effective communication and coordination of care.

Introdução: A ocorrência de quedas em pessoas idosas é considerada um problema de saúde pública, acarretando em prejuízos para a saúde, mas que pode ser prevenida a partir da manutenção de um ambiente seguro. Objetivo: Identificar condições relacionadas a ocorrência de quedas e segurança do ambiente domiciliar de pessoas idosas residentes na zona rural de um município do interior do Estado do RN. Metodologia: Foi realizada uma pesquisa-ação com uma das etapas de diagnóstico feito a partir de um estudo analítico e observacional. O estudo foi realizado com agentes comunitários de saúde (ACS) e idosos. Foram realizadas capacitações com os ACS para reconhecimento e identificação dos riscos ambientais de quedas nos domicílios dos idosos. Para coleta de dados, utilizou-se o questionário de avaliação ambiental e quedas da Caderneta de Saúde da Pessoa Idosa. Resultados: Participaram do estudo 288 idosos, dos quais 24,7% relataram ter sofrido queda e desses, 23,9% tiveram fratura óssea. 47,9% das quedas ocorreram dentro de casa, destas 42,2% ocorreram no banheiro. A maioria dos itens de segurança não estava adequado. 53,5% relataram impedimento nas áreas de locomoção, 55,6% não tinham pisos uniformes e tapetes fixos, apenas 27,1% tinham tapete antiderrapante na área do chuveiro, 14,6% afirmaram possuir escada no domicílio, porém, nenhuma apresentava corrimão dos dois lados e firmes e/ou piso antiderrapante. Foram encontradas diferenças significativas entre a ocorrência de queda e a ausência de pisos uniformes e tapetes bem fixos (p

Background/Objectives To identify major barriers to video‐based telehealth use among homebound older adults. Design Cross‐sectional survey. Setting A large home‐based primary care (HBPC) program in New York City (NYC) serving 873 homebound patients living in the community. Participants Sixteen primary care physicians. Measurements An 11‐item assessment of provider perceptions of patients' experience with and barriers to telehealth. Results According to physicians in the HBPC program, more than one‐third (35%) of homebound patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first‐time video‐based telehealth encounters between April and June 2020 during the first COVID‐19 surge in NYC. The majority (82%) required assistance from a family member and/or paid caregiver to complete the visit. Among patients who had not used telehealth, providers deemed 27% (n = 153) “unable to interact over video” for reasons including cognitive or sensory impairment and 14% lacked access to a caregiver to assist them with technology. Physicians were not knowledgeable of their patients' internet connectivity, ability to pay for cellular plans, or video‐capable device access. Conclusion The COVID‐19 pandemic resulted in a large and dramatic shift to video‐based telehealth use in home‐based primary care. However, 4 months into the pandemic a majority of patients had not participated in a video‐based telehealth encounter due to a number of barriers. Patients lacking caregiver support to assist with technology may benefit from novel approaches such as the deployment of community health workers to assist with device setup. Physicians may not be able to identify potentially modifiable barriers to telehealth use among their patients, highlighting the need for better systematic data collection before targeted interventions to increase video‐based telehealth use.

According to the World Health Organization, discrepancies in health statistics reflect unequal access to resources. The Truth and Reconciliation Commission of Canada calls for an increase in the number of Indigenous workers within health and social services. The involvement of local community workers is essential to ensure the cultural security of care and the decolonization of services. This article presents the role played by these workers in the expansion of mental health services and social interventions in Nunavik, the contextual considerations that influence their practice and their place within professional teams.A thematic analysis was conducted on semi-structured interviews done in 2016 with 60 Inuit and non-Inuit individuals working in the broad field of health and social services in Nunavik.The integration of local community workers is perceived to bring several benefits, including the improvement of interventions and unique learning opportunities. However, several factors hinder this collaboration, such as clarity of mandates, access to pre-requisite training and diplomas, recognition of local knowledge, and staff turnover. More flexibility and support after hiring would allow for the service structure to be adapted to the complex reality of Nunavik.This article adds to the body of literature highlighting the importance of collaboration with local community workers. The decolonization of services necessarily involves redesigning structures in order to recognize their contribution and to give a place to local knowledge.RéSUMé: OBJECTIFS: Selon l’Organisation mondiale de la santé, les écarts dans les statistiques de santé reflètent un accès inégal aux ressources. La Commission de vérité et de réconciliation du Canada appelle à l’accroissement du nombre de travailleurs autochtones dans le domaine des soins de santé et services sociaux. L’implication des travailleurs communautaires locaux est essentielle à la sécurisation culturelle des soins et la décolonisation des services. Cet article décrit le rôle de ces travailleurs dans l’extension des services de santé mentale et des interventions sociales au Nunavik et explore les considérations contextuelles qui influencent leur pratique et leur place au sein des équipes professionnelles. MéTHODE: Les résultats ont été obtenus par l’entremise d’une analyse thématique d’entrevues semi-structurées effectuées en 2016 auprès de 60 individus inuit et non-inuit travaillant dans le système de la santé et des services sociaux au Nunavik. RéSULTATS: L’intégration des travailleurs communautaires locaux est perçue comme apportant plusieurs bénéfices, notamment une amélioration des interventions. Cependant, plusieurs facteurs entravent cette collaboration tels que la clarté dans les mandats, l’accès aux formations et diplômes pré-requis, la reconnaissance du savoir local ainsi que le roulement de personnel. Plus de flexibilité et de soutien après l’embauche permettrait d’adapter la structure des services à la réalité complexe du Nunavik. CONCLUSION: Cet article s’ajoute au corpus de littérature qui met de l’avant l’importance de la collaboration avec les travailleurs locaux. La décolonisation des services passe nécessairement par le remaniement des structures afin de reconnaitre l’apport des travailleurs locaux.

Background and Objectives The high prevalence of overweight or obesity in older adults is a public health concern because obesity affects health, including the risk of mobility disability. Research Design and Methods The Mobility and Vitality Lifestyle Program, delivered by community health workers (CHWs), enrolled 303 community-dwelling adults to assess the impact of a 32-session behavioral weight management intervention. Participants completed the program at 26 sites led by 22 CHWs. Participation was limited to people aged 60–75 who had a body mass index (BMI) of 27–45 kg/m2. The primary outcome was the performance on the Short Physical Performance Battery (SPPB) over 12 months. Results Participants were aged 67.7 (SD 4.1) and mostly female (87%); 22.7% were racial minorities. The mean (SD) BMI at baseline was 34.7 (4.7). Participants attended a median of 24 of 32 sessions; 240 (80.3%) completed the 9- or 13-month outcome assessment. Median weight loss in the sample was 5% of baseline body weight. SPPB total scores improved by +0.31 units (p < .006), gait speed by +0.04 m/s (p < .0001), and time to complete chair stands by −0.95 s (p < .0001). Weight loss of at least 5% was associated with a gain of +0.73 in SPPB scores. Increases in activity (by self-report or device) were not independently associated with SPPB outcomes but did reduce the effect of weight loss. Discussion and Implications Promoting weight management in a community group setting may be an effective strategy for reducing the risk of disability in older adults.

Objective African American older adults living in disadvantaged communities are disproportionately burdened by disabling pain. To address their needs, we tested the feasibility and potential effects of a cognitive-behavioral chronic pain self-management program delivered by community health workers. Design A single-group, pre-post evaluation of the STEPS-2 (Seniors using Technology to Engage in Pain Self-management) intervention, in which participants learned pain-management skills through web-based videos. They were also given wearable activity trackers to facilitate incremental increases in walking. In weekly telephone calls, community health workers helped participants apply skills and set goals. Subjects/setting Thirty-one adults in Detroit, Michigan (97% African American, 97% female, mean 68.7 years), with chronic musculoskeletal pain. Methods Participants completed telephone surveys at baseline and eight weeks. We measured changes in PROMIS pain interference and pain intensity, as well as Patient Global Impression of Change in pain and functioning. Feasibility indicators included participant engagement and satisfaction, and fidelity to session protocols by community health workers. Results Participants on average completed 6.6/7 sessions, and 100% agreed or strongly agreed that they improved their understanding of pain management. Average community health worker fidelity score was 1.79 (0 to 2 scale). Pain interference decreased from baseline to post-program (T-score 61.6 to 57.3, P=.000), as did pain intensity (0 to 10 scale, 6.3 to 5.1, P=.004). Approximately 90% of participants reported that pain and function were at least “a little better” since baseline. Conclusions An intervention combining mobile health tools with support from community health workers holds promise for improving pain outcomes among underserved older adults.

The current increase in global dementia prevalence deserves public health intervention. While limited access to health care and a shortage of health care workers are significant shortcomings, utilizing community health workers (CHWs) could be a promising way to improve dementia care through cost-effective approaches. This scoping review synthesizes existing research on roles of CHWs in dementia-related services. PubMed, CINAHL, Scopus, CABI Global Health, Web of Science, PsycINFO, and Cochrane Library were searched from inception to October 2, 2019, and yielded 1,594 articles. Five broad areas emerged as potential roles of CHWs from 10 eligible articles: educational and community awareness, screening for dementia, screening for HIV-associated dementia, utilization of health care systems and other dementia-related resources by patients, and services to dementia caregivers. This scoping review sheds light on important contributions of CHWs in addressing dementia among vulnerable communities/groups around the world.

BACKGROUND/OBJECTIVES The number of older adults with complex health needs is growing, and this population experiences disproportionate morbidity and mortality. Interventions led by community health workers (CHWs) can improve clinical outcomes in the general adult population with multimorbidity, but few studies have investigated CHW-delivered interventions in older adults. DESIGN We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs. We searched for English-language articles from database inception through April 2020 using seven databases. PROSPERO protocol registration CRD42019118761. SETTING Any U.S. or international setting, including clinical and community-based settings. PARTICIPANTS Adults aged 60 years or older with complex health needs, defined in this review as multimorbidity, frailty, disability, or high-utilization. INTERVENTIONS Interventions led by a CHW or similar role consistent with the American Public Health Association's definition of CHWs. MEASUREMENTS Pre-defined health outcomes (chronic disease measures, general health measures, treatment adherence, quality of life, or functional measures) as well as qualitative findings. RESULTS Of 5671 unique records, nine studies met eligibility criteria, including four randomized controlled trials, three quasi-experimental studies, and two qualitative studies. Target population and intervention characteristics were variable, and studies were generally of low-to-moderate methodological quality. Outcomes included mood, functional status and disability, social support, well-being and quality of life, medication knowledge, and certain health conditions (e.g., falls, cognition). Results were mixed with several studies demonstrating significant effects on mood and function, including one high-quality RCT, while others noted no significant intervention effects on outcomes. CONCLUSION CHW-led interventions may have benefit for older adults with complex health needs, but additional high-quality studies are needed to definitively determine the effectiveness of CHW interventions in this population. Integration of CHWs into geriatric clinical settings may be a strategy to deliver evidence-based interventions and improve clinical outcomes in complex older adults.

PurposeThis study aimed to analyze the role of community health workers (CHWs) called accredited social health activists (ASHAs) in improving maternal health outcomes in the rural community of Punjab, India. The study also examined the expectations of these workers from the community and identified the problems faced by them in carrying out their roles.Design/methodology/approachUsing multistage sampling, a total of 28 villages were selected from seven districts of Punjab, and from these selected villages, a total of 57 ASHAs working as the interface between the rural community and the public health system and 420 women who had delivered a baby were interviewed.FindingsDesire to earn money was the most prominent reason for joining the community work program, but ASHAs felt overburdened and underpaid compared to their work commitments. Not only was the incentive paid to these workers was insufficient and irregular but they also suffered at the hands of medical staff at public hospitals.Originality/valueWhile exploring the problems experienced by the CHWs, this study recommends opting for a mix of monetary and nonmonetary incentives for acknowledging the work of CHWs. The study is the first of its kind for the state of Punjab battling with a worsening maternal mortality rate (MMR).

Nepalese Female Community Health Volunteers' (FCHVs) knowledge on social attention and communication development and the early signs of autism was evaluated before, immediately after, and 12-months following training on typical and atypical social-communicative development in infants/toddlers, early signs of autism, and monitoring of key "markers" of autism using Social Attention and Communication Surveillance. FCHVs (N = 60) significantly improved their knowledge about autism and reported increased perceived confidence in monitoring and referring young children at high likelihood of autism following training, which was sustained one year later. FCHVs also reported a positive impact of training on their work. These findings indicate the effectiveness of training in improving FCHVs' knowledge and perceived confidence to monitor and refer young children at high likelihood of autism.

BACKGROUND: This review was carried out to synthesize the evidence of the effectiveness of community health worker (CHW) navigation in primary care chronic disease management. METHODS: We searched the English language literature between January 1990 and March 2020 in Medline, Embase, Emcare, PubMed, Psych Info, CINAHL, Scopus, and Medline Epub ahead of print. Data extraction, quality rating, and assessment of the reporting of interventions were performed by two reviewers independently and the findings were synthesized narratively. RESULTS: Twenty-nine articles met the inclusion criteria. All but two were carried out in the USA and half were randomized controlled trials. Six of the 29 studies were of strong methodological quality while 12 were moderate and 11 weak. Overall, CHW navigation interventions were effective in increasing adherence to cancer screening and improving use of primary care for chronic disease management. There was insufficient evidence that they improved clinical outcomes or risk factors and reduced use of secondary or tertiary care or that they were cost-effective. However, criteria for recruitment, duration, and mode of training and supervision arrangements varied greatly between studies. DISCUSSION: CHW navigation interventions improved aspects of chronic disease management. However, there is insufficient evidence of the impact on patient experience, clinical outcomes, or cost-effectiveness of the interventions. Future research should focus on standardizing organizational components of the CHW navigation interventions and evaluating their cost-effectiveness. PROTOCOL REGISTRATION: The review protocol was published in PROSPERO (CRD42020153921). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-021-06667-y.

To control the increasing spread of coronavirus disease 2019 (COVID-19), the government of Thailand enforced the closure of public and business areas in Bangkok on 22 March 2020. As a result, large numbers of unemployed workers returned to their hometowns during April 2020, increasing the risk of spreading the virus across the entire country.In anticipation of the large-scale movement of unemployed workers, the Thai government trained existing village health volunteers to recognize the symptoms of COVID-19 and educate members of their communities. Provincial health offices assembled COVID-19 surveillance teams of these volunteers to identify returnees from high-risk areas, encourage self-quarantine for 14 days, and monitor and report the development of any relevant symptoms.Despite a significant and recent expansion of the health-care workforce to meet sustainable development goal targets, there still exists a shortage of professional health personnel in rural areas of Thailand. To compensate for this, the primary health-care system includes trained village health volunteers who provide basic health care to their communities.Village health volunteers visited more than 14 million households during March and April 2020. Volunteers identified and monitored 809 911 returnees, and referred a total of 3346 symptomatic patients to hospitals by 13 July 2020.The timely mobilization of Thailand's trusted village health volunteers, educated and experienced in infectious disease surveillance, enabled the robust response of the country to the COVID-19 pandemic. The virus was initially contained without the use of a costly country-wide lockdown or widespread testing.Pour lutter contre la propagation croissante de la maladie à coronavirus (COVID-19), le gouvernement de Thaïlande a ordonné la fermeture des espaces publics et commerciaux à Bangkok le 22 mars 2020. Par conséquent, de nombreux travailleurs au chômage sont retournés dans leurs contrées natales au cours du mois d'avril 2020, augmentant le risque de dissémination du virus dans l'ensemble du pays.En prévision de ces vastes mouvements de travailleurs au chômage, le gouvernement thaïlandais a formé des volontaires de la santé déjà présents dans les villages afin qu'ils puissent détecter les symptômes de la COVID-19 et sensibiliser les membres de leur communauté. Les bureaux provinciaux de la santé ont constitué des équipes de surveillance de la COVID-19 composées de ces volontaires en vue d'identifier les personnes revenant des zones à haut risque, d'encourager le respect d'une quarantaine spontanée de 14 jours, mais aussi de contrôler et signaler l'apparition de tout symptôme suspect.Malgré un renforcement récent du contingent de soignants dans le but de répondre aux objectifs de développement durable, la pénurie de professionnels de santé subsiste dans les régions rurales de la Thaïlande. Pour y remédier, le système de soins de santé primaires fait appel à des volontaires spécialement formés dans les villages, qui prodiguent des soins de base aux membres de leur communauté.Les volontaires de santé dans les villages ont rendu visite à plus de 14 millions de foyers en mars et avril 2020. Ils ont identifié et suivi 809 911 rapatriés et orienté un total de 3346 patients symptomatiques vers les hôpitaux au 13 juillet 2020.La mobilisation rapide de volontaires de santé fiables dans les villages thaïlandais, formés et habitués à surveiller les maladies infectieuses, a permis au pays de réagir avec fermeté à la pandémie de COVID-19. Dans un premier temps, la Thaïlande a pu maîtriser le virus sans imposer un confinement coûteux sur tout le territoire ni recourir à une campagne de dépistage à grande échelle.Para controlar la creciente propagación de la enfermedad por coronavirus (COVID-19), el gobierno de Tailandia impuso el cierre de las zonas públicas y comerciales de Bangkok el 22 de marzo de 2020. Como resultado, un gran número de trabajadores desempleados regresaron a sus ciudades de origen durante abril de 2020, lo que aumentó el riesgo de propagación del virus en todo el país.En previsión del movimiento a gran escala de trabajadores desempleados, el gobierno tailandés formó a los voluntarios sanitarios de las aldeas existentes para que reconocieran los síntomas de la COVID-19 y educaran a los miembros de sus comunidades. Las oficinas provinciales de salud formaron equipos de control de la COVID-19 con estos voluntarios para identificar a los que regresaban de las zonas de alto riesgo, fomentar la autocuarentena durante 14 días y controlar e informar sobre la aparición de cualquier síntoma relevante.A pesar de la importante y reciente ampliación del personal sanitario para alcanzar las metas de los objetivos de desarrollo sostenible, sigue habiendo escasez de personal sanitario profesional en las zonas rurales de Tailandia. Para compensar esta carencia, el sistema de atención primaria de salud incluye voluntarios sanitarios formados en las aldeas que prestan atención sanitaria básica a sus comunidades.Los voluntarios sanitarios de las aldeas visitaron más de 14 millones de hogares durante marzo y abril de 2020. Los voluntarios identificaron y controlaron a 809.911 repatriados, y remitieron a los hospitales a un total de 3.346 pacientes sintomáticos hasta el 13 de julio de 2020.La oportuna movilización de los voluntarios sanitarios de confianza de las aldeas tailandesas, formados y con experiencia en el control de enfermedades infecciosas, permitió la sólida respuesta del país a la pandemia de la COVID-19. En un principio, el virus se contuvo sin necesidad de recurrir a un costoso bloqueo en todo el país ni a pruebas generalizadas.المشكلة للتحكم في التفشي المتزايد للمرض الناتج عن فيروس كورونا (كوفيد 19) فرضت حكومة تايلند إغلاق الأماكن العامة وأماكن الأعمال التجارية في بانكوك يوم 22 مارس/آذار 2020. كانت نتيجة ذلك أن عادت أعداد كبيرة من العاطلين عن العمل إلى بلداتهم الأصلية خلال شهر أبريل/نيسان 2020، مما رفع خطر انتشار الفيروس على مستوى البلد بأكملها. الأسلوب بناء على توقع حكومة تايلند للانتقال واسع النطاق للعاطلين عن العمل، أجرت الحكومة تدريبًا للمتطوعين الصحيين القرويين الموجودين للتعرف على أعراض كوفيد 19 وتوعية أفراد مجتمعاتهم. أنشأت مكاتب الصحة الإقليمية فرقًا رقابية لمرض كوفيد 19 من هؤلاء المتطوعين لتتعرف على العائدين من المناطق عالية الخطر وتشجع على العزل الذاتي لمدة 14 يومًا وتراقب ظهور أي أعراض ذات صلة وتبلغ بالتطورات. المواقع المحلية على الرغم من التوسع الكبير مؤخرًا في القوى العاملة في مجال الرعاية الصحية لتحقيق أهداف التنمية المستدامة، ما زال هناك نقص في الأخصائيين الصحيين المحترفين في المناطق الريفية في تايلند. لتعويض هذا النقص، يتضمن نظام الرعاية الصحية الأساسية متطوعين صحيين قرويين مدربين يقدمون الرعاية الصحية الأساسية لمجتمعاتهم. التغيّرات ذات الصلة قام المتطوعون الصحيون القرويون بزيارات لأكثر من 14 مليون منزل خلال شهري مارس/آذار وأبريل/نيسان 2020. حدد المتطوعون 809911 من العائدين وراقبوهم وأحالوا إجمالاً 3346 مريضًا تظهر عليهم الأعراض إلى المستشفيات حتى يوم 13 يوليو/تموز 2020. الدروس المستفادة التعبئة في الوقت المناسب للمتطوعين الصحيين القرويين محل الثقة في تايلند ـ والذين لديهم الوعي والخبرة في مجال الرقابة على الأمراض المعدية ـ أدت إلى استجابة قوية من البلد لجائحة كوفيد 19. تم احتواء الفيروس مبدئيًا دون اللجوء إلى إغلاق مكلف على مستوى البلد أو اختبارات واسعة النطاق.为控制冠状病毒病（新型冠状病毒肺炎）的不断蔓延，泰国政府于 2020 年 3 月 22 日强制关闭了曼谷的公共场所和商业区域。因此，在 2020 年 4 月期间，大量失业工人返乡导致该病毒在全国范围内传播的风险加剧。.考虑到失业工人的大规模流动，泰国政府对现有的乡村卫生志愿者进行了培训，以确保其能够识别新型冠状病毒肺炎的症状，并对其社区成员进行教育。各省卫生厅组织这些志愿者组成新型冠状病毒肺炎监测小组，对来自疫情高发地区的返乡人员进行识别，鼓励其自我隔离 14 天，并对相关症状的发展进行监测和报告。.尽管为了实现可持续发展目标，医疗人员队伍已于最近进行了大幅度扩大，但是泰国农村地区仍然缺乏专业医疗人员。为了弥补这一点，初级卫生保健系统将训练有素的乡村卫生志愿者纳入其中，以安排其为社区提供基本的卫生保健服务。.2020 年 3 月至 4 月，乡村卫生志愿者走访了 1400 多万户家庭。截至 2020 年 7 月 13 日，志愿者确定并监测了 809 911 名返乡人员，并已将总计 3346 名有症状的患者转诊到医院。.泰国的乡村卫生志愿者在传染病监测方面受过培训且经验丰富，应及时动员这些值得信赖的志愿者，以确保该国能够有效应对新型冠状病毒肺炎疫情。最初并没有使用代价高昂的全国封锁或大规模检测来控制病毒。.С целью контроля над растущим распространением коронавирусной болезни (COVID-19) правительство Таиланда приказало закрыть общественные места и деловые кварталы в Бангкоке с 22 марта 2020 года. В результате множество безработных вернулись домой в апреле 2020 года, увеличив тем самым риск распространения вируса по всей стране.Предвидя масштабное перемещение безработных, тайское правительство обучило имеющихся в сельской местности добровольцев системы здравоохранения тому, как распознавать симптомы COVID-19 и распространять нужные знания среди местных жителей. Органы здравоохранения на уровне провинций собрали из этих добровольцев группы надзора за распространением инфекции COVID-19, задачей которых было выявлять лиц, вернувшихся из зон высокого риска, поощрять среди них самоизоляцию на 14 дней, а также отслеживать развитие любых релевантных симптомов и сообщать об этом.Несмотря на то что в последнее время количество медицинских работников в стране значительно возросло в связи с необходимостью достижения целей в области устойчивого развития в сельских районах Таиланда все еще отмечается нехватка профессиональных медработников. В целях компенсации нехватки кадров система первичной медико-санитарной помощи включает в себя также деятельность обученных деревенских добровольцев, оказывающих базовую медицинскую помощь жителям своих общин.Деревенские добровольцы системы здравоохранения посетили более 14 миллионов семей в течение марта и апреля 2020 г. Они выявили и отслеживали 809 911 лиц, вернувшихся домой, и направили в общей сложности 3346 лиц с симптомами в больницу по состоянию на 13 июля 2020 г.Своевременная мобилизация в Таиланде надежных добровольцев системы здравоохранения, обученных надзору за проявлениями инфекционного заболевания и опытных в этом вопросе, позволила стране уверенно противостоять пандемии COVID-19. На начальном этапе вирус удалось локализовать без дорогостоящих мер, таких как локдаун в масштабе всей страны или всеобщее тестирование.

Background Community-based surveillance (CBS) has been used successfully in many situations to strengthen existing health systems as well as in humanitarian crises. The Anglophone crisis of Northwest Southwest Cameroon, led to burning of villages, targeting of health personnel and destruction of health facilities which, in combination with distrust for the government services led to a collapse of surveillance for outbreak prone diseases. Methods We evaluated the ability of the CBS system to identify suspected cases of outbreak prone diseases (OPD) as compared to the facility-based surveillance, evaluated the timeliness of the CBS system in identifying an OPD, reporting of OPD to District Health Service (DHS) and timeliness in outbreak response. The paper also assessed the collaboration with the DHS and contribution of the CBS system with regards to strengthening the overall surveillance of the health district and also determine the interventions undertaken to contain suspected/confirmed outbreaks. Results In total 9 alerts of suspected OPDs were generated by the CBS system as compared to 0 by the DHS, with 8 investigated, 5 responses and 3 confirmed outbreaks. Average time from first symptoms to alert generation by the CBS system was 7.3 days. Average time lag from alert generation from the CBS to the DHS was 0.3 days which was essentially within 24 h. There was extensive and synergistic collaboration with the DHS. Discussion CBS generated a higher number of alerts than traditional outbreak reported used in the region, and had timely investigations and if appropriate, responses. Careful selection of CHWs with strong community engagement led to the success of the project, and the use of the mobile health team in situ allowed for rapid responses to potential outbreaks, as well as for feedback to CHWs and communities. CBS was also well utilized for identification of other events, such as displacement and malnutrition. Conclusion In conflict settings, CBS can help in outbreak identification as well as other events, and a mobile health team is crucial to the success of the CBS due to the ability to rapidly response to generated alerts. The mobile health team provided timely investigation of 8 of 9 alerts generated. Collaboration with existing DHS structures is important for systems strengthening in such settings.

Summary Background Early childhood development (ECD) programmes can help address early disadvantages for the 43% of children younger than 5 years in low-income and middle-income countries who have compromised development. We aimed to test the effectiveness of two group-based delivery models for an integrated ECD responsive stimulation and nutrition education intervention using Kenya's network of community health volunteers. Methods We implemented a multi-arm, cluster-randomised community effectiveness trial in three rural subcounties across 60 villages (clusters) in western Kenya. Eligible participants were mothers or female primary caregivers aged 15 years or older with children aged 6–24 months at enrolment. If married or in established relationships, fathers or male caregivers aged 18 years or older were also eligible. Villages were randomly assigned (1:1:1) to one of three groups: group-only delivery with 16 fortnightly sessions; mixed delivery combining 12 group sessions with four home visits; and a comparison group. Villages in the intervention groups were randomly assigned (1:1) to invite or not invite fathers and male caregivers to participate. Households were surveyed at baseline and immediately post-intervention. Assessors were masked. Primary outcomes were child cognitive and language development (score on the Bayley Scales of Infant Development third edition), socioemotional development (score on the Wolke scale), and parental stimulation (Home Observation for Measurement of the Environment inventory). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov , NCT03548558 . Findings Between Oct 1 and Nov 12, 2018, 1152 mother–child dyads were enrolled and randomly assigned (n=376 group-only intervention, n=400 mixed-delivery intervention, n=376 comparison group). At the 11-month endline survey (Aug 5–Oct 31, 2019), 1070 households were assessed for the primary outcomes (n=346 group only, n=373 mixed delivery, n=351 comparison). Children in group-only villages had higher cognitive (effect size 0·52 SD [95% CI 0·21–0·83]), receptive language (0·42 SD [0·08–0·77]), and socioemotional scores (0·23 SD [0·03–0·44]) than children in comparison villages at endline. Children in mixed-delivery villages had higher cognitive (0·34 SD [0·05–0·62]) and socioemotional scores (0·22 SD [0·05–0·38]) than children in comparison villages; there was no difference in language scores. Parental stimulation also improved for group-only (0·80 SD [0·49–1·11]) and mixed-delivery villages (0·77 SD [0·49–1·05]) compared with the villages in the comparison group. Including fathers in the intervention had no measurable effect on any of the primary outcomes. Interpretation Parenting interventions delivered by trained community health volunteers in mother–child groups can effectively promote child development in low-resource settings and have great potential for scalability. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health

Background: Latinos are the largest minority group in the United States and when compared with non-Latino whites suffer from higher rates of certain chronic diseases. Latino community health worker...

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 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.

Community case management by community health workers has substantially reduced malaria across the Greater Mekong Subregion and Central America. To sustain current and achieve further reductions in malaria, surveillance and delivery platforms must be redesigned to ensure their continued use by key populations., Key Findings Community health workers (CHWs) detect nearly 30% of all malaria cases in remaining hotspots in Lao PDR and more than 50% of all reported malaria cases in select regions of Honduras. Despite having dedicated funding, both countries face challenges supervising, equipping, and supporting CHWs. As malaria test positivity declines, expanding CHWs' responsibilities may encourage individuals to seek care and enable CHWs to more promptly detect and treat remaining cases. Key Implications National malaria programs should assess vertical CHW network design, management, and financing to identify opportunities to promote care seeking for febrile illness. As likelihood of malaria as the primary cause of fever decreases, providing an integrated package of services will become more critical in ensuring that patients' needs are met. CHWs are a major source of malaria testing, treatment, and disease intelligence. Information systems capable of tracking their performance and progress to guide remedial action and attribute impact are essential., Background: Across the Greater Mekong Subregion (GMS) and Central America, governments commonly employ community health workers (CHWs) to improve access to and uptake of malaria services. Many of these networks are vertical in design, organized to extend malaria-only services to those remaining communities in which malaria persists. Methods: Between 2019 and 2020, national ministries of health (MOH) and Clinton Health Access Initiative conducted mixed-methods CHW program evaluations across the GMS and Central America. Routine surveillance and programmatic data were analyzed to quantify CHW contributions to malaria elimination objectives and identify gaps and challenges. Semistructured interviews were conducted with governmental and nongovernmental stakeholders from central to community level. This article draws comparisons between the Lao People's Democratic Republic (PDR) and Honduras CHW program evaluation results to distill broader hypotheses about how vertical CHW programs might evolve as their primary mission nears its end. Results: CHWs contribute substantially to malaria case detection and surveillance, diagnosing and treating 27% of malaria cases in Lao PDR and 55% in the department of Gracias a Dios, Honduras in 2019. In the same year, malaria test positivity neared less than 1% in both countries. In 2019, 80% of CHWs in Lao PDR and 74% in Gracias a Dios, Honduras did not report a single malaria case. From inception, both programs were organized as vertical (malaria-only) CHW programs reliant upon Global Fund financing for malaria commodities, training, supervision and, where applicable, remuneration. Conclusions: Although community case management by CHWs has been highly impactful in reducing malaria cases to near zero, new challenges of acceptability and effectiveness of malaria-only service delivery, feasibility of continued vertical program management, and sustainable financing have emerged. To achieve and sustain reductions in malaria, surveillance and delivery platforms must be redesigned to encourage (and reward) care seeking based on experience of symptoms and not on a patient or caregiver's presumptive diagnosis of disease. By expanding the roles and responsibilities of currently vertical malaria CHWs, malarial interventions can be optimized and sustained. Such a shift will also position existing community-based platforms to be resilient and responsive as epidemiology of disease and community need shift.

Aim and objectives This review analysed the implementation and integration into healthcare systems of maternal and newborn healthcare interventions in Africa that include community health workers to reduce maternal and newborn deaths. Background Most neonatal deaths (99%) occur in low‐ and middle‐income countries, with approximately half happening at home. In resource‐constrained settings, community‐based maternal and newborn care is regarded as a sound programme for improving newborn survival. Health workers can play an important role in supporting families to adopt sound health practices, encourage delivery in healthcare facilities and ensure timeous referral. Maternal and newborn mortality is a major public health problem, particularly in sub‐Saharan Africa, where the Millennium Development Goals 4, 5 and 6 were not achieved at the end of 2015. Methods The review includes quantitative, qualitative and mixed‐method studies, with a data‐based convergent synthesis design being used, and the results grouped into categories and trends. The review took into account the participants, interventions, context and outcome frameworks (PICO), and followed the adapted PRISMA format for reporting systematic reviews of the qualitative and quantitative evidence guide checklist. Results The results from the 17 included studies focused on three themes: antenatal, delivery and postnatal care interventions as a continuum. The main components of the interventions were inadequate, highlighting the need for improved planning before each stage of implementation. A conceptual framework of planning and implementation was elaborated to improve maternal and newborn health. Conclusion The systematic review highlight the importance of thoroughly planning before any programme implementation, and ensuring that measures are in place to enable continuity of services. Relevant to the clinical practice Conceptual framework of planning and implementation of maternal and newborn healthcare interventions by maternal community health workers.

Palawan is the malaria-endemic province with the highest prevalence of malaria in the Philippines, and microscopists (community health workers) have been allowed to deliver early diagnosis and prompt treatment of malaria throughout the province since 1999. To improve the quality of care, the present mixed-methods study attempted to identify the factors associated with satisfaction of patients in Palawan with their microscopists by analyzing the patients’ perspectives. First, a quantitative cross-sectional study was conducted among 48 ex-patients and their nine microscopists. Ex-patients were asked about their satisfaction with care, and microscopists were asked about their job satisfaction and ability. Structural equation modeling was conducted for data analysis. Second, a qualitative cross-sectional study was performed using narrative interviews. Data were analyzed using the NVivo 10 software program. As a result, both studies revealed high patient satisfaction with microscopists. The quantitative study showed that ex-patients’ satisfaction with their microscopists was independently enhanced by two factors: high ability in malaria microscopic observation and low household wealth of the patients. Particularly, specific subpopulations (those with lower household wealth, relatively old people, and ethnic minorities) were more satisfied with the microscopists’ care. The qualitative study strengthens this finding by showing that their microscopists offered prompt and precise diagnosis and effective treatment for free. In conclusion, microscopists were shown to have an important role in narrowing the disparities in malaria care in Palawan. It is important to maintain/enhance the ability of microscopists in malaria microscopy to satisfy their patients.

Background People with chronic obstructive pulmonary disease (COPD) in Nepal are not receiving adequate support to self-manage their chronic conditions, and primary health care can play a key role in the effective management of these. In this study, we aimed to develop a model of care, using a co-design approach, for delivering evidence-based biomedical and psycho-social care to support self-management for people with multi-morbid COPD in rural Nepal. Methods A co-design approach, guided by the five stages of the design thinking model, was used for this study. Layering on “empathize” and “define” phases, we ideated a model of care that was further refined in a “prototype” stage, which included a series of consultative meetings and a 1-day co-design workshop with stakeholders. This co-design process involved a wide range of stakeholders from Nepal, including people with COPD and their families, community representatives, local government representatives, primary care practitioners, community health workers, policymakers, state-level government representatives and academics. Results Through our co-design approach, a model of integrated care for delivering evidence-based biomedical and psycho-social care to support self-management for people with multi-morbid COPD was designed. The integrated model of care included: screening of the community members aged > 40 years or exhibiting symptoms for COPD and management of symptomatic patients within primary health care, establishing referral pathways for severe cases to and from secondary/tertiary-level health care and establishing a community-based support system. It involved specific roles for community health workers, patients and their caregivers and community representatives. It was built on existing services and programmes linking primary health care centres and tertiary-level health facilities. Conclusion The co-design approach is different from the currently dominant approach of rolling out models of care, which were designed elsewhere with minimal community engagement. In our study, the co-design approach was found to be effective in engaging various stakeholders and in developing a model of care for rural Nepal. This grassroots approach is more likely to be acceptable, effective and sustainable in rural Nepal. Further research is required to test the effectiveness of an integrated model of care in delivering self-management support for people with multi-morbid COPD in rural Nepal.

Background In parallel with the change of malaria policy from control to elimination and declines in the malaria burden in Greater Mekong Sub-region, the motivation and social role of malaria volunteers has declined. To address this public health problem, in Myanmar, the role and responsibilities of malaria volunteers have been transformed into integrated community malaria volunteers (ICMV), that includes the integration of activities for five additional diseases (dengue, lymphatic filariasis, tuberculosis, HIV/AIDS and leprosy) into their current activities. However, this transformation was not evidence-based and did not consider inputs of different stakeholders. Therefore, qualitative stakeholder consultations were performed to optimize future malaria volunteer models in Myanmar. Methods Semi-structured interviews were conducted with key health stakeholders from the Myanmar Ministry of Health and Sports (MoHS) and malaria implementing partners to obtain their perspectives on community-delivered malaria models. A qualitative descriptive approach was used to explore the experiences of the stakeholders in policymaking and programme implementation. Interview topic guides were used during the interviews and inductive thematic data analysis was performed. Results While ICMVs successfully provided malaria services in the community, the stakeholders considered the ICMV model as not optimal and suggested that many aspects needed to be improved including better training, supervision, support, and basic health staff’s recognition for ICMVs. Stakeholders believe that the upgraded ICMV model could contribute significantly to achieving malaria elimination and universal health care in Myanmar. Discussion and conclusion In the context of high community demand for non-malaria treatment services from volunteers, the integrated volunteer service package must be developed carefully in order to make it effective in malaria elimination programme and to contribute in Myanmar’s pathway to universal health coverage (UHC), but without harming the community. An evidenced-based, community-delivered and preferred model, that is also accepted by the MoHS, is yet to be developed to effectively contribute to achieving malaria elimination and UHC goals in Myanmar by 2030.

Background Black men are disproportionately affected by prostate cancer, the most common non-cutaneous malignancy among men in the USA. The United States Preventive Services Task Force (USPSTF) encourages prostate-specific antigen (PSA) testing decisions to be based on shared decision-making (SDM) clinician professional judgment, and patient preferences. However, evidence suggests that SDM is underutilized in clinical practice, especially among the most vulnerable patients. The purpose of this study is to evaluate the efficacy of a community health worker (CHW)-led decision-coaching program to facilitate SDM for prostate cancer screening among Black men in the primary care setting, with the ultimate aim of improving/optimizing decision quality. Methods We proposed a CHW-led decision-coaching program to facilitate SDM for prostate cancer screening discussions in Black men at a primary care FQHC. This study enrolled Black men who were patients at the participating clinical site and up to 15 providers who cared for them. We estimated to recruit 228 participants, ages 40–69 to be randomized to either (1) a decision aid along with decision coaching on PSA screening from a CHW or (2) receiving a decision aid along with CHW-led interaction on modifying dietary and lifestyle to serve as an attention control. The independent randomization process was implemented within each provider and we controlled for age by dividing patients into two strata: 40–54 years and 55–69 years. This sample size sufficiently powered the detection differences in the primary study outcomes: knowledge, indicative of decision quality, and differences in PSA screening rates. Primary outcome measures for patients will be decision quality and decision regarding whether to undergo PSA screening. Primary outcome measures for providers will be acceptability and feasibility of the intervention. We will examine how decision coaching about prostate cancer screening impact patient-provider communication. These outcomes will be analyzed quantitatively through objective, validated scales and qualitatively through semi-structured, in-depth interviews, and thematic analysis of clinical encounters. Through a conceptual model combining elements of the Preventative Health Care Model (PHM) and Informed Decision-Making Model, we hypothesize that the prostate cancer screening decision coaching intervention will result in a preference-congruent decision and decisional satisfaction. We also hypothesize that this intervention will improve physician satisfaction with counseling patients about prostate cancer screening. Discussion Decision coaching is an evidence-based approach to improve decision quality in many clinical contexts, but its efficacy is incompletely explored for PSA screening among Black men in primary care. Our proposal to evaluate a CHW-led decision-coaching program for PSA screening has high potential for scalability and public health impact. Our results will determine the efficacy, cost-effectiveness, and sustainability of a CHW intervention in a community clinic setting in order to inform subsequent widespread dissemination, a critical research area highlighted by USPSTF. Trial registration The trial was registered prospectively with the National Institute of Health registry (www.clinicaltrials.gov), registration number NCT03726320, on October 31, 2018.

PURPOSE:African American patients with cancer underutilize advance care planning (ACP) and palliative care (PC). This feasibility study investigated whether community health workers (CHWs) could improve ACP and PC utilization for African American patients with advanced cancer.METHODS:African American patients diagnosed with an advanced solid organ cancer (stage IV or stage III disease with a palliative performance score < 60%) were enrolled. Patients completed baseline surveys that assessed symptom burden and distress at baseline and 3 months post-CHW intervention. The CHW intervention consisted of a comprehensive assessment of multiple PC domains and social determinants of health. CHWs provided tailored support and education on the basis of iterative assessment of patient needs. Intervention feasibility was determined by patient and caregiver retention rate above 50% at 3 months.RESULTS:Over a 12-month period, 24 patients were screened, of which 21 were deemed eligible. Twelve patients participated in the study. Patient retention was high at 3 months (75%) and 6 months (66%). Following the CHW intervention, symptom assessment as measured by Edmonton Symptom Assessment System improved from 33.8 at baseline to 18.8 ( P = .03). Psychological distress improved from 5.5 to 4.7 ( P = .36), and depressive symptoms from 42.2 to 33.6 ( P = .09), although this was not significant. ACP documentation improved from 25% at baseline to 75% at study completion. Sixty-seven percentage of patients were referred to PC, with 100% of three decedents using hospice.CONCLUSION:Utilization of CHWs to address PC domains and social determinants of health is feasible. Although study enrollment was identified as a potential barrier, most recruited patients were retained on study.

Objectives: The use of collaborative care teams, comprising nurse care managers and community health workers, has emerged as a promising strategy to tackle hyperten­sion disparities by addressing patients’ social determinants of health. We sought to identify which social determinants of health are associated with a patient’s likelihood of engaging with collaborative care team members and with the nurse care manager’s likelihood of enlisting community health workers (CHW) to provide additional sup­port to patients. Methods: We conducted a within-group longitudinal analysis of patients assigned to receive a collaborative care intervention in a pragmatic, cluster randomized trial that aims to reduce disparities in hypertension control (N=888). Generalized estimating equations were used to identify which social deter­minants of health, reported on the study’s baseline survey, were associated with the odds of patients engaging with the col­laborative care intervention, and of nurses deploying community health workers. Results: Patients who were unable to work and those with higher health literacy were less likely to engage with the collaborative care team than those who were employed full time or had lower health literacy, respectively. Patients had a greater likeli­hood of being referred to a community health worker by their care manager if they reported higher health literacy, perceived stress, or food insecurity, while those report­ing higher numeracy had lower odds of receiving a CHW referral. Implications/Conclusions: A patient’s social determinants of health influence the extent of engagement in a collaborative care intervention and nurse care manager appraisals of the need for supplementary support provided by community health workers. Ethn Dis. 2021;31(1):47-56; doi:10.18865/ed.31.1.47

OBJECTIVE: We evaluated the feasibility of a multi-level teleaudiology patient-site facilitator training program for Community Health Workers (CHWs) at a partnering health center in southern Arizona. DESIGN: Three levels were offered: Introductory, with basic information on hearing loss and teleaudiology; Intermediate, on technology, team roles, and access issues; and Facilitator, on further knowledge and hands-on skills to serve as patient-site facilitators in synchronous hearing aid service delivery. Six domains of feasibility were addressed using a mixed-methods design. Quantitative data included survey responses and observation of hands-on skills. Qualitative data included field notes from group discussion and open-ended survey questions, and were analyzed using CHW core competencies. STUDY SAMPLE: Twelve CHWs participated in the introductory training, ten moved on to intermediate, and three continued to the facilitator. RESULTS: Quantitative outcomes indicated that the trainings were feasible according to each of the six domains. CHWs in the facilitator training passed the practical hands-on skill assessment. Qualitative analyses revealed CHWs comments addressed eight of the ten possible CHW core competencies, and focused on service coordination/navigation, and capacity building. CONCLUSIONS: Teleaudiology trainings for CHWs were feasible, increasing service capacity for a potential pathway to improve access to hearing health care in low-resource areas.

To establish the impact of a face-to-face peer-support intervention on adults with type 2 diabetes in South Africa. A cluster randomised controlled trial was conducted involving 288 adults with typ...

Background Malaria volunteers have contributed significantly to malaria control achieving a reduction of annual parasite incidence to pre-elimination levels in several townships across Myanmar. However, the volunteers’ role is changing as Myanmar transitions from a malaria control to elimination programme and towards the goal of universal health coverage. The aim of the study is to explore the perspectives of community leaders, members and malaria volunteers in South-East Myanmar on community-delivered models to inform an optimal design that targets malaria elimination in the context of primary health care in Myanmar. Methods Qualitative methods including focus group discussions (FGDs) with community members and current or ex-malaria volunteers, and participatory workshops with community leaders were conducted. All data collection tools were pilot tested with similar participants. The FGDs were stratified into male and female participants in consideration of diverse gender roles among the ethnic groups of Myanmar. Data saturation was the key cut-off point to cease recruitment of participants. Inductive thematic analysis was used. Results Community members were willing to be tested for malaria because they were concerned about the consequences of malaria although they were aware that malaria prevalence is low in their villages. Malaria volunteers were the main service providers for malaria and other infectious diseases in the community. Apart from malaria, the community identified common health problems such as the flu (fever, sneezing and coughing), diarrhoea, skin infections and tuberculosis as priority diseases in this order. Incorporating preventive, and whenever possible curative, services for those diseases into the current malaria volunteer model was recommended. Discussion and conclusion There was a gap between the communities’ expectations of health services and the health services currently being delivered by volunteers in the community that highlights the need for reassessment and reform of the volunteer model in the changing context. An evidence-based, community preferred, pragmatic community-delivered integrated model should be constructed based on the context of malaria elimination and progressing towards universal health coverage in Myanmar.

PURPOSE: Routine eye examination in early life is not the practice in most resource-limited countries. Delay in the presentation for eye problems is typical. Community health officers are often consulted by caregivers for all health problems during routine immunization and well-baby clinics in primary healthcare for children aged 0–2 years. This study evaluated the value and limitation of interview, Bruckner red reflex test, and instrument vision screener by noneye care middle-level staff of rural and urban well-baby immunization clinics, in early detection and referral for childhood eye disorders. MATERIALS AND METHODS: This was a cross-sectional study. Middle-level community health workers (CHWs) working at well-baby/ immunization clinics were trained to perform vision screening using interview of caregivers, red reflex eye examination with ophthalmoscope, and instrument vision screener (Welch Allyn SPOT™ Vision Screener) without mydriatic drugs during routine immunization of children aged 0–2 years. IRB approval was obtained. RESULTS: Over a 6-month period in 2017, the CHWs screened 5609 children. Overall, 628 (11.2%) patients were referred to the tertiary child eye care unit. Referred cases included cataract, glaucoma, congenital nasolacrimal duct obstruction, ophthalmia neonatorum, retinoblastoma, and significant refractive errors. Referral from the interview of mothers was enhanced if specific questions to elicit visual function were asked. Bruckner red reflex test was more effective than instrument vision screener in the detection of cataract and life-threatening diseases such as retinoblastoma. Instrument vision screener was preferred by parents and better at detecting amblyopic risk factors. CONCLUSION: Preschool vision screening during routine immunization by primary healthcare workers in resource-limited settings was effective. Whenever instrument vision screener does not give any recommendation during screening, consider vision- or life-threatening pathology and refer.