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Kansiime WK, Atusingwize E, Ndejjo R, Balinda E, Ntanda M, Mugambe RK, Musoke D. Barriers and benefits of mHealth for community health workers in integrated community case management of childhood diseases in Banda Parish, Kampala, Uganda: a cross-sectional study. BMC PRIMARY CARE 2024; 25:173. [PMID: 38769485 PMCID: PMC11103880 DOI: 10.1186/s12875-024-02430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Low-quality data presents a significant challenge for community health workers (CHWs) in low and middle-income countries (LMICs). Mobile health (mHealth) applications offer a solution by enabling CHWs to record and submit data electronically. However, the barriers and benefits of mHealth usage among CHWs in informal urban settlements remain poorly understood. This study sought to determine the barriers and benefits of mHealth among CHWs in Banda parish, Kampala. METHODS This qualitative study involved 12 key informant interviews (KIIs) among focal persons from Kampala City Council Authority (KCCA) and NGOs involved in data collected by CHWs, and officials from the Ministry of Health (MOH) and two mixed-sex Focused Group Discussions (FGDs) of CHWs from Banda parish, Kampala district. Data analysis utilised Atlas Ti Version 7.5.7. Thematic analysis was conducted, and themes were aligned with the social-ecological model. RESULTS Three themes of institutional and policy, community and interpersonal, and individual aligning to the Social ecological model highlighted the factors contributing to barriers and the benefits of mHealth among CHWs for iCCM. The key barriers to usability, acceptability and sustainability included high training costs, CHW demotivation, infrastructure limitations, data security concerns, community awareness deficits, and skill deficiencies. Conversely, mHealth offers benefits such as timely data submission, enhanced data quality, geo-mapping capabilities, improved CHW performance monitoring, community health surveillance, cost-effective reporting, and CHW empowering with technology. CONCLUSION Despite limited mHealth experience, CHWs expressed enthusiasm for its potential. Implementation was viewed as a solution to multiple challenges, facilitating access to health information, efficient data reporting, and administrative processes, particularly in resource-constrained settings. Successful mHealth implementation requires addressing CHWs' demotivation, ensuring reliable power and network connectivity, and enhancing capacity for digital data ethics and management. By overcoming these barriers, mHealth can significantly enhance healthcare delivery at the community level, leveraging technology to optimize resource utilization and improve health outcomes. mHealth holds promise for transforming CHW practices, yet its effective integration necessitates targeted interventions to address systemic challenges and ensure sustainable implementation in LMIC contexts.
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Affiliation(s)
- Winnifred K Kansiime
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Edwinah Atusingwize
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Emmanuel Balinda
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Moses Ntanda
- Department of Networks, College of Computing and Information Science, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Richard K Mugambe
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Lim S, Mantsios A, Braithwaite RS, Pitts R. A secondary gendered analysis of interviews with Latina cisgender women indicated for HIV pre-exposure prophylaxis. AIDS Care 2024; 36:692-702. [PMID: 38466205 DOI: 10.1080/09540121.2024.2325070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
HIV infections disproportionately impact Latinx populations in the United States, yet oral pre-exposure prophylaxis (PrEP) uptake is low. This study was a secondary gendered analysis of interviews with Latina cisgender women (n = 20) recruited from an urban safety net hospital inNew York City between August 2019 and October 2022. All women were indicated for PrEP by the provider. In-depth interviews were conducted with participants in English and Spanish and asked about social determinants of health, sexual partnerships and behaviors, and PrEP-specific enablers and barriers. Secondary thematic content analysis was conducted to identify gender-related factors influencing PrEP uptake. The following themes emerged from the data:structural factors (e.g., employment), partner-related factors, low sexual health knowledge, and resilience and empowerment. Partner-related factors were the most salient; partner infidelity served as reasons for initiating PrEP. Despite being constrained by low power in relationships, women made empowered choices to initiate PrEP and protect themselves. Findings indicated that the impact of gender inequity was an important factor in Latina women's PrEP decision making, pointing to a need to address partner-driven HIV risk, imbalance of power in relationships, and gender norms.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Ronald S Braithwaite
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Robert Pitts
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Division of Infectious Diseases, NYC Health + Hospitals/Bellevue, New York, NY, USA
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Gobin R, Thomas T, Goberdhan S, Sharma M, Nasiiro R, Emmanuel R, Rambaran M, McFarlane S, Elia C, Van-Veen D, Govia I, Palmer T, Read U, Cruickshank JK, Samuels TA, Wilks R, Harding S. Readiness of primary care centres for a community-based intervention to prevent and control noncommunicable diseases in the Caribbean: A participatory, mixed-methods study. PLoS One 2024; 19:e0301503. [PMID: 38683831 PMCID: PMC11057736 DOI: 10.1371/journal.pone.0301503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/15/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Epidemiological transition to NCDs is a challenge for fragile health systems in the Caribbean. The Congregations Taking Action against NCDs (CONTACT) Study intervention proposes that trained health advocates (HAs) from places of worship (PoWs), supervised by nurses at nearby primary healthcare centres (PHCs), could facilitate access to primary care among vulnerable communities. Drawing on participatory and systems thinking, we explored the capacity of local PHCs in three Caribbean countries to support this intervention. METHODS Communities in Jamaica (rural, urban), Guyana (rural) and Dominica (Indigenous Kalinago Territory) were selected for CONTACT because of their differing socio-economic, cultural, religious and health system contexts. Through mixed-method concept mapping, we co-developed a list of perceived actionable priorities (possible intervention points ranked highly for feasibility and importance) with 48 policy actors, healthcare practitioners and civic society representatives. Guided in part by the concept mapping findings, we assessed the readiness of 12 purposefully selected PHCs for the intervention, using a staff questionnaire and an observation checklist to identify enablers and constrainers. RESULTS Concept mapping illustrated stakeholder optimism for the intervention, but revealed perceptions of inadequate primary healthcare service capacity, resources and staff training to support implementation. Readiness assessments of PHCs identified potential enablers and constrainers that were consistent with concept mapping results. Staff support was evident. Constraints included under-staffing, which could hinder supervision of HAs; and inadequate essential NCD medicines, training in NCDs and financial and policy support for embedding community interventions. Despite a history of socio-political disadvantage, the most enabling context was found in the Kalinago Territory, where ongoing community engagement activities could support joint development of programmes between churches and PHCs. CONCLUSION Multi-sectoral stakeholder consultation and direct PHC assessments revealed viability of the proposed POW-PHC partnership for NCD prevention and control. However, structural and policy support will be key for implementing change.
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Affiliation(s)
- Reeta Gobin
- College of Medical Sciences, University of Guyana, Georgetown, Guyana
| | - Troy Thomas
- Faculty of Natural Sciences, University of Guyana, Georgetown, Guyana
| | | | - Manoj Sharma
- College of Medical Sciences, University of Guyana, Georgetown, Guyana
| | | | - Rosana Emmanuel
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - Madan Rambaran
- Institute of Health Science Education, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Shelly McFarlane
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | | | - Davon Van-Veen
- College of Medical Sciences, University of Guyana, Georgetown, Guyana
| | - Ishtar Govia
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Tiffany Palmer
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | | | - J. Kennedy Cruickshank
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - T. Alafia Samuels
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Rainford Wilks
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Seeromanie Harding
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
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Pandya S, Kan L, Parr E, Twose C, Labrique AB, Agarwal S. How Can Community Data Be Leveraged to Advance Primary Health Care? A Scoping Review of Community-Based Health Information Systems. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300429. [PMID: 38626945 PMCID: PMC11057800 DOI: 10.9745/ghsp-d-23-00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Community-based health information systems (CBISs) can provide critical insights into how community health systems function, and digitized CBISs may improve the quality of community-level data and facilitate integration and use of CBISs within the broader health system. This scoping review aims to understand how CBISs have been implemented, integrated, and used to support community health outcomes in low- and middle-income countries (LMICs). METHODS Both peer-reviewed and gray literature were included; relevant articles were identified using key terms and controlled vocabulary related to community/primary health care, health information systems, digital health, and LMICs. A total of 11,611 total records were identified from 5 databases and the gray literature. After deduplication, 6,985 peer-reviewed/gray literature were screened, and 95 articles/reports were included, reporting on 105 CBIS implementations across 38 countries. RESULTS Findings show that 55% of CBISs included some level of digitization, with just 28% being fully digitized (for data collection and reporting). Data flow from the community level into the health system varied, with digitized CBISs more likely to reach national-level integration. National-level integration was primarily seen among vertical CBISs. Data quality challenges were present in both paper-based and digitized CBISs, exacerbated by fragmentation of the community health landscape with often parallel reporting systems. CBIS data use was constrained to mostly vertical and digitized (partially or fully) CBISs at national/subnational levels. CONCLUSION Digitization can play a pivotal role in strengthening CBIS use, but findings demonstrate that CBISs are only as effective as the community health systems they are embedded within. Community-level data are often not being integrated into national/subnational health information systems, undermining the ability to understand what the community health needs are. Furthermore, stronger investments within community health systems need to be in place broadly to reduce fragmentation and provide stronger infrastructural and systemic support to the community health workforce.
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Affiliation(s)
- Shivani Pandya
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lena Kan
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily Parr
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Twose
- Welch Medical Library, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Smisha Agarwal
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lopez JZ, Lee M, Park SK, Zolezzi ME, Mitchell-Bennett LA, Yeh PG, Perez L, Heredia NI, McPherson DD, McCormick JB, Reininger BM. An expanded chronic care management approach to multiple chronic conditions in Hispanics using community health workers as community extenders in the Rio Grande Valley of Texas. Prev Med 2024; 184:107975. [PMID: 38685533 DOI: 10.1016/j.ypmed.2024.107975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The synergistic negative effects of type 2 diabetes (T2DM) and hypertension increases all-cause mortality and the medical complexity of management, which disproportionately impact Hispanics who face barriers to healthcare access. The Salud y Vida intervention was delivered to Hispanic adults living along the Texas-Mexico Border with comorbid poorly controlled T2DM and hypertension. The Salud y Vida multicomponent intervention incorporated community health workers (CHWs) into an expanded chronic care management model to deliver home-based follow-up visits and provided community-based diabetes self-management education. METHODS We conducted multivariable longitudinal analysis to examine the longitudinal intervention effect on reducing systolic and diastolic blood pressure among 3806 participants enrolled between 2013 and 2019. Participants were compared according to their program participation as either higher (≥ 10 combined educational classes and CHW visits) or lower engagement (<10 encounters). Data was collected between 2013 and 2020. RESULTS Baseline mean systolic and diastolic blood pressure were 138 and 81 mmHg respectively. There were overall improvements in systolic (-6.49; 95% CI = [-7.13, -5.85]; p < 0.001) and diastolic blood pressure (-3.97; 95% CI = [-4.37, -3.56]; p < 0.001). The higher engagement group had greater systolic blood pressure reduction at 3 months (adjusted mean difference = -1.8 mmHg; 95% CI = [-3.2, -0.3]; p = 0.016) and at 15 month follow-up (adjusted mean difference = -2.3 mmHg; 95% CI = [-4.2, -0.39]; p = 0.0225) compared to the lower engagement group. CONCLUSION This intervention, tested and delivered in a real-world setting, provides an example of how CHW integration into an expanded chronic care model can improve blood pressure outcomes for individuals with co-morbidities.
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Affiliation(s)
- Juliana Z Lopez
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - MinJae Lee
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, USA
| | - Soo K Park
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, Houston, TX, USA; Management, Policy and Community Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maria E Zolezzi
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Lisa A Mitchell-Bennett
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Paul G Yeh
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA; Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - LuBeth Perez
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Natalia I Heredia
- Department of Health Promotion & Behavioral Science, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David D McPherson
- Internal Medicine Cardiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joseph B McCormick
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Belinda M Reininger
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA; Department of Health Promotion & Behavioral Science, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Ebbs D, Taricia M, Funaro MC, O’Daniel M, Cappello M. Prehospital use of point-of-care tests by community health workers: a scoping review. Front Public Health 2024; 12:1360322. [PMID: 38721545 PMCID: PMC11076783 DOI: 10.3389/fpubh.2024.1360322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/06/2024] [Indexed: 05/15/2024] Open
Abstract
Introduction Point-of-Care Tests (POCTs) are utilized daily in resource abundant regions, however, are limited in the global south, particularly in the prehospital setting. Few studies exist on the use of non-malarial POCTs by Community Health Workers (CHWs). The purpose of this scoping review is to delineate the current diversity in and breadth of POCTs evaluated in the prehospital setting. Methods A medical subject heading (MeSH) analysis of known key articles was done by an experienced medical librarian and scoping searches were performed in each database to capture "point of care testing" and "community health workers." This review was guided by the PRISMA Extension for scoping reviews. Results 2735 publications were returned, 185 were nominated for full-text review, and 110 studies were confirmed to meet study criteria. Majority focused on malaria (74/110; 67%) or HIV (25/110; 23%); 9/110 (8%) described other tests administered. Results from this review demonstrate a broad geographic range with significant heterogeneity in terminology for local CHWs. Conclusion The use of new POCTs is on the rise and may improve early risk stratification in limited resource settings. Current evidence from decades of malaria POCTs can guide future implementation strategies.
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Affiliation(s)
- Daniel Ebbs
- Department of Pediatrics, Yale University, New Haven, CT, United States
| | - Max Taricia
- Department of Pediatrics, Yale University, New Haven, CT, United States
| | - Melissa C. Funaro
- Department of Medicine, Harvey Cushing/John Hay Whitney Medical Library, New Haven, CT, United States
| | - Maggie O’Daniel
- University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Michael Cappello
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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Zuñiga RO, Parra-García I, Gómez-Barrera LA. Overview of the participation of community health workers in primary health care in 6 Latin American countries and a proposal for their integration into the health system: a qualitative study. Fam Pract 2024; 41:139-146. [PMID: 38300797 DOI: 10.1093/fampra/cmae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND According to some health programmes, implementing primary health care through community health workers (CHWs) facilitates the connection between community and health services in Latin America. However, these are isolated processes that face different obstacles and would benefit from an overview of the corresponding health policies and programmes. OBJECTIVE To provide an overview of CHW participation in 6 Latin American countries. METHODS This exploratory qualitative study was based on 3 sources of information: a literature review, a review of public health policy documents, and interviews with experts who have led CHW programmes in 6 Latin American countries. RESULTS The role of CHWs in Latin America and some advances in public health policies in the region were evidenced. However, limitations arising from variable implementation of the WHO guidelines on health programmes with CHWs were also apparent. CONCLUSIONS CHWs contribute to the primary healthcare processes in the 6 Latin American countries studied in versatile and comprehensive ways. However, they constitute an underutilized human resource because they must provide various services that are not always relevant in different work contexts. Therefore, we propose a classification of the CHW profile, using the level of access to healthcare services of the population they serve as the main differentiator. This way, CHWs will not have to provide a wide range of services but only those most relevant to the specific needs of each community.
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Affiliation(s)
- Rosalia Olaya Zuñiga
- School of Medicine, Universidad El Bosque, Bogota, D.C., Colombia
- School of Nursing, Universidad de Ciencias Ambientales y Aplicadas (UDCA), Bogota, D.C., Colombia
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O'Connell WP, Renn BN, Areán PA, Raue PJ, Ratzliff A. Behavioral Health Workforce Development in Washington State: Addition of a Behavioral Health Support Specialist. Psychiatr Serv 2024:appips20230312. [PMID: 38616648 DOI: 10.1176/appi.ps.20230312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
The mental and behavioral health workforce shortage has hindered access to care in the United States, resulting in long waitlists for persons who need behavioral health care. Global models for task sharing, combined with U.S.-led studies of nonspecialists delivering interventions for depression and anxiety, support the development of this workforce in a stepped care system. This Open Forum highlights an innovative effort in Washington State to initiate a bachelor's-level behavioral health support specialist curriculum leading to credentialing to expand the mental health workforce and improve access to care for people with depression and anxiety.
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Affiliation(s)
- William P O'Connell
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (O'Connell, Raue, Ratzliff); Department of Psychology, University of Nevada, Las Vegas, Las Vegas (Renn); Division of Services and Interventions Research, NIMH, Bethesda (Areán)
| | - Brenna N Renn
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (O'Connell, Raue, Ratzliff); Department of Psychology, University of Nevada, Las Vegas, Las Vegas (Renn); Division of Services and Interventions Research, NIMH, Bethesda (Areán)
| | - Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (O'Connell, Raue, Ratzliff); Department of Psychology, University of Nevada, Las Vegas, Las Vegas (Renn); Division of Services and Interventions Research, NIMH, Bethesda (Areán)
| | - Patrick J Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (O'Connell, Raue, Ratzliff); Department of Psychology, University of Nevada, Las Vegas, Las Vegas (Renn); Division of Services and Interventions Research, NIMH, Bethesda (Areán)
| | - Anna Ratzliff
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (O'Connell, Raue, Ratzliff); Department of Psychology, University of Nevada, Las Vegas, Las Vegas (Renn); Division of Services and Interventions Research, NIMH, Bethesda (Areán)
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Tikkanen RS, Closser S, Prince J, Chand P, Justice J. An anthropological history of Nepal's Female Community Health Volunteer program: gender, policy, and social change. Int J Equity Health 2024; 23:70. [PMID: 38614976 PMCID: PMC11015651 DOI: 10.1186/s12939-024-02177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/06/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Community health workers (CHWs) are central to Primary Health Care globally. Amidst the current flourishing of work on CHWs, there often is a lack of reference to history-even in studies of programs that have been around for decades. This study examines the 35-year trajectory of Nepal's Female Community Health Volunteers (FCHVs). METHODS We conducted a content analysis of an archive of primary and secondary research materials, grey literature and government reports collected during 1977-2019 across several regions in Nepal. Documents were coded in MAXQDA using principles of inductive coding. As questions arose from the materials, data were triangulated with published sources. RESULTS Looking across four decades of the program's history illuminates that issues of gender, workload, and pay-hotly debated in the CHW literature now-have been topics of discussion for observers and FCHVs alike since the inception of the program. Following experiments with predominantly male community volunteers during the 1970s, Nepal scaled up the all-female FCHV program in the late 1980s and early 1990s, in part because of programmatic goals focused on maternal and child health. FCHVs gained legitimacy as health workers in part through participation in donor-funded vertical campaigns. FCHVs received a stable yet modest regular stipend during the early years, but since it was stopped in the 1990s, incentives have been a mix of activity-based payments and in-kind support. With increasing outmigration of men from villages and growing work responsibilities for women, the opportunity cost of health volunteering increased. FCHVs started voicing their dissatisfaction with remuneration, which gave rise to labor movements starting in the 2010s. Government officials have not comprehensively responded to demands by FCHVs for decent work, instead questioning the relevance of FCHVs in a modern, medicalized Nepali health system. CONCLUSIONS Across public health, an awareness of history is useful in understanding the present and avoiding past mistakes. These histories are often not well-archived, and risk getting lost. Lessons from the history of Nepal's FCHV program have much to offer present-day debates around CHW policies, particularly around gender, workload and payment.
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Affiliation(s)
- Roosa Sofia Tikkanen
- Institute of Sociology and Political Science, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Edvard Bulls veg 1, 7491, Trondheim, Norway.
| | - Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - Justine Prince
- Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, 3400 N. Charles Street, Baltimore, Maryland, 21218, USA
| | - Priyankar Chand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - Judith Justice
- Institute for Health & Aging, School of Nursing, University of California at San Francisco, 490 Illinois Street, San Francisco, CA, 94143, USA
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Job N, Johnston JS, Westgate C, Skinner NA, Ward V, Ballard M. Community health worker perspectives on advocacy: design-based research to develop a digital advocacy training course. Front Public Health 2024; 12:1334279. [PMID: 38660355 PMCID: PMC11039831 DOI: 10.3389/fpubh.2024.1334279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction While community health workers (CHWs) are well-positioned as health advocates, they frequently lack support and feel undervalued. Advocacy training may prepare CHWs to support communities better. Methods This study uses a design-based research approach to (1) explore how participation in curriculum-development workshops for a digital advocacy course influenced CHWs' (n = 25) perceptions of advocacy and (2) describe how CHW involvement shaped course development. Data were collected via five discussion groups and seven surveys over six months. Results Initially, the CHWs perceived themselves as community-advocates but not as self-advocates. They increasingly reflected on the merits of advocating for better working conditions and aspired to greater involvement in decision-making. CHWs reflected positively on their advisory role in shaping the course to improve content acceptability and validity. Discussion Training efforts to engage CHWs in advocacy must overcome systemic barriers and norms internalized by CHWs that deter them from reaching their full potential as advocates.
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Affiliation(s)
- Nophiwe Job
- Stanford Center for Health Education, Cape Town, South Africa
| | | | - Carey Westgate
- Community Health Impact Coalition, London, United Kingdom
| | | | - Victoria Ward
- Stanford Center for Health Education, Stanford, CA, United States
- Stanford University School of Medicine, Stanford, CA, United States
| | - Madeleine Ballard
- Community Health Impact Coalition, London, United Kingdom
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Jessup RL, Slade S, Roussy V, Whicker S, Pelly J, Rane V, Lewis V, Naccarella L, Lee M, Campbell D, Stockman K, Brooks P. Peer Health Navigators to improve equity and access to health care in Australia: Can we build on successes from the COVID-19 pandemic? Aust N Z J Public Health 2024; 48:100128. [PMID: 38442568 DOI: 10.1016/j.anzjph.2024.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/23/2023] [Accepted: 12/20/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Rebecca L Jessup
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; School of Rural Health, Monash University, Warragul, Australia.
| | - Sian Slade
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - Veronique Roussy
- Department of Epidemiology and Preventative Medicine, Monash University, Clayton Australia; EACH Community Health, Ferntree Gully, Australia
| | - Susan Whicker
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Janet Pelly
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Vinita Rane
- Pandemic Wards, Northern Health, Epping Australia; Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Virginia Lewis
- Australian Insititute of Primary Care and Ageing, La Trobe University, Bundoora, Australia
| | - Lucio Naccarella
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Max Lee
- Strategic Alliances and Partnerships, DPV Health, Epping, Australia
| | - Donald Campbell
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Keith Stockman
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Peter Brooks
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Acharya H, Sykes KJ, Neira TM, Scott A, Pacheco CM, Sanner M, Ablah E, Oyowe K, Ellerbeck EF, Greiner KA, Corriveau EA, Finocchario-Kessler S. A Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers: Development and Usability Study. JMIR Form Res 2024; 8:e52920. [PMID: 38557671 PMCID: PMC11019415 DOI: 10.2196/52920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic added to the decades of evidence that public health institutions are routinely stretched beyond their capacity. Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency. OBJECTIVE We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs. METHODS The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection system for CHWs. Pilot tests with CHWs occurred over several months to ensure that the functionality supported their daily use. Following implementation of the database, procedures were set to sustain the collection of feedback from CHWs, community partners, and organizations with similar systems to continually modify the database to meet the needs of users. A continuous quality improvement process was conducted monthly to evaluate CHW performance; feedback was exchanged at team and individual levels regarding the continuous quality improvement results and opportunities for improvement. Further, a 15-item feedback survey was distributed to all 33 COPE CHWs and supervisors for assessing the feasibility of database features, accessibility, and overall satisfaction. RESULTS At launch, the database had 60 active users in 20 counties. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE [Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences]) and continue with the longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. The database contains over 55,000 documented encounters across more than 5079 clients. Available resources from over 2500 community organizations have been documented. Survey data indicated that 84% (27/32) of the respondents considered the overall navigation of the database as very easy. The majority of the respondents indicated they were overall very satisfied (14/32, 44%) or satisfied (15/32, 48%) with the database. Open-ended responses indicated the database features, documentation of community organizations and visual confirmation of consent form and data storage on a Health Insurance Portability and Accountability Act-compliant record system, improved client engagement, enrollment processes, and identification of resources. CONCLUSIONS Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE database provides real-world data on CHW accomplishments, thereby improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings.
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Affiliation(s)
- Harshdeep Acharya
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, United States
| | - Kevin J Sykes
- Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, United States
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Ton Mirás Neira
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Angela Scott
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Christina M Pacheco
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Matthew Sanner
- Sanner Software Solutions, Kansas City, KS, United States
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | | | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Erin A Corriveau
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah Finocchario-Kessler
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
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Bernhart JA, Turner-McGrievy GM, DuBois KE, Sentman C, Rudisill C, Okpara N, Wilcox S, Clemons BD. Community Health Worker Implementation and Cost Analysis of a Plant-Based Nutrition Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:256-264. [PMID: 38310498 PMCID: PMC10999348 DOI: 10.1016/j.jneb.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVE This study describes program implementation through a research-restaurant partnership and assesses participant satisfaction, program costs, and percent body weight changes. METHODS Participants (n = 60) in a virtual synchronous (n = 43) or virtual asynchronous (n = 17) 12-week plant-based nutrition program received restaurant vouchers. Class satisfaction data were collected weekly. Assessments were completed at baseline, 3 months, and 9 months, along with interviews (n = 13) between 3 and 9 months. The costing approach estimated costs per participant. Interviews were coded using a content analysis and constant comparative method. RESULTS Participants rated the intervention favorably. Program costs were $198.63/participant, and participants' willingness to pay postintervention was $101.50 ± $63.90. Participants shared satisfaction with course content, the restaurant partnership, and suggestions for future delivery. No changes in participants' percent body weight were observed between 3 and 9 months (P = 0.98), indicating maintenance of 3-month weight loss. CONCLUSIONS AND IMPLICATIONS A research-restaurant partnership successfully implemented a nutrition program and generated positive feedback. With the lifting of coronavirus disease 2019 pandemic restrictions, future research can now test alternative implementation methods (in person vs online) in other restaurants.
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Affiliation(s)
- John A Bernhart
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - Gabrielle M Turner-McGrievy
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Kelli E DuBois
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Claudia Sentman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Caroline Rudisill
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Nkechi Okpara
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Gore R, Engelberg RS, Johnson D, Jebb O, Schwartz MD, Islam N. Integrating Community Health Workers' Dual Clinic-Community Role in Safety-Net Primary Care: Implementation Lessons from a Pragmatic Diabetes-Prevention Trial. J Gen Intern Med 2024; 39:774-781. [PMID: 37973708 PMCID: PMC11043246 DOI: 10.1007/s11606-023-08512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Over a third of US adults carry a diagnosis of prediabetes, 70% of whom may progress to type 2 diabetes mellitus ("diabetes"). Community health workers (CHWs) can help patients undertake healthy behavior to prevent diabetes. However, there is limited guidance to integrate CHWs in primary care, specifically to address CHWs' dual clinic-based and community-oriented role. OBJECTIVE Using evidence from CHWs' adaptations of a diabetes-prevention intervention in safety-net hospitals in New York City, we examine the nature, intent, and possible consequences of CHWs' actions on program fidelity. We propose strategies for integrating CHWs in primary care. DESIGN Case study drawing on the Model for Adaptation Design and Impact (MADI) to analyze CHWs' actions during implementation of CHORD (Community Health Outreach to Reduce Diabetes), a cluster-randomized pragmatic trial (2017-2022) at Manhattan VA and Bellevue Hospital. PARTICIPANTS CHWs and clinicians in the CHORD study, with a focus in this analysis on CHWs. APPROACH Semi-structured interviews and focus group discussion with CHWs (n=4); semi-structured interviews with clinicians (n=17). Interpretivist approach to explain CHWs' adaptations using a mix of inductive and deductive analysis. KEY RESULTS CHWs' adaptations extended the intervention in three ways: by extending social assistance, healthcare access, and operational tasks. The adaptations were intended to improve fit, reach, and retention, but likely had ripple effects on implementation outcomes. CHWs' focus on patients' complex social needs could divert them from judiciously managing their caseload. CONCLUSIONS CHWs' community knowledge can support patient engagement, but overextension of social assistance may detract from protocolized health-coaching goals. CHW programs in primary care should explicitly delineate CHWs' non-health support to patients, include multiprofessional teams or partnerships with community-based organizations, establish formal communication between CHWs and clinicians, and institute mechanisms to review and iterate CHWs' work to resolve challenges in their community-oriented role.
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Affiliation(s)
- Radhika Gore
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
| | - Rachel S Engelberg
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Danielle Johnson
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Bellevue Hospital Center, New York, NY, USA
| | - Olivia Jebb
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Bellevue Hospital Center, New York, NY, USA
| | - Mark D Schwartz
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- VA NY Harbor Health Care System, New York, NY, USA
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Panaite A, Desroches O, Warren É, Rouly G, Castonguay G, Boivin A. Engaging with peers to integrate community care: Knowledge synthesis and conceptual map. Health Expect 2024; 27:e14034. [PMID: 38567865 PMCID: PMC10989131 DOI: 10.1111/hex.14034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
CONTEXT Engaging with peers is gaining increasing interest from healthcare systems in numerous countries. Peers are people who offer support by drawing on lived experiences of significant challenges or 'insider' knowledge of communities. Growing evidence suggests that peers can serve as a bridge between underserved communities and care providers across sectors, through their ability to build trust and relationships. Peer support is thus seen as an innovative way to address core issues of formal healthcare, particularly fragmentation of care and health inequalities. The wide body of approaches, goals and models of peer support speaks volumes of such interest. Navigating the various labels used to name peers, however, can be daunting. Similar terms often hide critical differences. OBJECTIVES/BACKGROUND This article seeks to disentangle the conceptual multiplicity of peer support, presenting a conceptual map based on a 3-year knowledge synthesis project involving peers and programme stakeholders in Canada, and international scientific and grey literature. SYNTHESIS/MAIN RESULTS The map introduces six key questions to navigate and situate peer support approaches according to peers' roles, pathways and settings of practice, regardless of the terms used to label them. As a tool, it offers a broad overview of the different ways peers contribute to integrating health and community care. DISCUSSION We conclude by discussing the map's potential and limitations to establish a common language and bridge models, in support of knowledge exchange among practitioners, policymakers and researchers. PATIENT OR PUBLIC CONTRIBUTION Our team includes one experienced peer support worker. She contributed to the design of the conceptual map and the production of the manuscript. More than 10 peers working across Canada were also involved during research meetings to validate and refine the conceptual map.
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Affiliation(s)
- Andreea‐Cătălina Panaite
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
| | - Odile‐Anne Desroches
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
- School of Public HealthUniversité de MontréalMontréalQuébecCanada
| | - Émilie Warren
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
| | - Ghislaine Rouly
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
| | - Geneviève Castonguay
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
| | - Antoine Boivin
- Canada Research Chair in Partnership with Patients and CommunitiesCHUM Research CenterMontréalQuébecCanada
- School of Public HealthUniversité de MontréalMontréalQuébecCanada
- Department of Family MedicineUniversité de MontréalMontréalQuébecCanada
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Adsul N, Tyagi J, Bhaumik S. Community health workers for health systems resilience during COVID-19: protocol for qualitative evidence synthesis. BMJ Open 2024; 14:e074920. [PMID: 38531568 DOI: 10.1136/bmjopen-2023-074920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION COVID-19 exposed the fragility of health systems, where even the most basic health services in high-income and low-income and middle-income nations could not withstand the health systems shock due to the pandemic. Community health workers (CHWs) can contribute to improving the resilience of health systems, specifically to withstand shocks and emergencies and to avoid disruptions of routine service delivery. We aim to explore and understand the 'individual' and 'systems-level' resilience factors that shaped the involvement of CHWs in the COVID-19 response. METHODS AND ANALYSIS We will search five electronic databases (PubMed, Cochrane Library, EMBASE, CINAHL and SciELO (Spanish)) and conduct citation screening to identify studies on CHWs' response during the COVID-19 pandemic. Two review authors will independently screen the studies for inclusion and to extract data. The software Rayyan will be used to assist in screening the relevant literature. A thematic analysis approach will be followed to analyse and synthesise the qualitative evidence. The quality of the included studies will be critically assessed using the Critical Skills Appraisal Programme Tool. We will use the GRADE CERQual(Grading of Recommendations, Assessment, Development, and Evaluations - Confidence in the Evidence from Reviews of Qualitative Research) approach to assess certainty in the synthesised findings of the qualitative evidence. ETHICS AND DISSEMINATION This study will be conducted on published evidence, with no living participants; thus, no ethical approval is required. The final review will be submitted and published in a peer-reviewed journal. We will also develop a policy brief to communicate the review findings to the stakeholders.
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Affiliation(s)
- Neha Adsul
- Meta-research and Evidence Synthesis Unit, The George Institute for Global Health India, New Delhi, India
| | - Jyoti Tyagi
- Meta-research and Evidence Synthesis Unit, The George Institute for Global Health India, New Delhi, India
| | - Soumyadeep Bhaumik
- Meta-research and Evidence Synthesis Unit, The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia
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Wilson K, Agwuncha R, Franco-Castano J, Gilbert L. Assets in Primary Care: Community Health Workers Tackle Inequities in Texas. PRIMER (LEAWOOD, KAN.) 2024; 8:22. [PMID: 38681809 PMCID: PMC11051697 DOI: 10.22454/primer.2024.879447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
- Kennedi Wilson
- Tilman J. Fertitta Family College of Medicine at University of Houston, Houston, TX
| | - Rosemary Agwuncha
- Tilman J. Fertitta Family College of Medicine at University of Houston, Houston, TX
| | - Jason Franco-Castano
- Paul L. Foster School of Medicine at Texas Tech University Health Sciences Center El Paso, and Humana Integrated Health System Sciences Institute, El Paso, TX
| | - Lauren Gilbert
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine at University of Houston and Humana Integrated Health System Sciences Institute, Houston, TX
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18
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Rowe JT, Parrillo E, Stanford O, Wenzel J, Johnston FM. Individual and Systemic Barriers Blocking Community Health Workers from Helping the Seriously Ill. J Palliat Med 2024; 27:358-366. [PMID: 38010809 PMCID: PMC10903179 DOI: 10.1089/jpm.2022.0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Palliative care is a valuable component of health care that improves a patient's quality of life, yet its availability to patients with serious chronic illness remains relatively low. Due to their knowledge of community preferences and ability to improve patient education and access to care, community health workers (CHWs) can increase palliative care usage by patients. Notably, barriers to CHWs helping patients with serious chronic illness remain poorly understood. Objective: Explore the perception of barriers CHWs feel they face when attempting to support the health care of patients with serious chronic illness. Design: Qualitative semistructured individual interviews of CHWs and qualitative descriptive analysis. Setting/Subjects: Twelve CHWs who have worked with patients with serious chronic illness were recruited from the Johns Hopkins Healthcare LLC and the Baltimore Alliance for Careers in Healthcare organizations to virtually participate. Results: CHWs perceived both active and passive barriers that obstructed their efforts to work with seriously ill patients. CHWs shared that these barriers were dependent on themselves, their peers, and their work environments. Prevalent themes included interprofessional conflict, poor health care worker understanding of the CHW's role, and lack of access to quality resource organizations. CHWs noted job-specific training, better means to identify needed resources for patients, and inclusive health care teams as solutions to support their professional goals, while helping patients with serious illness. Conclusions: There are multiple perceived barriers to CHWs helping seriously ill patients. CHWs aiding patients with serious illness can be supported through better job training, better resource management tools, and improved communication between health care team members.
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Affiliation(s)
- Julian T. Rowe
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elaina Parrillo
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Olivia Stanford
- Community Outreach and Engagement Department, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fabian M. Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Joseph G. The role of sovereignty in Indigenous community-based health interventions: A qualitative metasynthesis. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 73:216-233. [PMID: 37058286 DOI: 10.1002/ajcp.12670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 06/01/2022] [Accepted: 01/10/2023] [Indexed: 06/19/2023]
Abstract
Indigenous peoples around the world suffer from health disparities attributed to a plethora of risk factors and social determinants of health stemming from colonialism and systemic oppression. Community-based health interventions have been identified as a means for addressing and reducing Indigenous health disparities by allowing for Indigenous sovereignty to be respected and centered. However, sovereignty relating to Indigenous health and well-being is underresearched. The present article explores the role of sovereignty in Indigenous community-based health interventions. A qualitative metasynthesis was conducted among 14 primary research studies co-authored by Indigenous people describing and evaluating Indigenous community-based health interventions. Five conceptual themes emerged as aspects of sovereignty which benefit Indigenous health and well-being outcomes: integration of culture; relocation of knowledge; connectedness; self-actualization; and stewardship. Implications are discussed, with the goal of creating a decolonial framework rooted in Indigenous epistemologies and perspectives for how sovereignty impacts Indigenous health, as well as strengthening a clear need for further research on and praxis of sovereignty in Indigenous healthcare.
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Affiliation(s)
- Gillian Joseph
- Center for World Indigenous Studies, Olympia, Washington, USA
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20
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Blondino CT, Knoepflmacher A, Johnson I, Fox C, Friedman L. The use and potential impact of digital health tools at the community level: results from a multi-country survey of community health workers. BMC Public Health 2024; 24:650. [PMID: 38429773 PMCID: PMC10905785 DOI: 10.1186/s12889-024-18062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/10/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Community health workers (CHWs) are increasingly viewed as a critical workforce to address health system strengthening and sustainable development goals. Optimizing and widening the capacity of this workforce through digital technology is currently underway, though there is skepticism regarding CHWs' willingness and optimism to engage in digital health. We sought to understand CHWs' perceptions on the use of digital health tools in their work. METHODS We obtained survey data from 1,141 CHWs from 28 countries with complete study information. We conducted regression analyses to explore the relationship between CHWs' training and perceived barriers to digital health access with current use of digital devices/tools and belief in digital impact while adjusting for demographic factors. RESULTS Most of the CHWs worked in Kenya (n = 502, 44%) followed by the Philippines (n = 308, 27%), Ghana (n = 107, 9.4%), and the United States (n = 70, 6.1%). There were significant, positive associations between digital tools training and digital device/tool use (Adjusted Odds Ratio (AOR) = 2.92, 95% CI = 2.09-4.13) and belief in digital impact (AORhigh impact = 3.03, 95% CI = 2.04-4.49). CHWs were significantly less likely to use digital devices for their work if they identified cost as a perceived barrier (AORmobile service cost = 0.68, 95% CI = 0.49-0.95; AORphone/device cost = 0.66, 95% CI = 0.47-0.92). CHWs who were optimistic about digital health, were early adopters of technology in their personal lives, and found great value in their work believed digital health helped them to have greater impact. Older age and greater tenure were associated with digital device/tool use and belief in digital impact, respectively. CONCLUSIONS CHWs are not an obstacle to digital health adoption or use. CHWs believe that digital tools can help them have more impact in their communities regardless of perceived barriers. However, cost is a barrier to digital device/tool use; potential solutions to cost constraints of technological access will benefit from further exploration of reimbursement models. Digital health tools have the potential to increase CHW capacity and shape the future of community health work.
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Affiliation(s)
- Courtney T Blondino
- Department of Health Studies, School of Arts and Sciences, University of Richmond, Richmond, VA, 23173, USA.
- Mercer, New York, NY, 10036, USA.
| | | | | | - Cameron Fox
- Platform for Shaping the Future of Health & Healthcare, World Economic Forum, New York, NY, 10017, USA
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Dickson CA, Ergun-Longmire B, Greydanus DE, Eke R, Giedeman B, Nickson NM, Hoang LN, Adabanya U, Payares DVP, Chahin S, McCrary J, White K, Moon JH, Haitova N, Deleon J, Apple RW. Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon). Dis Mon 2024; 70:101631. [PMID: 37739834 DOI: 10.1016/j.disamonth.2023.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.
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Affiliation(s)
- Cheryl A Dickson
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Berrin Ergun-Longmire
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ransome Eke
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Bethany Giedeman
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nikoli M Nickson
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | - Uzochukwu Adabanya
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Daniela V Pinto Payares
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Summer Chahin
- Department of Psychology, C.S. Mott Children's Hospital/Michigan Medicine, Ann Arbor, MI, United States
| | - Jerica McCrary
- Center for Rural Health and Health Disparities, Mercer University School of Medicine, Columbus, GA, United States
| | - Katie White
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Jin Hyung Moon
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Nizoramo Haitova
- Department of Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, MI, United States
| | - Jocelyn Deleon
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Roger W Apple
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
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Szarkowski A, Gale E, Moeller MP, Smith T, Birdsey BC, Moodie STF, Carr G, Stredler-Brown A, Yoshinaga-Itano C, Fcei-Dhh International Consensus Panel, Holzinger D. Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Structure Principles. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2024; 29:SI86-SI104. [PMID: 38422449 DOI: 10.1093/deafed/enad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 03/02/2024]
Abstract
This article is the seventh in a series of eight articles that comprise a special issue on family-centered early intervention for children who are deaf or hard of hearing and their families, or FCEI-DHH. This article, Structure Principles, is the third of three articles (preceded by Foundation Principles and Support Principles) that describe the 10 FCEI-DHH Principles. The Structure Principles include 4 Principles (Principle 7, Principle 8, Principle 9, and Principle 10) that highlight (a) the importance of trained and effective Early Intervention (EI) Providers, (b) the need for FCEI-DHH teams to work collaboratively to support families, (c) the considerations for tracking children's progress through developmental assessment, and (d) the essential role of progress monitoring to continuously improve systems.
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Affiliation(s)
- Amy Szarkowski
- The Institute, Children's Center for Communication/Beverly School for the Deaf, Beverly, MA, United States
- Institute for Community Inclusion, University of Massachusetts Boston, Boston, MA, United States
| | - Elaine Gale
- School of Education, Deaf and Hard-of-Hearing Program, Hunter College, City University of New York, New York, NY, United States
| | - Mary Pat Moeller
- Center for Childhood Deafness, Language & Learning, Boys Town National Research Hospital, Omaha, NE, United States
| | | | - Bianca C Birdsey
- Global Coalition of Parents of Children Who Are Deaf or Hard of Hearing (GPODHH), Durban, South Africa
| | - Sheila T F Moodie
- Health Sciences, School of Communication Sciences & Disorders, Western University, London, ON, Canada
| | - Gwen Carr
- Early Hearing Detection and Intervention and Family Centered Practice, London, United Kingdom
| | - Arlene Stredler-Brown
- Colorado Early Hearing Detection and Intervention Program, Colorado Department of Human Services, Denver, CO, United States
| | | | | | - Daniel Holzinger
- Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz, Austria
- Research Institute for Developmental Medicine, Johannes Kepler University, Linz, Austria
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Kuroda M, Shaw AV, Campagna CD. The experiences of community health workers when communicating with refugees about COVID-19 vaccines in Syracuse, NY: A qualitative study. Heliyon 2024; 10:e26136. [PMID: 38434037 PMCID: PMC10906162 DOI: 10.1016/j.heliyon.2024.e26136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024] Open
Abstract
Background Refugees are among the most health-vulnerable members of society. Despite the importance of vaccination to mitigate the risks associated with COVID-19 infection, ensuring adequate access and uptake of the COVID-19 vaccine remains a pressing concern for refugee populations. Research has suggested that community-oriented approaches and open communication with trusted individuals are essential to address this challenge. Vaccine outreach efforts were performed in Syracuse, NY, by Community Health Workers (CHWs) as trusted refugee community members. This study explored CHWs' experiences during vaccine outreach and perceptions about COVID-19 vaccine hesitancy and acceptance among refugees, including barriers and facilitators to vaccination. Methods A qualitative study was performed using thematic analysis following six semi-structured interviews with CHWs. Results Four main themes supported by 16 sub-themes were extracted. CHWs described the (1) diverse beliefs and attitudes of refugees by ethnic group, with most having low vaccine acceptance at first. (2) Barriers included contextual barriers, lack of awareness, misinformation, and withdrawal when forced from vaccine mandates. However, CHWs also identified numerous (3) facilitators to vaccination, including the internal processing and eventual vaccine acceptance, supported by external messaging by CHWs and time. Culturally sensitive intervention strategies occurred through (4) CHW team efforts and their provision of reliable information to refugee clients, with openness and over time. The team efforts of CHWs significantly contributed to refugee acceptance and uptake of the COVID-19 vaccine. Conclusions This study revealed how the refugee population changed their belief towards the COVID-19 vaccine through trust, time, and reliable information provided by CHWs and describes culturally sensitive strategies for vaccine uptake by refugees. CHWs' reflection on COVID-19 vaccine hesitancy and acceptance among refugees during outreach efforts is an essential perspective when implementing future public health interventions.
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Affiliation(s)
- Moe Kuroda
- Norton College of Medicine, MPH Program, SUNY Upstate Medical University, Syracuse, NY, USA
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of General Medicine, Toyama University Hospital, Toyama, Japan
| | - Andrea V. Shaw
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Christina D. Campagna
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Clark K, Messineo E, Bryant-Stephens T, Song A, Marx D, Lieberman A, Beidas RS, Wolk CB. Evaluating the implementation of a community health worker-delivered intervention integrating asthma care in West Philadelphia public schools. J Asthma 2024:1-11. [PMID: 38299937 DOI: 10.1080/02770903.2024.2313146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/29/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Schools are an important setting because students spend much of their time in school and engage in physical activity during the school day that could exacerbate asthma symptoms. Our objective is to understand the barriers and facilitators to implementing an experimental community health worker-delivered care coordination program for students with asthma within the context of the West Philadelphia Controls Asthma study. METHODS Surveys (n = 256) and semi-structured interviews (n = 41) were completed with principals, teachers, nurses, and community health workers from 21 public and charter schools in West Philadelphia between January 2019 and September 2021. Survey participants completed the Evidence Based Practice Attitudes Scale, the Implementation Leadership Scale, and Organizational Climate Index. Semi-structured qualitative interview guides were developed, informed by the Consolidated Framework for Implementation Research. RESULTS Participant responses indicate that they perceived benefits for schools and students related to the community health worker-based care coordination program. Several barriers and facilitators to implementing the program were noted, including challenges associated with incorporating the program into school nurse workflow, environmental triggers in the school environment, and challenges communicating with family members. An important facilitator that was identified was having supportive school administrators and staff who were engaged and saw the benefits of the program. CONCLUSIONS This work can inform implementation planning for other locales interested in implementing community-based pediatric asthma control programs delivered by community health workers in schools.
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Affiliation(s)
- Kayla Clark
- Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Messineo
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Tyra Bryant-Stephens
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Angela Song
- Department of Psychiatry, Kaiser Permanente, San Jose, CA, USA
| | - Darby Marx
- Joan & Sanford I. Weill Medical College of Cornell University, Ithaca, NY, USA
| | - Adina Lieberman
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Porterfield L, Santiago Delgado Z, Patel PG, Goodman ML, Campbell KM, Vaughan EM. Preparing Community Health Workers to Empower Latino(a)s With Diabetes: A Real-World Implementation Study. Sci Diabetes Self Manag Care 2024; 50:56-64. [PMID: 38243754 PMCID: PMC10851650 DOI: 10.1177/26350106231220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE The purpose of the study was to evaluate the delivery of diabetes self-management education (DSME) to Latino(a) adults by community health workers (CHWs). METHODS Investigators developed an evidence-based, bilingual (Spanish/English) diabetes education curriculum and trained 10 CHWs on its content. CHWs then implemented the curriculum in 6-month diabetes group visit programs for low-income Latino(a)s with type 2 diabetes in nonacademic 501(c)3 community clinics. Investigators evaluated efficacy of the training through successful implementation, measured by participant group visit acceptance and attendance. RESULTS Participants (n = 70) reported high levels of program satisfaction (3.8/4.0), improvement in quality of life (9.7/10), meeting of individual needs (3.8/4.0), and acceptability (9.7/10.0). Content analyses revealed that 87.1% of participants would not change the program or wanted to extend it. Participant attendance was 81.6%. CONCLUSIONS Investigators demonstrated the ability to develop a training that nonmedical personnel (CHWs) successfully implemented in a real-world study. This study provides a curricular framework for CHW-led education that may serve as a template to extend to other diseases and populations.
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Affiliation(s)
- Laura Porterfield
- Department of Family Medicine, University of Texas Medical Branch (UTMB), Galveston, Texas
- Sealy Institute for Vaccine Sciences, UTMB, Galveston, Texas
| | | | | | | | - Kendall M. Campbell
- Department of Family Medicine, University of Texas Medical Branch (UTMB), Galveston, Texas
| | - Elizabeth M. Vaughan
- Department of Internal Medicine, UTMB, Galveston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
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Nichols C. Equity and empowerment effects: Multiple styles of 'voluntarism' in community-based health projects. WORLD DEVELOPMENT 2024; 174:106448. [PMID: 38304852 PMCID: PMC10753287 DOI: 10.1016/j.worlddev.2023.106448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 02/03/2024]
Abstract
Community health workers (CHW) are individuals with no formal health training who perform various roles to address health disparities. There are long-sustained debates over how different forms of incentives shape CHW programs, which are often staffed with volunteer or minimally remunerated women. These debates are complicated by the diversity of CHW roles and contexts in which they work. Evidence is particularly scant around "change-agent" style CHWs, who shape health knowledge and norms within their community. This paper addresses this gap through an analysis of a change agent-staffed program that provided nutrition participatory education through women's groups in three eastern Indian sites. We examine how contextual factors across sites shaped change-agent management, and analyze the implications of each approach for efficacy, empowerment, and equity. Analyzing 68 interviews and 10 focus groups this study advances a typology of 'varieties' of voluntarism that we name laissez faire, active-cultivation, and honorarium-accountability, and uses comparative analysis to examine the equity and empowerment effects within selection, management, and payment. First, we find tensions in the community-based selection of volunteers because rather than selecting highly motivated women, groups selected women in the most favorable socioeconomic position to volunteer. Second, there is a tension around responsibility and expectations in that greater training and responsibility leads women to see more psychosocial empowerment (e.g., knowledge, confidence), but also may create more 'costs' to participation and leads to wider economic inequities in change-agent ranks. Third, we observe a misplaced focus on payments as central to change-agent motivation. While the two volunteer-only sites see payment as 'the answer' to motivation problems, the honorarium site sees payments as 'the problem' because they attract less intrinsically motivated individuals. We conclude that while payments may not make an unmotivated volunteer into a motivated one, this analysis suggests payments would potentially allow more marginalized women to participate, which may be key to making more equitable and efficacious impacts.
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Affiliation(s)
- Carly Nichols
- Department of Geographical and Sustainability Sciences, University of Iowa, 312 Jessup Hall, Iowa City, IA 52242, USA
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Varadharajan V, Subramaniyan B, Ramkumar V, Venkatesh L, Chandrasekar K. Field validation of an app based developmental and speech language screening (SRESHT screener) conducted by grass root workers. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2024; 26:101529. [PMID: 38623525 PMCID: PMC7615829 DOI: 10.1016/j.cegh.2024.101529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
This study validated an app-based developmental and speech language screening (SRESHT screener) conducted by Grass Roots Workers (GRWs) among children below six years of age in a rural community in the state of Tamil Nadu (the field). Method The study was carried out in two phases, first the training of GRWs and then the validation of the screening conducted by them using the app. For the training, suitable materials were developed, and the GRW's knowledge and skills were evaluated pre- and post-training. Two closed-ended questionnaires were used to evaluate the GRWs' knowledge about the screening tools. The Observed Structured Practical Examination (OSPE) method was used to evaluate their skill. All the participants were selected by convenience sampling and were screened independently by both a Speech Language Pathologist (SLP) and a GRW using the application. Cohen's kappa and percent agreement were used to determine agreement in screening results between the SLP and GRWs. Results All the GRWs scored at least 75 % and above in both the knowledge and skill assessments conducted post-training. "Substantial agreement" on kappa-based extent of agreement and "almost perfect" agreement on percent agreement were obtained between GRWs and SLP for the app-based screening. Conclusion The findings of this study imply that the app-based developmental and speech language screening performed in the community by GRWs is valid.
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Affiliation(s)
- Vasudharany Varadharajan
- Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - B Subramaniyan
- The Cleft & Craniofacial Centre, Department of Speech Language Pathology & Audiology, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, India
| | - Vidya Ramkumar
- Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - Lakshmi Venkatesh
- Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - Kavyashree Chandrasekar
- Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
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Fung A, Farmer J, Borkhoff CM. Young Infants Clinical Signs Study 8-sign Algorithm for Identification of Sick Infants Adapted for Routine Home Visits: A Systematic Review and Critical Appraisal of its Measurement Properties. Glob Pediatr Health 2024; 11:2333794X231219598. [PMID: 38283299 PMCID: PMC10812101 DOI: 10.1177/2333794x231219598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 10/12/2023] [Accepted: 11/23/2023] [Indexed: 01/30/2024] Open
Abstract
Objective. The 8-sign algorithm adapted from the Young Infants Clinical Signs Study (YICSS) is widely used to identify sick infants during home visits (YICSS-home algorithm). We aimed to critically appraise the development and evidence of measurement properties, including sensibility, reliability, and validity, of the YICSS-home algorithm. Methods. Relevant studies were identified through a systematic literature search. Results. The YICSS-home algorithm has good sensibility. The algorithm demonstrated at least moderate inter-rater reliability and sensitivity ranging from 69% to 80%. However, the algorithm was developed among sick infants brought for care to a health facility and not initially developed for use by community health workers (CHWs) during home visits. Some important risk factors were omitted at item generation. Inter-CHW reliability and construct validity have not been estimated. Conclusion. Future research should build on the strengths of the YICSS-home algorithm and address its limitations to develop a new algorithm with improved predictive accuracy.
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Affiliation(s)
- Alastair Fung
- Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | - Cornelia M. Borkhoff
- University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children Research Institute, Toronto, ON, Canada
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Vaugoyeau E, Rambliere L, David M, Lemguarni H, Le Gac S, Pasquet-Cadre A, Rasli S, Ghosn J, Rozenbaum W, Bouvet E, Prioux M. Proof of concept of a sexual health outreach program led by community health workers in homeless hostels in the greater Paris region. Front Public Health 2024; 11:1305874. [PMID: 38283290 PMCID: PMC10811606 DOI: 10.3389/fpubh.2023.1305874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/12/2023] [Indexed: 01/30/2024] Open
Abstract
Context Homeless individuals face exacerbated risks of infectious diseases, including sexually transmitted infections (STIs). Programs led by Community Health Workers (CHWs) have demonstrated potential to enhance healthcare access for marginalized groups such as homeless families. This study aims to evaluate the feasibility and effectiveness of a novel CHW-based outreach program addressing sexual health issues among individuals residing in homeless hostels. Methods Twelve social homeless hostels in the greater Paris region were selected as program implementation sites. An outreach program was developed consisting of two interventions: sexual health workshops and STI screening sessions (HIV and hepatitis B and C) accompanied by individual interviews, both conducted by CHWs within each hostel over an 8-week period and scheduled weekly. Feasibility, participation and engagement were evaluated using complementary methods including qualitative field observations, semi-structured interviews and focus groups with CHWs, satisfaction questionnaires for participants, and quantitative outcome data collection of each intervention. Results A total of 80 program activities (workshops and screening sessions) were conducted. Among the participants, 542 women and 30 men engaged in workshops. During the 30 Rapid Diagnostic Testing sessions, 150 individuals underwent testing for HIV, hepatitis B, and/or hepatitis C. Positivity rates were 6.7% for hepatitis B and 0.9% for hepatitis C. No HIV infections were detected. Participant satisfaction rates were consistently high (>76%) across workshops. Qualitative analysis unveiled two critical axes influencing program feasibility and effectiveness: program organization and CHW involvement. Discussion This assessment of the program highlights its feasibility among a population that is difficult to reach through conventional healthcare efforts. The intervention's potential effectiveness is suggested by self- and CHW-reported improvements in sexual health literacy and high rates of referral to the healthcare system, as well as holistic well-being considerations. CHW involvement is a vital determinant of program success, as are robust coordination among stakeholders, deep understanding of the target population, and strong partner engagement. Conclusion This outreach program amplifies the voices of often-overlooked populations while empowering them to navigate health and social challenges. Although these workshops serve as lifelines for those frequently excluded from mainstream services, long-term improvements to the health and wellbeing of homeless populations will necessitate systemic governmental intervention.
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Affiliation(s)
| | - Lison Rambliere
- Observatoire du Samusocial de Paris, Samusocial de Paris, Paris, France
| | - Manon David
- Pôle DELTA, Samusocial de Paris, Paris, France
| | | | | | | | - Samy Rasli
- Pôle DELTA, Samusocial de Paris, Paris, France
| | - Jade Ghosn
- COREVIH Île-de-France Nord, Paris, France
| | | | | | - Maëlle Prioux
- Pôle médical et soins, Samusocial de Paris, Paris, France
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Piamjariyakul U, McKenrick SR, Smothers A, Giolzetti A, Melnick H, Beaver M, Shafique S, Wang K, Carte KJ, Grimes B, Haut MW, Navia RO, Patrick JH, Wilhelmsen K. Developing, implementing, and evaluating the visiting Neighbors' program in rural Appalachia: A quality improvement protocol. PLoS One 2024; 19:e0296438. [PMID: 38166130 PMCID: PMC10760886 DOI: 10.1371/journal.pone.0296438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Older adults living alone in rural areas frequently experience health declines, social isolation, and limited access to services. To address these challenges, our medical academic university supported a quality improvement project for developing and evaluating the Visiting Neighbors program in two rural Appalachian counties. Our Visiting Neighbors program trained local volunteers to visit and guide rural older adults in healthy activities. These age-appropriate activities (Mingle, Manage, and Move- 3M's) were designed to improve the functional health of older adults. The program includes four in-home visits and four follow-up telephone calls across three months. PURPOSE The purpose of this paper was to describe the 3M's Visiting Neighbors protocol steps guiding the quality improvement procedures relating to program development, implementation, and evaluation. METHODS AND MATERIALS This Visiting Neighbors study used a single-group exploratory quality improvement design. This program was tested using quality improvement standards, including collecting participant questionnaires and visit observations. RESULTS Older adults (> 65 years) living alone (N = 30) participants were female (79%) with a mean age of 82.96 (SD = 7.87) years. Volunteer visitor participants (N = 10) were older adult females. Two volunteer visitors implemented each visit, guided by the 3M's activities manual. All visits were verified as being consistently delivered (fidelity). Enrollment and retention data found the program was feasible to conduct. The older adult participants' total program helpfulness ratings (1 to 5) were high (M = 51.27, SD = 3.77). All volunteer visitor's program helpfulness ratings were also high (M = 51.78, SD = 3.73). DISCUSSION The Visiting Neighbors program consistently engaged older Appalachian adults living alone in the 3M's activities. The feasibility and fidelity of the 3M's home visits were verified. The quality improvement processes included engaging the expert advisory committee and rural county stakeholders to ensure the quality of the program development, implementation, and evaluation.
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Affiliation(s)
- Ubolrat Piamjariyakul
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Susan R. McKenrick
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Angel Smothers
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Angelo Giolzetti
- West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Helen Melnick
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Molly Beaver
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Saima Shafique
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Kesheng Wang
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Kerri J. Carte
- Family & Community Development, West Virginia University-Extension, Kanawha County, Charleston, WV, United States of America
| | - Brad Grimes
- Meredith Center for Career Services and Professional Development, West Virginia University College of Law, Morgantown, WV, United States of America
| | - Marc W. Haut
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Department of Behavioral Medicine/Psychiatry, Director, Memory Health Clinic, Rockefeller Neuroscience Institute, Morgantown, WV, United States of America
| | - R. Osvaldo Navia
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Division Chief of Geriatrics, Palliative Medicine & Hospice and Grace Kinney Mead Chair of Geriatrics, West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Julie Hicks Patrick
- Life-Span Developmental Psychology, West Virginia University, Morgantown, WV, United States of America
| | - Kirk Wilhelmsen
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Chief Cognitive Neurology, Rockefeller Neuroscience Institute, Morgantown, WV, United States of America
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Kaysin A, Antoniello P, Agarwal S, Perry H. Strategies for Sustained Empowerment of Community Health Workers: A Qualitative Analysis of the Comprehensive Rural Health Project in Jamkhed, India. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241235059. [PMID: 38424697 PMCID: PMC10908227 DOI: 10.1177/00469580241235059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/29/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
To understand the core aspects of an empowerment-based Community Health Worker (CHW) training program, we studied the model of the Comprehensive Rural Health Project (CRHP) in Jamkhed, India-an organization known for facilitating empowerment of women as Village Health Workers (VHWs) and agents of community change. We define empowerment as a means by which individuals gain health and development-related skills and knowledge to facilitate positive change within their lives and communities. Using VHW training observations and semi-structured interviews with health workers and senior trainers, 6 themes were developed and applied in 4 focus group sessions with 18 multigenerational VHWs trained by the CRHP. Transcripts were qualitatively analyzed under 6 themes-selection, baseline training, continuing education and support, community participation, community empowerment, and commitment and longevity. Empowerment of VHWs was found to be an intentional process involving the creation of safe and supportive environments conducive to long-term participatory and experiential learning with professionals who facilitate and mentor. The impact of the baseline training is maintained through ongoing program-VHW interactions and knowledge reinforcement in both the field and training center. Importantly, these interactions reinforce VHWs' credibility and confidence in communities served. Community participation was found to be of key importance starting at the selection phase. The methods used for selection, training and ongoing support are critical to developing a cadre of competent, effective and motivated VHWs as well as fostering long-lasting self-development and leadership skills. Downstream effectiveness of community empowerment on health outcomes is demonstrated through indicators such as access to safe deliveries, declining child malnutrition rates, high vaccination rates as well as reductions in stigmatization of illness and caste discrimination.
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Affiliation(s)
- Alexander Kaysin
- Department of Family Medicine, University of Maryland Capital Region Health, Largo, MD, USA
| | - Patricia Antoniello
- Department of Anthropology and Archeology, Brooklyn College of the City University of New York, Brooklyn, NY, USA
| | - Smisha Agarwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henry Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Yoon HS, Teshome BF, Eisenbeis A, Micek ST. Pharmacy technicians trained as community health workers: A prospective multicenter cohort study. J Am Pharm Assoc (2003) 2024; 64:47-54.e1. [PMID: 37673283 DOI: 10.1016/j.japh.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Community health workers (CHWs) are health professionals who are experts in linking patients to health resources. Although CHWs are employed in a variety of health institutions, access to their services may be challenging for patients in underserved locations. Community pharmacies are uniquely positioned to mitigate this barrier as they provide readily accessible care for patients residing in these areas. OBJECTIVES To 1) quantify and report the CHW services provided by certified pharmacy technicians (CPhTs) in an underserved population and 2) provide an initial framework for the implementation of CHW services in community pharmacies or similar health care settings. METHODS This prospective cohort study reports the findings of training CPhTs as CHWs in 3 independent community pharmacies from January 1, 2021 to July 1, 2021. CPhT-CHWs conducted monthly visits by phone, patient home, or pharmacy and documented services using a standardized assessment form. Descriptive statistics were used to summarize the baseline characteristics of the patient population, service codes, types of services and referrals made, and time spent per visit by CPhT-CHWs. RESULTS A total of 198 patient visits by phone, patient home, or at the pharmacy were completed in a 6-month timespan. During these visits, the CPhT-CHW provided 351 services (203 primary services and 149 secondary services) and completed 51 referrals. The average time spent per visit (standard deviation) was 15.5 (11.5) 68.9 (35.4), and 30.6 (16.8) minutes for phone, home, and pharmacy visits, respectively. Patient home visits resulted in the highest average primary services per visit, longest time spent with the patient, and accounted for a majority of social services. CONCLUSION CPhT-CHWs were able to use various methods to contact these patients to further develop patient-to-provider and patient-to-pharmacy relationships. Training CPhTs as CHWs can be an effective way to increase patient contact and provide additional health services.
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Shrivastava R, Singh A, Khan A, Choubey S, Haney JR, Karyotaki E, Tugnawat D, Bhan A, Naslund JA. Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India. SSM - MENTAL HEALTH 2023; 4:100230. [PMID: 38188869 PMCID: PMC10769151 DOI: 10.1016/j.ssmmh.2023.100230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background Community health workers (CHWs) face high levels of stress (both professional and personal) and risk of burnout, highlighting the need for efforts to promote their mental health and well-being. This study seeks to develop a digital stress reduction program for CHWs in rural India. Methods A stepwise design process was employed to adapt and digitize the evidence-based World Health Organization's Self-Help Plus (SH+) intervention for addressing psychological distress among CHWs in Madhya Pradesh, India. This involved participatory design workshops with CHWs to ensure that the digital stress reduction intervention would be relevant for their needs and the local culture and context. Small groups of CHWs reviewed the adapted program content, allowing the research team to make refinements such as simplifying language, tailoring content to the local setting, and ensuring that program materials are both interesting and relevant. Simultaneously, the research team digitized the content, leveraging a combination of video and graphical content, and uploaded it to the Sangath Learning Management System, a digital platform accessible on a smartphone app. Results In total, 18 CHWs contributed to the adaptation of the SH+ content and digital intervention development. Participants commented on finding some terms difficult to follow and recommended simplifying the language and providing detailed explanations. Participants offered positive feedback on the adapted content, expressing that they found the examples covered in the material both relatable and relevant to their own personal experiences at home and in the workplace. By combining participants' insights and comments with feedback from content experts, it was possible to finalize a digital Hindi version of the SH+ intervention for CHWs in rural India. Conclusions This study is timely given the continued detrimental impacts of the COVID-19 pandemic, and offers a promising and potentially scalable digital program to alleviate psychological distress among frontline health workers.
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Affiliation(s)
| | | | | | | | | | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Babalola O, Levin J, Goudge J, Griffiths F. Community health workers' quality of comprehensive care: a cross-sectional observational study across three districts in South Africa. Front Public Health 2023; 11:1180663. [PMID: 38162597 PMCID: PMC10755947 DOI: 10.3389/fpubh.2023.1180663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Background Community healthcare worker (CHW) training programs are becoming increasingly comprehensive (an expanded range of diseases). However, the CHWs that the program relies on have limited training. Since CHWs' activities occur largely during household visits, which often go unsupervised and unassessed, long-term, ongoing assessment is needed to identify gaps in CHW competency, and improve any such gaps. We observed CHWs during household visits and gave scores according to the proportion of health messages/activities provided for the health conditions encountered in households. We aimed to determine (1) messages/activities scores derived from the proportion of health messages given in the households by CHWs who provide comprehensive care in South Africa, and (2) the associated factors. Methods In three districts (from two provinces), we trained five fieldworkers to score the messages provided by, and activities of, 34 CHWs that we randomly selected during 376 household visits in 2018 and 2020 using a cross-sectional study designs. Multilevel models were fitted to identify factors associated with the messages/activities scores, adjusted for the clustering of observations within CHWs. The models were adjusted for fieldworkers and study facilities (n = 5, respectively) as fixed effects. CHW-related (age, education level, and phase of CHW training attended/passed) and household-related factors (household size [number of persons per household], number of conditions per household, and number of persons with a condition [hypertension, diabetes, HIV, tuberculosis TB, and cough]) were investigated. Results In the final model, messages/activities scores increased with each extra 5-min increase in visit duration. Messages/activities scores were lower for households with either children/babies, hypertension, diabetes, a large household size, numerous household conditions, and members with either TB or cough. Increasing household size and number of conditions, also lower the score. The messages/activities scores were not associated with any CHW characteristics, including education and training. Conclusion This study identifies important factors related to the messages provided by and the activities of CHWs across CHW teams. Increasing efforts are needed to ensure that CHWs who provide comprehensive care are supported given the wider range of conditions for which they provide messages/activities, especially in households with hypertension, diabetes, TB/cough, and children or babies.
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Affiliation(s)
- Olukemi Babalola
- Center for Health Policy, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Jonathan Levin
- Division of Epidemiology and Biostatistics, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Jane Goudge
- Center for Health Policy, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
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Encina-Zúñiga E, Rodante D, Agrest M, Tapia-Munoz T, Vidal-Zamora I, Ardila-Gómez S, Alvarado R, Leiderman EA, Reavley N. Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile. BMC Psychiatry 2023; 23:928. [PMID: 38082256 PMCID: PMC10712185 DOI: 10.1186/s12888-023-05417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context. METHODS A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as "essential" or "important" from both panels. RESULTS Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts' reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs. CONCLUSIONS A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina.
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Affiliation(s)
- Esteban Encina-Zúñiga
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Chile, Santiago, Chile.
| | - Demián Rodante
- Facultad de Medicina, Instituto de Farmacología, Universidad de Buenos Aires, Buenos Aires, Argentina
- Fundación Foro para la salud mental, Buenos Aires, Argentina
| | - Martín Agrest
- Proyecto Suma, Güemes 4130 (1425), Ciudad Autónoma de Buenos Aires, Argentina
- Facultad de Psicología, Universidad de Buenos Aires, Instituto de Investigaciones, Buenos Aires, Argentina
| | - Thamara Tapia-Munoz
- Department of Behavioural Science and Health, University College London, London, UK
| | - Isidora Vidal-Zamora
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Chile, Santiago, Chile
| | - Sara Ardila-Gómez
- Facultad de Psicología, Universidad de Buenos Aires, Instituto de Investigaciones, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Rosario, Santa Fe, Argentina
| | - Rubén Alvarado
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Salud Pública, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Eduardo A Leiderman
- Departamento de Neurociencias, Facultad de Ciencias Sociales, Universidad de Palermo, Buenos Aires, Argentina
| | - Nicola Reavley
- Melbourne School of Population and Global Health, Centre for Mental Health, University of Melbourne, Victoria, Australia
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Kasper T, Yamey G, Dwyer S, McDade KK, Lidén J, Lüdemann C, Diab MM, Ogbuoji O, Poodla P, Schrade C, Thoumi A, Zimmerman A, Assefa Y, Allen LN, Basinga P, Garcia PJ, Jackson D, Mwanyika H, Nugent R, Ofosu A, Rawaf S, Reddy KS, Settle D, Tritter B, Benn C. Rethinking how development assistance for health can catalyse progress on primary health care. Lancet 2023; 402:2253-2264. [PMID: 37967568 DOI: 10.1016/s0140-6736(23)01813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 11/17/2023]
Abstract
Global campaigns to control HIV, tuberculosis, malaria, and vaccine-preventable illnesses showed that large-scale impact can be achieved by using additional international financing to support selected, evidence-based, high-impact investment areas and to catalyse domestic resource mobilisation. Building on this paradigm, we make the case for targeting additional international funding for selected high-impact investments in primary health care. We have identified and costed a set of concrete, evidence-based investments that donors could support, which would be expected to have major impacts at an affordable cost. These investments are in: (1) individuals and communities empowered to engage in health decision making, (2) a new model of people-centred primary care, and (3) next generation community health workers. These three areas would be supported by strengthening two cross-cutting elements of national systems. The first is the digital tools and data that support facility, district, and national managers to improve processes, quality of care, and accountability across primary health care. The second is the educational, training, and supervisory systems needed to improve the quality of care. We estimate that with an additional international investment of between US$1·87 billion in a low-investment scenario and $3·85 billion in a high-investment scenario annually over the next 3 years, the international community could support the scale-up of this evidence-based package of investments in the 59 low-income and middle-income countries that are eligible for external financing from the World Bank Group's International Development Association.
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Affiliation(s)
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA.
| | | | - Kaci Kennedy McDade
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | | | - Mohamed Mustafa Diab
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Osondu Ogbuoji
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | | | - Andrea Thoumi
- Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Armand Zimmerman
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Luke N Allen
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Paulin Basinga
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Patricia J Garcia
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Debra Jackson
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rachel Nugent
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Alavi S, Nishar S, Morales A, Vanjani R, Guy A, Soske J. 'We need to get paid for our value': Work-place experiences and role definitions of peer recovery specialists/community health workers. ALCOHOLISM TREATMENT QUARTERLY 2023; 42:95-114. [PMID: 38352063 PMCID: PMC10861181 DOI: 10.1080/07347324.2023.2272797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Despite growing research on peer recovery specialists and community health workers (CHWs) in fields such as substance use disorder (SUD) treatment and recovery support, their workplace experiences are little understood. Through semi-structured interviews with 21 CHWs and peer recovery specialists working within substance use disorder treatment and/or traditional health care settings, we identified six prevalent themes: Benefits/Pleasures of the Role; Reciprocity; Challenges; Duality of Lived Experience; Relationships with Medical Professionals and Supervisors; and Defining Metrics. These themes reveal a complex narrative of system failures, organizational hierarchies, and experiential realities in which shared experiences and personal connections with clients undergird both positive and negative aspects of the role. In the words of one study participant: "We have not taken a vow of poverty, we need to get paid for our value."
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Affiliation(s)
- Sara Alavi
- Health and Human Biology, Brown University, Providence, USA
| | - Shivani Nishar
- Center for Health and Justice Transformation, Rhode Island Hospital, Providence, USA
| | | | - Rahul Vanjani
- Warren Alpert School of Medicine, Brown University, Providence, USA; Amos House, Providence, USA
| | - Arryn Guy
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, USA
| | - Jon Soske
- Lifespan Division of Addiction Medicine, Rhode Island Hospital, Providence, USA
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Kitzman H, Dodgen L, Vargas C, Khan M, Montgomery A, Patel M, Ajoku B, Allison P, Strauss AM, Bowen M. Community health worker navigation to improve allostatic load: The Integrated Population Health (IPOP) study. Contemp Clin Trials Commun 2023; 36:101235. [PMID: 38156244 PMCID: PMC10753173 DOI: 10.1016/j.conctc.2023.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 12/30/2023] Open
Abstract
Background Social determinants of health (SDOH) and cumulative stress contribute to chronic disease development. The physiological response to repeated stressors typical of lower-income environments can be measured through allostatic load - a composite measure of cardiovascular, metabolic, and immune variables. Healthcare systems have employed patient navigation for social and medical needs to improve SDOH that has demonstrated limited impact on chronic disease outcomes. This study evaluates a novel community health worker navigation intervention developed using behavioral theories to improve access to social and medical services and provide social support for poverty stressed adults. Methods The Integrated Population Health Study (IPOP) study is a randomized, parallel two arm study evaluating community health worker navigation in addition to an existing integrated population health program (IPOP CHW) as compared to Usual Care (population health program only, IPOP) on allostatic load and chronic disease risk factors. IPOP CHW participants receive a 10-month navigation intervention. Results From 381 screened individuals, a total of 202 participants (age 58.15 ± 12.03 years, 74.75 % female, 79.21 % Black/African American, 17.33 % Hispanic) were enrolled and randomized to IPOP CHW (n = 100) or IPOP Only (n = 102). Conclusion This study will evaluate whether CHW navigation, using a structured intervention based on health behavior theories, can effectively guide poverty stressed individuals to address social and medical needs to improve allostatic load-a composite of cumulative stress and physiological responses. Healthcare systems, nonprofit organizations, and governmental entities are interested in addressing SDOH to improve health, thus developing evidence-based interventions could have broad clinical and policy implications.
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Affiliation(s)
- Heather Kitzman
- Peter J. O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Leilani Dodgen
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Cristian Vargas
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Mahbuba Khan
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Aisha Montgomery
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Meera Patel
- Peter J. O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Brittany Ajoku
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Patricia Allison
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | | | - Michael Bowen
- Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Hancock H, Carlson O, Hempstone H, Arnold B, Hoffmann K, Gul X, Spielman K. Six Recommendations for Provider Behavior Change in Family Planning. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200495. [PMID: 38035718 DOI: 10.9745/ghsp-d-22-00495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/21/2023] [Indexed: 12/02/2023]
Abstract
Health care provider behavior has the power to influence family planning and reproductive health outcomes positively and negatively, underlining the importance of provider behavior change (PBC) initiatives. However, global health practitioners lack a shared understanding of PBC interventions and what influences provider behavior. Furthermore, PBC interventions in family planning and reproductive health have tended to address individual and workplace environmental factors rather than the full breadth of factors that influence provider behavior, including the broader systems and contexts where providers operate. This commentary contributes to a common understanding of PBC, including the determinants of provider behavior, and describes actions to advance PBC efforts in family planning and reproductive health. To inform these considerations, we conducted a narrative review of more than 70 articles and project materials describing interventions that aimed to change provider behaviors pertaining to family planning and reproductive health and used the review to identify the most and least common provider cadres addressed, behavioral determinants targeted, and strategies implemented. We strongly encourage global health practitioners to design future PBC interventions for a more diverse set of cadres and contexts, consider the full set of factors that influence provider behavior, pair provider- and client-side interventions, shift the narrative around PBC from "blaming" to supporting providers, move beyond training-only interventions, and improve the rigor of measurement and evidence-building efforts for PBC. These considerations can be used to advance the field of PBC in family planning and reproductive health to improve outcomes across the service delivery continuum.
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Affiliation(s)
- Heather Hancock
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Olivia Carlson
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.
| | | | | | - Kamden Hoffmann
- USAID/MOMENTUM Integrated Health Resilience, IMA World Health, Washington, DC, USA
| | - Xaher Gul
- Pathfinder International, Watertown, MA, USA
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Dahal U, Tamang RL, Dræbel TA, Neupane D, Koirala Adhikari S, Soti PB, Gyawali B. Female community health volunteers' experience in navigating social context while providing basic diabetes services in western Nepal: Social capital and beyond from systems thinking. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002632. [PMID: 37992049 PMCID: PMC10664953 DOI: 10.1371/journal.pgph.0002632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
The global burden of non-communicable diseases (NCDs) has led to an increased mobilization of community health workers (CHWs) in the prevention and management of NCDs, particularly in resource-poor settings. However, little is known about the experiences of CHWs as they navigate the complex social context while proving home-based NCD management. This study aims to explore the experiences of female community health volunteers (FCHVs) in a community-based pilot project in western Nepal, specially regarding the social challenges they face while delivering basic type 2 diabetes (T2D) services. Using a qualitative phenomenological approach, the study conducted two focus group discussions and nine in-depth interviews with a total of 14 and 9 FCHVs, respectively. Social Capital theory was employed to understand the sociological aspects. The findings shed light on the challenges encountered by FCHVs in expanding their social networks, building trust, and fostering reciprocity among T2D intervention recepients. Notably, social trust was a significant challenge, compounded by power dynamics related to gender and socioeconomic status. FCHVs managed to overcome these challenges through their perseverance, self-motivation, and leaveraging their strong bonding and linking social capital. The recognition they received from the community played a crucial role in sustaining their motivation. The study highlights the importance of FCHVs' strong social capital, supported by available resources and personal motivation, in overcoming social obstacles. It is imperative for community health interventions to anticipate challenges across various elements of social capital to ensure the long-term retention and motivation of CHWs. Establishing appropriate support systems that address personal motivating factors and the strengthen social capital is essential.
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Affiliation(s)
- Usha Dahal
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rekha Lama Tamang
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tania Aase Dræbel
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dinesh Neupane
- Nepal Development Society, Kaski, Nepal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | | | | | - Bishal Gyawali
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Maraschin FG, Adella FJ, Nagraj S. A scoping review of the post-discharge care needs of babies requiring surgery in the first year of life. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002424. [PMID: 37992047 PMCID: PMC10664918 DOI: 10.1371/journal.pgph.0002424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
Congenital anomalies are among the leading causes of under-5 mortality, predominantly impacting low- and middle-income countries (LMICs). A particularly vulnerable group are babies with congenital disorders requiring surgery in their first year. Addressing this is crucial to meet SDG-3, necessitating targeted efforts. Post-discharge, these infants have various care needs provided by caregivers, yet literature on these needs is scant. Our scoping review aimed to identify the complex care needs of babies post-surgery for critical congenital cardiac conditions and non-cardiac conditions. Employing the Joanna Briggs Institute's methodological framework for scoping reviews we searched Pubmed, EMBASE, CINAHL, PsychINFO, and Web of Science databases. Search terms included i) specific congenital conditions (informed by the literature and surgeons in the field), ii) post-discharge care, and iii) newborns/infants. English papers published between 2002-2022 were included. Findings were summarised using a narrative synthesis. Searches yielded a total of 10,278 papers, with 40 meeting inclusion criteria. 80% of studies were conducted in High-Income Countries (HICs). Complex care needs were shared between cardiac and non-cardiac congenital conditions. Major themes identified included 1. Monitoring, 2. Feeding, and 3. Specific care needs. Sub-themes included monitoring (oxygen, weight, oral intake), additional supervision, general feeding, assistive feeding, condition-specific practices e.g., stoma care, and general care. The post-discharge period poses a challenge for caregivers of babies requiring surgery within the first year of life. This is particularly the case for caregivers in LMICs where access to surgical care is challenging and imposes a financial burden. Parents need to be prepared to manage feeding, monitoring, and specific care needs for their infants before hospital discharge and require subsequent support in the community. Despite the burden of congenital anomalies occurring in LMICs, most of the literature is HIC-based. More research of this nature is essential to guide families caring for their infants post-surgical care.
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Affiliation(s)
- Francesca Giulia Maraschin
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
| | - Fidelis Jacklyn Adella
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
| | - Shobhana Nagraj
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
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Carson M, Fernandez A, Martin M. A Review of Community Health Worker Interventions for Latinx/o/a Individuals With Unhealthy Alcohol Use. J Addict Med 2023; 17:717-721. [PMID: 37934543 DOI: 10.1097/adm.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
ABSTRACT Unhealthy alcohol use (UAU) affects nearly 1 in 4 Latinx/o/a individuals in the United States (US). Compared with White individuals, Latinx/o/a individuals with UAU face increased morbidity, decreased access to addiction treatment, and higher rates of incarceration. Community health workers (CHWs), also known as promotores, provide culturally and linguistically informed services while augmenting social and health care interventions. Although there is extensive literature evaluating the role of CHW interventions for chronic conditions including hypertension and diabetes, less is known about CHW interventions for UAU in the US. To better understand how CHWs can address UAU in the Latinx/o/a community in the US, we performed a scoping review of the literature for CHW interventions for UAU in the Latinx/o/a population. We reviewed publications up to March 8, 2022, which described CHW interventions for UAU in Latinx/o/a individuals in the US and identified 6 publications that met inclusion criteria after full-text review. These publications included 3 randomized controlled trials, 2 follow-up feasibility and acceptability assessments within the randomized controlled trial intervention group, and a pre-post noncontrolled feasibility study. All interventions were brief, with low-intensity touchpoints between CHWs and patients. None included medications for alcohol use disorder. We found few publications related to CHW-delivered interventions for UAU within the Latinx/o/a population. Given the acceptance and success of CHW-delivered interventions other conditions, as well as the increasing use of CHWs in the US, we need to invest in research that examines the efficacy of the CHWs in UAU.
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Affiliation(s)
- Mariam Carson
- From the Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
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Bakkabulindi P, Ampeire I, Ayebale L, Mubiri P, Feletto M, Muhumuza S. Engagement of community health workers to improve immunization coverage through addressing inequities and enhancing data quality and use is a feasible and effective approach: An implementation study in Uganda. PLoS One 2023; 18:e0292053. [PMID: 37856451 PMCID: PMC10586601 DOI: 10.1371/journal.pone.0292053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Uganda, like many other developing countries, faces the challenges of unreliable estimates for its immunization target population. Strengthening immunization data quality and its use for improving immunization program performance are critical steps toward improving coverage and equity of immunization programs. The goal of this study was to determine the effectiveness of using community health workers (CHWs) to obtain quality and reliable data that can be used for planning and evidence-based response actions. METHODS An implementation study in which 5 health facilities were stratified and randomized in two groups to (i) receive a package of interventions including monthly health unit immunization data audit meetings, and defaulter tracking and linkage and (ii) to serve as a control group was conducted between July and September 2020. Immunization coverage of infants in both arms was determined by a review of records three months before and after the study interventions. In addition, key informant and in-depth interviews were conducted among facility-based health workers and CHWs respectively, at the endline to explore the feasibility of the interventions. RESULTS Overall, a total of 2,048 children under one year eligible for immunization were registered in Bukabooli sub-county by CHWs as compared to the estimated district population of 1,889 children representing a moderate variance of 8.4%. The study further showed that it is feasible to use CHWs to track and link defaulters to points of immunization services as more than two-thirds (68%) of the children defaulting returned for catch-up immunization services. At the endline, immunization coverage for the Oral Polio Vaccine third dose; Rotavirus vaccine second dose; Pneumococcal Conjugate Vaccine third dose increased in both the intervention and control health facilities. There was a decrease in coverage for the Measles-Rubella vaccine decreased in the intervention health facilities and a decrease in Bacillus Calmette-Guérin vaccine coverage in the control facilities. Difference in difference analysis demonstrated that the intervention caused a significant 35.1% increase in coverage of Bacillus Calmette-Guérin vaccine (CI 9.00-61.19; p<0.05)). The intervention facilities had a 17.9% increase in DTP3 coverage compared to the control facilities (CI: 1.69-34.1) while for MR, OPV3, and Rota2 antigens, there was no significant effect of the intervention. CONCLUSION The use of CHWs to obtain reliable population estimates is feasible and can be useful in areas with consistently poor immunization coverage to estimate the target population. Facilitating monthly health unit immunization data audit meetings to identify, track, and link defaulters to immunization services is effective in increasing immunization coverage and equity.
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Affiliation(s)
- Pamela Bakkabulindi
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Health Support Initiatives, Kampala, Uganda
| | | | - Lillian Ayebale
- Health Support Initiatives, Kampala, Uganda
- School of Statistics and Planning, Department of Population Studies Makerere University, Kampala, Uganda
| | - Paul Mubiri
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Simon Muhumuza
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Layer E, Slim S, Mussa I, Al-Mafazy AW, Besana GVR, Msellem M, Fulcher I, Hornung H, Lampariello R. The Journey of Zanzibar's Digitally Enabled Community Health Program to National Scale: Implementation Report. JMIR Med Inform 2023; 11:e48097. [PMID: 37812488 PMCID: PMC10594132 DOI: 10.2196/48097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/19/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND While high-quality primary health care services can meet 80%-90% of health needs over a person's lifetime, this potential is severely hindered in many low-resource countries by a constrained health care system. There is a growing consensus that effectively designed, resourced, and managed community health worker programs are a critical component of a well-functioning primary health system, and digital technology is recognized as an important enabler of health systems transformation. OBJECTIVE In this implementation report, we describe the design and rollout of Zanzibar's national, digitally enabled community health program-Jamii ni Afya. METHODS Since 2010, D-tree International has partnered with the Ministry of Health Zanzibar to pilot and generate evidence for a digitally enabled community health program, which was formally adopted and scaled nationally by the government in 2018. Community health workers use a mobile app that guides service delivery and data collection for home-based health services, resulting in comprehensive service delivery, access to real-time data, efficient management of resources, and continuous quality improvement. RESULTS The Zanzibar government has documented increases in the delivery of health facilities among pregnant women and reductions in stunting among children younger than 5 years since the community health program has scaled. Key success factors included starting with the health challenge and local context rather than the technology, usage of data for decision-making, and extensive collaboration with local and global partners and funders. Lessons learned include the significant time it takes to scale and institutionalize a digital health systems innovation due to the time to generate evidence, change opinions, and build capacity. CONCLUSIONS Jamii ni Afya represents one of the world's first examples of a nationally scaled digitally enabled community health program. This implementation report outlines key successes and lessons learned, which may have applicability to other governments and partners working to sustainably strengthen primary health systems.
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Affiliation(s)
- Erica Layer
- D-tree International, Norwell, MA, United States
| | - Salim Slim
- Ministry of Health, Zanzibar, United Republic of Tanzania
| | - Issa Mussa
- D-tree International, Zanzibar, United Republic of Tanzania
| | | | | | - Mwinyi Msellem
- Ministry of Health, Public Health Laboratory, Zanzibar, United Republic of Tanzania
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Katena NA, Shamu S, Fana GT, Rusakaniko S. Effects of a Community Health Worker-Led Health Literacy Intervention on Lifestyle Modification Among Patients With Hypertension and Diabetes in the City of Harare, Zimbabwe: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47512. [PMID: 37788044 PMCID: PMC10582805 DOI: 10.2196/47512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Hypertension and diabetes are among the most common noncommunicable diseases in Zimbabwe. These 2 conditions are largely prevented and controlled by lifestyle modifications, such as healthy eating habits, physical activity, and avoiding the use of tobacco and alcohol. OBJECTIVE This study aims to evaluate the effects of a community health worker (CHW)-led health literacy intervention on lifestyle modification among patients with diabetes and hypertension in the City of Harare, Zimbabwe, in terms of (1) adherence to recommended lifestyle changes, (2) blood pressure and blood glucose levels, and (3) medication adherence. METHODS This is a 6-month-long cluster randomized controlled trial, which will be conducted in primary health care clinics in the city of Harare. A total of 14 clinics will be randomly allocated into either the intervention or control group. A total of 680 (49 participants per clinic) adult patients with hypertension and diabetes will be enrolled for the trial. Participants in the intervention arm will receive a simple health literacy intervention on lifestyle modification, which will be delivered by trained CHWs, while those in the control arm will receive usual care. The intervention consists of 4 face-to-face interactive educational sessions and monthly support visits by trained CHWs and will be carried out over a period of 6 months. The primary study outcomes will be blood pressure and blood glucose levels and levels of adherence to the recommended lifestyle modifications. Other outcomes will include adherence to medication. Data management and analysis will be done using Epi Info software, and the data will be analyzed using the intention-to-treat principle. RESULTS Recruitment of study participants commenced on June 1, 2023, and was completed on July 30, 2023. Baseline data are being collected after participants' recruitment, and the final data collection will be completed by January 31, 2024. CONCLUSIONS There is an information dearth regarding the effectiveness of CHW-led interventions for the management and control of hypertension in Zimbabwe. Our study offers an opportunity to show the effectiveness of CHWs in addressing the gaps in the management of hypertension and diabetes. The findings from our study will provide crucial evidence on the effectiveness and feasibility of a simple intervention delivered by CHWs in resource-constrained areas. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47512.
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Affiliation(s)
- Nyaradzai Arster Katena
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shepherd Shamu
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Golden Tafadzwa Fana
- Internal Medicine Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
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Fernandes TF, Lima CCME, Silva PLND, Rossi-Barbosa LAR, Pinho LD, Caldeira AP. Working conditions and mental health of community health workers in the COVID-19 pandemic. CIENCIA & SAUDE COLETIVA 2023; 28:2931-2940. [PMID: 37878935 DOI: 10.1590/1413-812320232810.09802023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/01/2023] [Indexed: 10/27/2023] Open
Abstract
This study examined the prevalence of anxiety and depression associated with Community Health Workers' (CHWs') working conditions in the context of the COVID-19 pandemic. This cross-sectional study was carried out in the north of Minas Gerais, Brazil by applying a questionnaire addressing sociodemographic conditions, command of technologies and working conditions during the pandemic, as well as the State-Trait Anxiety Inventory and the Patient Health Questionnare-9 (PHQ-9). Descriptive and multiple Poisson regression analyses were performed with robust variance, to a 5% level of significance (p < 0.05) for the final model. A total of 1,220 CHWs from 36 municipalities participated in the study. Prevalences were 41.8% and 31.6% for anxiety and depression, respectively, while 22.5% of the group displayed symptoms of both conditions. Being female, up to 40 years old, having more than 500 users registered for monitoring, and inadequate supply of personal protective equipment were associated with anxiety and depression among the CHWs. Prevalence of anxiety and depression was high among CHWs during the pandemic and working conditions figured prominently among the associated factors.
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Affiliation(s)
- Tatiana Fróes Fernandes
- Universidade Estadual de Montes Claros. Av. Rui Braga s/n, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | | | | | | | - Lucineia de Pinho
- Universidade Estadual de Montes Claros. Av. Rui Braga s/n, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | - Antônio Prates Caldeira
- Universidade Estadual de Montes Claros. Av. Rui Braga s/n, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
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Wennerstrom A, Smith DO. Labour exploitation among community health workers. Lancet Glob Health 2023; 11:e1484-e1485. [PMID: 37734782 DOI: 10.1016/s2214-109x(23)00409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Ashley Wennerstrom
- Department of Behavioral and Community Health Sciences, School of Public Health, LSU Health-New Orleans, New Orleans, LA 70112, USA.
| | - Denise Octavia Smith
- National Association of Community Health Workers, Boston, MA, USA; Primary Care Program in Global Primary Care and Social Change, Harvard Medical School, Havard University, Boston, MA, USA
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Katzen LS, Skeen S, Dippenaar E, Laurenzi C, Notholi V, le Roux K, le Roux I, WaluWalu N, Mbewu N, Borus MJR, Tomlinson M. Community Health Workers' experiences of a package providing increased support and supervision - a qualitative study of a home visiting model in rural South Africa. RESEARCH SQUARE 2023:rs.3.rs-3333610. [PMID: 37841874 PMCID: PMC10571624 DOI: 10.21203/rs.3.rs-3333610/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Deploying Community Health Workers is a crucial strategy to improve health at a community level in low and middle income countries. While there is substantial evidence for CHW effectiveness, there is a need for more research on the mechanisms through which these programs work. Understanding CHWs experiences of how programmes function is important. This article examines CHW's experiences of three key programmatic domains; training, logistical support and supervision. Data were gathered using a qualitative study embedded within a cluster randomized controlled trial of an enhanced supervision package delivered to government-employed CHWs in the rural Eastern Cape, South Africa. We interviewed CHWs (n = 16) and two supervisors. Three overarching areas and five sub-themes emerged from our interviews. CHW knowledge and confidence increased through additional training, that CHW motivation and community acceptance improved because of added logistical support, and that CHW supervision led to improved sense of accountability, feelings of respect, and sense of being supported. Our findings highlight the importance of a functional support system within which CHWs can operate, in a context where most CHWs operate in isolation and without support. CHWs receiving supportive supervision reported positive impacts on their motivation and ability to carry out their work effectively.
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Baynes C, Kanté AM, Exavery A, Tani K, Sikustahili G, Mushi H, Baraka J, Ramsey K, Sherr K, Weiner BJ, Phillips JF. The implementation and effectiveness of multi-tasked, paid community health workers on maternal and child health: A cluster-randomized pragmatic trial and qualitative process evaluation in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002050. [PMID: 37725612 PMCID: PMC10508634 DOI: 10.1371/journal.pgph.0002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
Community health worker programs have proliferated worldwide based on evidence that they help prevent mortality, particularly among children. However, there is limited evidence from randomized studies on the processes and effectiveness of implementing community health worker programs through public health systems. This paper describes the results of a cluster-randomized pragmatic implementation trial (registration number ISRCTN96819844) and qualitative process evaluation of a community health worker program in Tanzania that was implemented from 2011-2015. Program effects on maternal, newborn and child health service utilization, childhood morbidity and sick childcare seeking were evaluated using difference-in-difference regression analysis with outcomes measured through pre- and post-intervention household surveys in intervention and comparison trial arms. A qualitative process evaluation was conducted between 2012 and 2014 and comprised of in-depth interviews and focus group discussions with community health workers, community members, facility-based health workers and staff of district health management teams. The community health worker program reduced incidence of illness and improved access to timely and appropriate curative care for children under five; however, there was no effect on facility-based maternal and newborn health service utilization. The positive outcomes occurred because of high levels of acceptability of community health workers within communities, as well as the durability of community health workers' motivation and confidence. Implementation factors that generated these effects were the engagement of communities in program startup; the training, remuneration and supervision of the community health workers from the local health system and community. The lack of program effects on maternal and newborn health service utilization at facilities were attributed to lapses in the availability of needed care at facilities. Strategies that strengthen and align communities' and health systems core capacities, and their ability to learn, adapt and integrate evidence-based interventions, are needed to maximize the health impact of community health workers.
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Affiliation(s)
- Colin Baynes
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Almamy Malick Kanté
- Department of International Health, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | | | - Kate Ramsey
- Scope Impact, Brooklyn, NY, United States of America
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - James F. Phillips
- Department of Population and Family Health, Columbia University, New York, NY, United States of America
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Buchanan G, Sullivan E, Berkel C, Breitenstein S, Feinberg E, Valado T, Willis D. Implementing Parenting Programs in Primary Care: A Framework and a Call for Action. Acad Pediatr 2023; 23:1315-1325. [PMID: 37088132 DOI: 10.1016/j.acap.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
Healthy parent-child relationships are clearly critical to healthy child development. Parenting programs develop caregivers' skills to support the health and well-being of children. Rigorous evidence has demonstrated the efficacy of these programs. Rising rates of child and youth depression, anxiety, grief, and suicide, both prior to and compounded by the COVID-19 pandemic, provide further reasons to implement parenting programs that support all parents in their essential roles. Parents can act as a buffer to stressors and support for children's well-being when they have the knowledge and skills to do so. Pediatric primary care practices are a natural setting for parenting programs, but challenges, including stigma, technology, workflow issues, and funding, have prevented their broad dissemination, implementation, and sustainability. In this article, we develop a framework for implementing parenting programs in primary care and present key considerations for selecting programs that fit the needs of parents, providers, patients, and the practice. We offer lessons from our experiences in overcoming these challenges, using the updated Consolidated Framework for Implementation Research to structure our discussion. We also provide an initial stepwise process which readers may use to plan their own parenting program implementation. Pediatric clinicians and practices can use this article and associated resources to plan, implement, and evaluate parenting programs in their practices as a strategy to help address the growing youth mental health crisis. Improving parenting behaviors can reduce the need for current or future mental health interventions by supporting optimal child development, emotional regulation, and parent-child relationships.
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Affiliation(s)
- Gretchen Buchanan
- Center for Mental Health Services Research and Brown School of Social Work (G Buchanan), Washington University in St. Louis, MO.
| | | | - Cady Berkel
- College of Health Solutions (C Berkel), Arizona State University, Tempe
| | - Susie Breitenstein
- College of Nursing (S Breitenstein), The Ohio State University, Columbus
| | - Emily Feinberg
- Department of Pediatrics (E Feinberg), Chobanian and Avedisian School of Medicine and Department of Community Health Sciences, Boston University School of Public Health, Boston University School of Medicine, MA
| | - Trenna Valado
- ZERO TO THREE National Center for Infants, Toddlers, and Families (T Valado), Washington, D.C
| | - David Willis
- Center for the Study of Social Policy (D Willis), Washington, D.C
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