Browsing by Subject "Community Health Workers"
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Item Open Access Barriers and Facilitators for Including Village Health Workers (VHW) in Non-communicable Diseases (NCDs) Prevention and Control in Chi Linh District, Hai Duong Province, Vietnam(2017) Long, HongfeiThe burden of non-communicable diseases (NCDs) continues to grow in Vietnam. Recently, Vietnam government initiated a new national plan with a strong focus on NCD prevention and control in the community. This study is intended to investigate the current role of Vietnamese village health workers (VHWs) in preventive and NCD-related care, and to explore the barriers and facilitators to expand the role by including routine community-based NCD prevention and control services. From June to July 2016, four focus group discussions with VHWs (n=24) and thirteen in-depth interviews (n=13) with public health administrators (n=13) were conducted in Chi Lin District, Hai Duong Province, Vietnam. A thematic analysis was conducted to identify themes in the data. The participants identified health education, program outreach, and case management as the current responsibilities of VHW. In NCD programs, VHWs provide these services mostly to hypertension and diabetes patients. Majority of the participants endorsed the idea of incorporating NCD early detection and risk reduction into VHW role and thought their close connection with community justified their strength in conducting these services. Currently perceived barriers included aging VHW, insufficient NCD-related knowledge, poor training quality, imbalanced workload and remuneration, lack of resource, and policy-driven guideline. While, participants believed that upon empowering through training, guidance, and proper incentive, VHWs would serve as effective NCD risk detector and healthy behavior promoter in their communities. The study indicates that, with interpersonal, organizational and policy support, VHWs may have the potential to conduct routine community-based NCD early detection and risk reduction activities in Vietnam.
Item Open Access Improving rational use of ACTs through diagnosis-dependent subsidies: Evidence from a cluster-randomized controlled trial in western Kenya.(PLoS medicine, 2018-07-17) Prudhomme O'Meara, Wendy; Menya, Diana; Laktabai, Jeremiah; Platt, Alyssa; Saran, Indrani; Maffioli, Elisa; Kipkoech, Joseph; Mohanan, Manoj; Turner, Elizabeth LBACKGROUND:More than half of artemisinin combination therapies (ACTs) consumed globally are dispensed in the retail sector, where diagnostic testing is uncommon, leading to overconsumption and poor targeting. In many malaria-endemic countries, ACTs sold over the counter are available at heavily subsidized prices, further contributing to their misuse. Inappropriate use of ACTs can have serious implications for the spread of drug resistance and leads to poor outcomes for nonmalaria patients treated with incorrect drugs. We evaluated the public health impact of an innovative strategy that targets ACT subsidies to confirmed malaria cases by coupling free diagnostic testing with a diagnosis-dependent ACT subsidy. METHODS AND FINDINGS:We conducted a cluster-randomized controlled trial in 32 community clusters in western Kenya (population approximately 160,000). Eligible clusters had retail outlets selling ACTs and existing community health worker (CHW) programs and were randomly assigned 1:1 to control and intervention arms. In intervention areas, CHWs were available in their villages to perform malaria rapid diagnostic tests (RDTs) on demand for any individual >1 year of age experiencing a malaria-like illness. Malaria RDT-positive individuals received a voucher for a discount on a quality-assured ACT, redeemable at a participating retail medicine outlet. In control areas, CHWs offered a standard package of health education, prevention, and referral services. We conducted 4 population-based surveys-at baseline, 6 months, 12 months, and 18 months-of a random sample of households with fever in the last 4 weeks to evaluate predefined, individual-level outcomes. The primary outcome was uptake of malaria diagnostic testing at 12 months. The main secondary outcome was rational ACT use, defined as the proportion of ACTs used by test-positive individuals. Analyses followed the intention-to-treat principle using generalized estimating equations (GEEs) to account for clustering with prespecified adjustment for gender, age, education, and wealth. All descriptive statistics and regressions were weighted to account for sampling design. Between July 2015 and May 2017, 32,404 participants were tested for malaria, and 10,870 vouchers were issued. A total of 7,416 randomly selected participants with recent fever from all 32 clusters were surveyed. The majority of recent fevers were in children under 18 years (62.9%, n = 4,653). The gender of enrolled participants was balanced in children (49.8%, n = 2,318 boys versus 50.2%, n = 2,335 girls), but more adult women were enrolled than men (78.0%, n = 2,139 versus 22.0%, n = 604). At baseline, 67.6% (n = 1,362) of participants took an ACT for their illness, and 40.3% (n = 810) of all participants took an ACT purchased from a retail outlet. At 12 months, 50.5% (n = 454) in the intervention arm and 43.4% (n = 389) in the control arm had a malaria diagnostic test for their recent fever (adjusted risk difference [RD] = 9 percentage points [pp]; 95% CI 2-15 pp; p = 0.015; adjusted risk ratio [RR] = 1.20; 95% CI 1.05-1.38; p = 0.015). By 18 months, the ARR had increased to 1.25 (95% CI 1.09-1.44; p = 0.005). Rational use of ACTs in the intervention area increased from 41.7% (n = 279) at baseline to 59.6% (n = 403) and was 40% higher in the intervention arm at 18 months (ARR 1.40; 95% CI 1.19-1.64; p < 0.001). While intervention effects increased between 12 and 18 months, we were not able to estimate longer-term impact of the intervention and could not independently evaluate the effects of the free testing and the voucher on uptake of testing. CONCLUSIONS:Diagnosis-dependent ACT subsidies and community-based interventions that include the private sector can have an important impact on diagnostic testing and population-wide rational use of ACTs. Targeting of the ACT subsidy itself to those with a positive malaria diagnostic test may also improve sustainability and reduce the cost of retail-sector ACT subsidies. TRIAL REGISTRATION:ClinicalTrials.gov NCT02461628.Item Open Access Knowledge and Attitudes toward HIV and People Living with HIV (PLWH) among Public Health Midwives in the Galle District, Sri Lanka(2017) Suk, JihyeBackground: Even though a recent increase in HIV prevalence has been noticed in Sri Lanka, not many studies have been done there relating to HIV/AIDS. In particular, little is known about HIV-related stigma among healthcare workers, which has been identified as an obstacle to addressing the HIV epidemic. To examine this issue, this study first aimed to assess knowledge and attitudes of PHMs, the frontline community health workers in Sri Lanka. Second, the study examined the factors associated with their knowledge and attitudes. Lastly, the study examined the association of demographic information, knowledge, and attitudes with extra precautionary behaviors. Methods: Two hundred and ninety-one PHMs were recruited for this cross-sectional study. The study team visited each of the 20 Medical Officers of Health areas (MOH: administrative division) in the Galle District and surveyed PHMs during their monthly meetings. The study utilized two questionnaires to assess knowledge (16 items), attitudes and stigma (37 items). After assessing the PHMs knowledge and attitudes, the study explored the association of demographic information with knowledge and attitudes, and then examined how such individual factors, knowledge, and attitudes were associated with extra precautionary behaviors. Results: PHMs’ knowledge level was good (79.9% of answers were correct) but could be improved. Those more knowledgeable about HIV and with higher education demonstrated a more positive attitude towards PLWH. A more negative attitude was associated with having a stronger intention to engage in extra precautionary behaviors. Conclusions: As PHMs are community health workers whose attitude can potentially influence to the general public’s point of view, they need further HIV training to improve their knowledge so as to better educate the community. By reducing the PHMs misperceptions about HIV, they may develop a more positive attitude and thus help reduce stigma towards PLWH.
Item Open Access ¿No Hay Racismo?: application of the levels of racism framework to Latinx perspectives on barriers to health and wellbeing.(BMC public health, 2024-08) Plasencia, Gabriela; Kaalund, Kamaria; Gupta, Rohan; Martinez-Bianchi, Viviana; Gonzalez-Guarda, Rosa; Sperling, Jessica; Thoumi, AndreaBackground
The purpose of this study is to increase understanding of the forms of systemic racism experienced by Latinx communities in North Carolina during the COVID-19 pandemic as identified by Latinx community health workers (CHWs) and community-based organization (CBO) leaders.Methods
We held three focus groups in July 2022 (N = 16) with CHWs and CBO leaders in Spanish to discuss policy and community interventions that improved access to resources during the COVID-19 pandemic; policy or community interventions needed to improve care of Latinx communities; and lessons learned to improve the health of Latinx communities in the future. We performed directed and summative qualitative content analysis of the data in the original language using the Levels of Racism Framework by Dr. Camara Jones to identify examples of implicitly and explicitly discussed forms of systemic racism.Results
Latinx CHWs and CBO leaders implicitly discussed numerous examples of all levels of racism when seeking and receiving health services, such as lack of resources for undocumented individuals and negative interactions with non-Latinx individuals, but did not explicitly name racism. Themes related to institutionalized racism included: differential access to resources due to language barriers; uninsured or undocumented status; exclusionary policies not accounting for cultural or socioeconomic differences; lack of action despite need; and difficulties obtaining sustainable funding. Themes related to personally-mediated racism included: lack of cultural awareness or humility; fear-inciting misinformation targeting Latinx populations; and negative interactions with non-Latinx individuals, organizations, or institutions. Themes related to internalized racism included: fear of seeking information or medical care; resignation or hopelessness; and competition among Latinx CBOs. Similarly, CHWs and CBO leaders discussed several interventions with systems-level impact without explicitly mentioning policy or policy change.Conclusion
Our research demonstrates community-identified examples of racism and confirms that Latinx populations often do not name racism explicitly. Such language gaps limit the ability of CHWs and CBOs to highlight injustices and limit the ability of communities to advocate for themselves. Although generally COVID-19 focused, themes identified represent long-standing, systemic barriers affecting Latinx communities. It is therefore critical that public and private policymakers consider these language gaps and engage with Latinx communities to develop community-informed anti-racist policies to sustainably reduce forms of racism experienced by this unique population.Item Open Access Optimizing linkage and retention to hypertension care in rural Kenya (LARK hypertension study): study protocol for a randomized controlled trial.(Trials, 2014-04-27) Vedanthan, Rajesh; Kamano, Jemima H; Naanyu, Violet; Delong, Allison K; Were, Martin C; Finkelstein, Eric A; Menya, Diana; Akwanalo, Constantine O; Bloomfield, Gerald S; Binanay, Cynthia A; Velazquez, Eric J; Hogan, Joseph W; Horowitz, Carol R; Inui, Thomas S; Kimaiyo, Sylvester; Fuster, ValentinBACKGROUND: Hypertension is the leading global risk factor for mortality. Hypertension treatment and control rates are low worldwide, and delays in seeking care are associated with increased mortality. Thus, a critical component of hypertension management is to optimize linkage and retention to care. METHODS/DESIGN: This study investigates whether community health workers, equipped with a tailored behavioral communication strategy and smartphone technology, can increase linkage and retention of hypertensive individuals to a hypertension care program and significantly reduce blood pressure among them. The study will be conducted in the Kosirai and Turbo Divisions of western Kenya. An initial phase of qualitative inquiry will assess facilitators and barriers of linkage and retention to care using a modified Health Belief Model as a conceptual framework. Subsequently, we will conduct a cluster randomized controlled trial with three arms: 1) usual care (community health workers with the standard level of hypertension care training); 2) community health workers with an additional tailored behavioral communication strategy; and 3) community health workers with a tailored behavioral communication strategy who are also equipped with smartphone technology. The co-primary outcome measures are: 1) linkage to hypertension care, and 2) one-year change in systolic blood pressure among hypertensive individuals. Cost-effectiveness analysis will be conducted in terms of costs per unit decrease in blood pressure and costs per disability-adjusted life year gained. DISCUSSION: This study will provide evidence regarding the effectiveness and cost-effectiveness of strategies to optimize linkage and retention to hypertension care that can be applicable to non-communicable disease management in low- and middle-income countries. TRIAL REGISTRATION: This trial is registered with (NCT01844596) on 30 April 2013.Item Open Access Performance of accredited social health activists to provide home-based newborn care: a situational analysis.(Indian pediatrics, 2014-02) Das, Emily; Panwar, Dharmendra Singh; Fischer, Elizabeth A; Bora, Girdhari; Carlough, Martha CObjective
To assess Accredited social health activists' (ASHAs) ability to recognize illness in infants aged less than 2 months.Methods
Investigators observed 25 ASHAs conducting 47 visits.Results
ASHA-investigator agreement on the need to further assess infants was intermediate (kappa 0.48, P<0.001). Using IMNCI's color codes, ASHAs misclassified 80% of infants. ASHAs did not follow home-based newborn care formats and skipped critical signs. Overall ASHA-investigator agreement on diagnosis was poor (kappa=0.23, P=0.01).Conclusion
There is a need for improved training, tools, and supportive supervision.Item Open Access Population impact of a high cardiovascular risk management program delivered by village doctors in rural China: design and rationale of a large, cluster-randomized controlled trial.(BMC Public Health, 2014-04-11) Yan, Lijing L; Fang, Weigang; Delong, Elizabeth; Neal, Bruce; Peterson, Eric D; Huang, Yining; Sun, Ningling; Yao, Chen; Li, Xian; MacMahon, Stephen; Wu, YangfengBACKGROUND: The high-risk strategy has been proven effective in preventing cardiovascular disease; however, the population benefits from these interventions remain unknown. This study aims to assess, at the population level, the effects of an evidence-based high cardiovascular risk management program delivered by village doctors in rural China. METHODS: The study will employ a cluster-randomized controlled trial in which a total of 120 villages in five northern provinces of China, will be assigned to either intervention (60 villages) or control (60 villages). Village doctors in intervention villages will be trained to implement a simple evidence-based management program designed to identify, treat and follow-up as many as possible individuals at high-risk of cardiovascular disease in the village. The intervention will also include performance feedback as well as a performance-based incentive payment scheme and will last for 2 years. We will draw two different (independent) random samples, before and after the intervention, 20 men aged≥50 years and 20 women aged≥60 years from each village in each sample and a total of 9,600 participants from 2 samples to measure the study outcomes at the population level. The primary outcome will be the pre-post difference in mean systolic blood pressure, analyzed with a generalized estimating equations extension of linear regression model to account for cluster effect. Secondary outcomes will include monthly clinic visits, provision of lifestyle advice, use of antihypertensive medications and use of aspirin. Process and economic evaluations will also be conducted. DISCUSSION: This trial will be the first implementation trial in the world to evaluate the population impact of the high-risk strategy in prevention and control of cardiovascular disease. The results are expected to provide important information (effectiveness, cost-effectiveness, feasibility and acceptability) to guide policy making for rural China as well as other resource-limited countries. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (NCT01259700). Date of initial registration is December 13, 2010.Item Open Access Stakeholder Perspectives on the Use of Community Health Workers To Improve Palliative Care Use by African Americans with Cancer.(Journal of palliative medicine, 2019-03) Johnston, Fabian M; Neiman, Joseph H; Parmley, Lauren E; Conca-Cheng, Alison; Freund, Karen M; Concannon, Thomas W; Smith, Thomas J; Cooper, Lisa ABackground
African Americans in the United States have worse end-of-life care and cancer outcomes than whites. Palliative care may improve this disparity. Community Health Workers may provide a means to improve palliative care disparities.Methods
Semistructured in-depth interviews (five) and stakeholder focus groups (four) were conducted with cancer patients, caregivers, health care administrators, oncologists, and community health workers (CHWs). Patients were recruited through snowball sampling. Three raters coded interviews independently. Data were analyzed using interpretative phenomenological analysis.Results
Seventy-one individuals were contacted to participate with 24 stakeholders (34%) participating in individual interviews or across 4 stakeholder engagements. Eleven constructs were identified and grouped in three broader themes: "hub of the wheel," understanding palliative care, and patient-provider relationships. Participants felt that the role of a CHW should be central, bridging patients with their providers, information, and resources, including psychosocial support and advance care planning documents. They also placed an emphasis on the background of CHWs, saying individuals selected should be familiar with the history, culture, and norms of the communities from which they operate. Stakeholders reported that a CHW could activate a patient to contact their primary care physician or oncologist who may refer to or provide palliative care. Stakeholders reported that given the barriers to palliative care, a CHW could contribute to patient-centered multidisciplinary care while addressing palliative care domains with patients and families in a culturally sensitive manner.Conclusion
Based on feedback from patients, caregivers, and providers, a culturally adapted CHW intervention may improve palliative care use for African American patients with advanced malignancies.