Training Female Community Health Volunteers(FCHVs) for Cardiovascular Risk Screening in Lalitpur, Nepal: A Mixed Methods Feasibility Study
Background: Faced with the surging trends of cardiovascular diseases (CVDs) and the limited numbers of health professionals in Nepal, more innovative measures should be explored to tackle the challenges of CVD prevention and control. This study explored the feasibility of shifting some CVD-related tasks to the community by engaging female community health volunteers (FCHVs) for CVD risk screening. Methods: This study was conducted in a rural and an urban study site in Lalitpur (Kathmandu Valley), Nepal. Mixed methods were employed in this study. Ten FCHVs were recruited and trained to use the Cardiovascular Risk Scoring Chart adapted from the World Health Organization’s Package for Essential Non-Communicable Diseases (PEN). After the training, FCHVs administered cardiovascular risk factor questionnaires and used the risk scoring chart to screen eligible community residents in their catchment area. Using the data collected by FCHVs, a medical doctor calculated the second risk score with the same risk scoring chart. A kappa concordance test was used to compare these two sets of risk screening results for agreement, and a sensitivity and specificity test was conducted to assess the reliability of the FCHVs’ CVD risk screening results. Two focus group discussions were administered to investigate the FCHVs’ training and fieldwork experiences during the study. Results: There were 491 community residents screened for cardiovascular risk at two study sites. The mean level of agreement between the two sets of risk screening results was 94.5% (Kappa = 0.77, P < 0.05). The sensitivity of the FCHV screening test was 90.3% (95% CI [0.801, 0.964]); and the specificity was 97% (95% CI [0.948, 0.984]). In the FGD, FCHVs expressed a strong enthusiasm and readiness for NCD related work. Besides, all FCHVs agreed that they could manage their current workload and were confident that they could perform more tasks for the prevention and control of NCDs with the proper training. More NCD-related programs and training are called for by FCHVs. Conclusions: It is feasible to train FCHVs to use the simple cardiovascular scoring chart to screen and identify community residents at high risk of developing CVDs. Although FCHVs expressed interests in taking on more responsibility regarding the prevention and control of NCDs, further studies are needed to assess the feasibility of engaging FCHVs within the existing healthcare system.
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