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PubMed2003

Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans.

BACKGROUND: African Americans suffer disproportionately from diabetes complications, but little research has focused on how to improve diabetic control in this population. There are also few or no data on a combined primary care and community-based intervention approach. METHODS: We randomly assigned 186 urban African Americans with type 2 diabetes (76% female, mean A SD age 59 A 9 years) to 1 of 4 parallel arms: (1) usual care only; (2) usual care + nurse case manager (NCM); (3) usual care + community health worker (CHW); (4) usual care + nurse case manager/community health worker team. Using the framework of the Precede-Proceed behavioral model, interventions included patient counseling regarding self-care practices and physician reminders. RESULTS: The 2-year follow-up visit was completed by 149 individuals (84%). Compared to the Usual care group, the NCM group and the CHW group had modest declines in HbA(1c) over 2 years (0.3 and 0.3%, respectively), and the combined NCM/CHW group had a greater decline in HbA(1c) (0.8%. P = 0.137). After adjustment for baseline differences and/or follow-up time, the combined NCM/CHW group showed improvements in triglycerides (-35.5 mg/dl; P = 0.041) and diastolic blood pressure, compared to the usual care group (-5.6 mmHg; P = 0.042). CONCLUSIONS: Combined NCM/CHW interventions may improve diabetic control in urban African Americans with type 2 diabetes. Although results were clinically important, they did not reach statistical significance. This approach deserves further attention as a means to reduce the excess risk of diabetic complications in African Americans.

Baltimore↗
PubMed1998

Ethical holistic thinking and practice for community health workers and nurses.

If we take on board the assumption that social realities are perceived through filters of experience, social position, personality and emotion, then we accept that 'facts' can be differently construed or constructed Compassion cannot be taught as a competency, but we can be made aware through reflexive thinking that the closest we can ever get to a shared truth is through listening to and understanding the other. This paper is a modest attempt to provide some tools for community health workers and nurses who are concerned about the quality of their practice and wish to find creative solutions.

Community Health Nursing↗
PubMed2004

Provider counseling, health education, and community health workers: the Arizona WISEWOMAN project.

BACKGROUND: The Arizona Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project used provider counseling, health education, and community health workers (CHWs) to target chronic disease risk factors in uninsured, primarily Hispanic women over age 50. METHODS: Participants were recruited from two Tucson clinics participating in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Women were randomly assigned into one of three intervention groups: (1) provider counseling, (2) provider counseling and health education, or (3) provider counseling, health education, and CHW support. At baseline and 12 months (1998-2000), participants were measured for height, weight, waist and hip circumference, and blood pressure. Blood tests were conducted to check blood glucose, cholesterol, and triglyceride levels. At each time point, participants also completed 24-hour dietary recalls and questionnaires focusing on their physical activity levels. RESULTS: A total of 217 women participated in baseline and 12-month follow-up. Three fourths were Hispanic. All three intervention groups showed an increase in self-reported weekly minutes of moderate-to-vigorous physical activity, with no significant differences between the groups. Significantly more women who received the comprehensive intervention of provider counseling, health education, and CHW support progressed to eating five fruits and vegetables per day, compared with participants who received only provider counseling or provider counseling plus health education. CONCLUSIONS: All three interventions increased moderate-to-vigorous physical activity but not fruit and vegetable consumption. The intervention group with provider counseling, health education, and CHW support significantly increased the number of women meeting national recommendations for fruit and vegetable consumption.

Aged↗
PubMed1988

Simple tricoloured measuring tapes for identification of low birthweight babies by community health workers.

A total of 446 singleton neonates were subjected to measurements of birthweight, chest circumference (CC) and mid-arm circumference (MAC). A high degree of correlation between birthweight and CC as well as MAC was observed. Chest circumference correlated better with birthweight than MAC. Further analysis of data showed that CC measurements of less than or equal to 30.0 cm and less than or equal to 27.5 cm reliably identify neonates less than 2500 g and less than 2000 g, respectively, with a high degree of specificity and predictive value. The corresponding values for MAC were less than or equal to 9.0 cm and less than or equal to 8.5 cm, respectively. Using these inferences, two tricoloured measuring tapes, one each for CC and MAC, are proposed as simple screening tools for use by primary health workers for identifying low-birthweight neonates in the community without resorting to weighing scales.

Anthropometry↗
PubMed1989

Assessment of MCH services offered by professional and community health workers in the district of Solenzo, Burkina Faso. I. Utilization of MCH services.

A representative household survey of a district of Burkina Faso was carried out in order to study the utilization of trained birth attendants (TBA) versus professional health workers as providers of under fives' (UFC), antenatal (ANC), and maternity care (MC). Overall utilization by the target groups varied between 13 per cent (UFC), 31 per cent (ANC), and 32 per cent (MC). The presence of a village health post did not increase utilization of MCH care. Furthermore, those who did utilize, preferred to choose another source of care: the professional midwife for ANC, the traditional 'old woman' for delivery. Sick infants were generally not taken to the village health worker (VHW), but rather treated by the family itself. The determinants of utilization were assessed by means of multivariate analysis. The level of care offered in the village (health post, dispensary, and medical centre), educational level of both the mother and the husband, and ethnic group were identified as major factors influencing health seeking behaviour in MCH. A strong case is made for improvement of quality of care before extension of geographical coverage. The importance of involving husbands in sensitization for the utilization of MCH-care is stressed and the implications are discussed for the role of the community health workers in caring for mothers and children.

Burkina Faso↗
PubMed1995

Case management by community health workers of children with acute respiratory infections: implications for national ARI control programme.

Health worker performance in the management of children with acute respiratory infections (ARI) was assessed in two local government areas (LGAs) in Nigeria. The data derived were utilized to identify training needs. Survey instruments included an inventory list for ARI-related equipment and supplies, observation checklists for children presenting to the health worker with ARI symptoms, a questionnaire for exist interviews with mothers, and a supervisor performance checklist. One hundred and twenty-three health workers in Ife Central LGA and 50 in Ojo were observed at selected public health facilities. Most health workers took a good general history, but specific ARI-related history and physical examination were frequently omitted. Symptomatic diagnosis and treatment were common. Drugs most commonly prescribed for treatment of ARI were chloroquine, paracetamol and antibiotics. Essential drugs and supplies for ARI management were not available in some facilities. Communication with mothers was generally unsatisfactory and instruction on home management incomplete. Many of the health workers had not attended a continuing education programme in the previous two years and supervision which could have provided on-the-spot training was irregular. Improvements in ARI case management will require attention to policy, logistics, training (including in-service education) and supervision. The possible role of an integrated approach to the management of the sick child in improving the quality of health worker performance is discussed.

Child Health Services↗
PubMed1999

Outcomes and costs of a community support worker service for the severely mentally ill.

There has recently been an expansion of paraprofessional staff involved in the provision of care for the severely mentally ill. In this paper we shall evaluate the effects of a community support worker (CSW) service in South London. A sample of patients with severe mental illness receiving the service was assessed over a 6-month period in order to examine the effects of continuing use of CSWs on outcomes, service use and costs. During the study period there were improvements in outcome reflecting service satisfaction, needs, quality of life and social behaviour. Whilst provision of the CSW service did not lead to extra total service costs, service use and cost data suggest that CSWs are associated with the substitution of in-patient use by community-based services.

Adult↗
PubMed2004

How do health workers and community members perceive and practice community participation in the Bamako Initiative programme in Nigeria? A case study of Oji River local government area.

The objective of this study was to assess the perceptions and practices of health workers and households in relation to community participation in the Bamako Initiative programme (BI). The study was conducted in Oji River local government area of South-East Nigeria where the BI program has been operational since 1993. A pre-tested questionnaire was used to collect information from 20 health workers charged with operating the BI in 20 health centres. In addition, focus group discussions were conducted with members of the district and village health committees. Community participation from both health worker and community perspectives seem to have been enhanced by the introduction of BI, despite some constraints. However, the communities were not involved in core areas of community participation, and the health workers seem to be resisting their participation fully. It is concluded the community participation in BI could be improved if expectations were made explicit. This improvement should take into consideration the desires and priorities of the communities and issues impeding participation should be addressed.

Community Networks↗
PubMed1999

Women, the welfare state, and their transnational dimension: the case of Mexico's community health worker programs.

Feminist scholarship has shown that the welfare state is not only a set of agencies and policies to distribute services, but is engaged in the promotion of normative concepts of the female through its structural arrangements and the content of its programs and policies. Yet, this scholarship conceptualizes the state as a national entity and free from external influences, ignoring its transnational dimension. States are embedded in an international network consisting of other states, international agencies, and corporations that influence the practices and discursive frame of the welfare state. To uncover the process by which the welfare state institutionalizes and promotes female identities and the transnational dimension of this process, the author analyzes the case of community health worker programs conducted by the Mexican state from the 1970s to the early 1990s. The analysis corroborates the gender practices of the welfare state and suggests a reconceptualization that takes into account the transnational dimension of the state practices. The implications for feminist theories on the welfare state and for analyses of health promotion policies and programs are discussed.

Community Health Services↗