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PubMed2006

Evaluation of the training of Korean community health workers for chronic disease management.

The use of community health workers (CHWs) or lay health advisors has been increasingly popular as an effective means of secondary prevention for cardiovascular health in hard-to-reach, underserved populations. Yet, published evaluations of the CHW training programs are rare. The purpose of this article is to report the results of an evaluation of a CHW training program for hypertension and diabetes management for Korean-American seniors. Forty-eight hours of training was developed and delivered to 12 Korean CHWs. Evaluation of the training program involved CHW surveys, trainer observation and debriefing and CHW focus groups. Testing of CHW knowledge showed that all CHWs met the minimum required knowledge level of 70%. Independent ratings by two trainer observations revealed that the overall CHW performance was satisfactory. Both CHW ratings and focus group data indicated that the training program met their expectation (average 9.3 on a 10-point scale) and was successful in empowering them to assume their role as a 'health initiator', 'health advertising agent' or 'health role model'. While this course is judged to be effective in general, future research is warranted to determine whether CHW provision of care and support will affect health outcomes in the target population.

Asian↗
PubMed2004

Direct observation of treatment for tuberculosis: a randomized controlled trial of community health workers versus family members.

We implemented community-based direct observation of treatment, short course (DOTS), including a randomized controlled trial of direct observation either by community health workers (CHWs) or family members, under operational conditions in a region of Swaziland. There was a high death rate of 15%, due to the high HIV rates in the region. There was no significant difference in the cure and completion rate between direct observation of treatment by CHWs and family members [2% difference (95% CI -3% to 7%), exact P = 0.52]. A before-and-after comparison of outcomes demonstrated that the cure and treatment completion rate improved from a baseline of 27-67% following implementation of community-based DOTS. We conclude that community-based tuberculosis DOTS can improve successful outcomes of treatment. However, direct observation can be undertaken effectively using either daily family or CHW supervision. The choice of treatment supporter should be based on access, patient preference and availability of CHW resource.

Adolescent↗
PubMed1998

Training and retaining Shasthyo Shebika: reasons for turnover of community health workers in Bangladesh.

Shasthyo Shebikas (SS) are community health workers forming the core of BRAC's Essential Health Care (EHC) programme. The SS dropout was 44 percent for study area and 32 percent for EHC programme. The SS discontinued their work due to lack of time, lack of "profit", and family's disapproval. The effects of the dropouts were decreased achievement of targets, and a loss of money in the amount of $24 (U.S.) per dropout SS for their training and supervision. The SS retention may increase if EHC strictly adheres to its existing guidelines when selecting trainees, and if it highlights during SS training that SS; s first and foremost role will be as that of a volunteer and then of a salesperson.

Allied Health Personnel↗
PubMed2006

Effect of multiple interventions on community health workers' adherence to clinical guidelines in Siaya district, Kenya.

Evaluation of a community health worker (CHW) programme in Siaya district, Kenya, showed CHWs commonly made errors in managing childhood illness. We assessed the effect of multiple interventions on CHW healthcare practices. A sample of 192 ill-child consultations performed by 114 CHWs in a hospital outpatient department between February and March 2001 were analysed. The mean percentage of assessment, classification and treatment procedures performed correctly for each child was 79.8% (range 13.3-100%). Of the 187 children who required at least one treatment or referral to a health facility, only 38.8% were prescribed all treatments (including referral) recommended by the guidelines. Multivariate analyses found no evidence that the intervention-related factors studied (refresher training, supervision, involvement of community women in the CHW selection process, adequacy of medicine supplies, and use of a guideline flipchart during consultations) were significantly associated with overall or treatment-specific guideline adherence. A multivariate linear regression analysis revealed that several non-intervention-related factors, such as patient characteristics, were significantly associated with overall guideline adherence. Given that our study was cross-sectional and our measurement of exposure to several interventions was based on CHW recall, the estimated effects of the interventions should be interpreted with caution. Despite these limitations, however, our results raise questions about the effectiveness, in the setting of Siaya district, of several interventions commonly used to improve the quality of care given by CHWs.

Child Health Services↗
PubMedDate not supplied

Prevalence of sexual harassment among rural community care workers.

This study identified the prevalence of sexual harassment and the demographic characteristics of rural, midwestern community care workers (CCWs). To prevent premature institutionalization, community care workers provide home-based assistance that enables elderly persons to remain in their homes. Data were collected from 735 CCWs to determine their demographic characteristics and the prevalence of sexual harassment at the work site. The prevalence portion of the instrument provided data which indicated that 27.8% of the CCWs were harassed on the job and that 15% of the workers were harassed by their elderly client. Demographic characteristics were collected which showed that 94.8% of the CCWs were women, 60.4% were married, and 89.8% were white. Discussion and recommendations drawn from the results of the collected data are included in this article.

Adolescent↗
PubMedDate not supplied

Employment in family planning and women's status in Bangladesh.

This study investigates how employment in family planning affects the status of community workers. The focus is on three critical variables: prestige, professional status, and social influence. The data are derived from a focus-group study conducted in 1987-88 in the Maternal and Child Health and Family Planning Project in Matlab, Bangladesh. Focus-group sessions were held with community workers, their husbands, community leaders, and community women. Results show that although community workers initially faced intense hostility in the community, they succeeded in maintaining the prestige that is traditionally accorded to women in their conservative, rural society. Moreover, they established themselves as valued health and family planning professionals in a social context where professional roles for women have been extremely circumscribed. Finally, they gained social influence by performing a range of functions in the community that exceed formally prescribed job responsibilities. The professional and social leadership roles that community workers now assume imply a degree of status that seemed inconceivable a decade ago. That such change could result from a well-designed and appropriately managed family planning project deserves careful attention.

Bangladesh↗
PubMed2005

The Seattle-King County Healthy Homes Project: a randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers.

OBJECTIVES: We assessed the effectiveness of a community health worker intervention focused on reducing exposure to indoor asthma triggers. METHODS: We conducted a randomized controlled trial with 1-year follow-up among 274 low-income households containing a child aged 4-12 years who had asthma. Community health workers provided in-home environmental assessments, education, support for behavior change, and resources. Participants were assigned to either a high-intensity group receiving 7 visits and a full set of resources or a low-intensity group receiving a single visit and limited resources. RESULTS: The high-intensity group improved significantly more than the low-intensity group in its pediatric asthma caregiver quality-of-life score (P=.005) and asthma-related urgent health services use (P=.026). Asthma symptom days declined more in the high-intensity group, although the across-group difference did not reach statistical significance (P=.138). Participant actions to reduce triggers generally increased in the high-intensity group. The projected 4-year net savings per participant among the high-intensity group relative to the low-intensity group were 189-721 dollars. CONCLUSIONS: Community health workers reduced asthma symptom days and urgent health services use while improving caregiver quality-of-life score. Improvement was greater with a higher-intensity intervention.

Air Pollution, Indoor↗
PubMed1994

The identification of continuing education needs for community rehabilitation workers in a rural health district in the Republic of South Africa.

Based on the principle that education is a lifelong process, the paper presents the identification of continuing education needs of community rehabilitation workers, who recently completed a 2-year certificate course in a rural health district of the Republic of South Africa. The need for a new cadre of worker in the rehabilitation field, namely a community-rehabilitation worker (CRW), was advocated by WHO in 1981. The CRW works at the community level to address the needs of disabled people, as part of primary health care services. The nominal group technique (NGT) and a focused group discussion was done with the community rehabilitation workers (n = 8) and their supervisors (n = 5), to identify learning needs that should be addressed through a continuing education programme. Focused group discussions involving people with disabilities and their family members (n = 45), from villages where the CRWs work, were carried out to discover their opinions on skills that the community rehabilitation workers still needed. The results show a strong correlation between the needs identified by the three groups, viz, skills in advocacy and public education, social work, community development and organizational development.

Certification↗
PubMed1995

Community health workers: integral members of the health care work force.

As the US health care system strives to function efficiently, encourage preventive and primary care, improve quality, and overcome nonfinancial barriers to care, the potential exists for community health workers to further these goals. Community health workers can increase access to care and facilitate appropriate use of health resources by providing outreach and cultural linkages between communities and delivery systems; reduce costs by providing health education, screening, detection, and basic emergency care; and improve quality by contributing to patient-provider communication, continuity of care, and consumer protection. Information sharing, program support, program evaluation, and continuing education are needed to expand the use of community health workers and better integrate them into the health care delivery system.

Community Health Workers↗
PubMed1996

Using community health workers for malaria control: experience in Zaire.

The potential for using community health workers (CHW) for administering timely and effective treatment for presumptive malaria attacks was evaluated in the Katana health zone in Zaire. In each of the 12 villages of an intervention area (area A) with 13000 inhabitants, a CHW was trained in the use of a simple fever management algorithm. The CHWs performed their services under the supervision of the nurse in charge of the area's health centre (HC). Malaria morbidity and mortality trends were monitored during 2 years in area A and in an ecologically comparable control area (area B), where malaria treatment continued to be available at the HC only. Health care behaviour changed dramatically in the intervention area, and by the end of the observation period 65% of malaria episodes were treated at the community level. Malaria morbidity declined 50% in area A but remained stable in the control area. Parasitological indices showed similar trends. Malaria-specific mortality rates remained, however, at essentially the same levels in both areas. The non-comprehensiveness of the CHWs' care and their ambiguous position in the health care system created problems that compromise the sustainability of the intervention.

Adolescent↗
PubMed1988

A personal effectiveness and stress management course for community health workers: a pilot study.

Since the role of a community health worker in an inner city area is potentially very stressful, there is a requirement to provide help, support and training to enable them to function successfully. An individual who has learned coping skills might also feel confident about teaching these skills to clients. This paper describes a short course intended to enable professionals such as health visitors, speech therapists, community nurses and physiotherapists to cope better with stress and to be more effective in their daily work with colleagues as well as in sharing skills with clients. The initial, actual knowledge of the participant and confidence in perceived knowledge and ability was assessed before and immediately after the training and at a 4-month follow-up and this was replicated in a second nurse. The preliminary results suggested that the course brought about highly significant changes which were generally maintained at follow-up.

Adaptation, Psychological↗
PubMedDate not supplied

Reducing home triggers for asthma: the Latino community health worker approach.

This study assessed the ability of a community health worker asthma intervention to change home asthma triggers. A total of 56 children and 47 adults with asthma were enrolled. Home trigger scores for the children averaged 2.8 at the initial home visit and then 2.3, 2.1, and 2.0 at 3, 6, and 12 months. Home trigger scores for the adults showed a similar trend. Every home visit was associated with a 0.32 reduction in home trigger score (p < 0.01) for children and a 0.41 reduction (p < 0.01) for adults. This intervention shows promise as a way to reduce asthma triggers in urban low-income Latino communities.

Adolescent↗
PubMed1989

Are large-scale volunteer community health worker programmes feasible? The case of Sri Lanka.

National community health worker (CHW) programmes supported by Ministries of Health have been introduced in a number of countries as part of their primary health care policy. Although in many of these programmes the CHWs are salaried or receive an honorarium, there are a number of large-scale programmes in which CHWs work as unpaid volunteers. This paper looks at one such programme in Sri Lanka, in order to understand the motivation of such volunteers and to consider the feasibility of relying on volunteers to support primary health care policies. The lessons from the Sri Lanka case are generalized to other studies. The conclusion is that large-scale community level volunteer programmes will be characterized by high attrition and low activity rates and will only be sustainable under particular enabling conditions.

Community Health Workers↗
PubMed2004

Community health workers and home-based care programs for HIV clients.

In Nyanza Province, Kenya, estimated HIV prevalence is 22%. Given that more than 80% of the population resides in rural areas, the majority of individuals in Nyanza Province do not have access to medical facilities on a regular basis. In response to the growing demands the HIV epidemic has placed on the people and communities in this region, hundreds of lay individuals have been trained as community health workers to provide home-based care to sick or dying HIV/AIDS clients in rural areas. This paper discusses the role and impact of these community health workers in Nyanza Province, Kenya. It outlines the collaborative relationship between community health workers and the Ministry of Health, examining community health workers' use of extant biomedical structures at the district level to provide services that government-run health facilities lack the monetary resources or personnel to provide. Finally, it explores the role played by community health workers in providing HIV/AIDS education to individuals in an attempt to prevent further infections.

Community Health Workers↗
PubMedDate not supplied

Community health workers in national programmes: the case of the family welfare educators of Botswana.

Community health worker programmes have become a prominent feature of many primary health care schemes in developing countries. This paper, which is based on a larger collaborative study undertaken in 3 countries, focuses on the experiences with such workers in Botswana, and concludes that many of the key issues that were highlighted in the Botswana study are similar to those in other countries. These can be summarized under four headings: unrealistic expectations, poor initial planning, problems of sustainability, and the difficulty of maintaining quality of care. The future success of these workers will depend on their being integrated more systematically into local services, with concomitant strengthening of management support and supervision.

Botswana↗
PubMed1985

What caused India's massive community health workers scheme: a sociology of knowledge.

A program to train Community Health Workers was initiated in India in 1977 using a rhetoric that referred to claims for the success of health policies in China. This paper considers conflicting interpretations of the program at the time when it was implemented, its failure to use the extensive institutional structure of indigenous medicine, and the failure of those who planned and evaluated the program to utilize the substantial body of ethnographic work on medical practices and traditions in South Asia.

Community Health Services↗