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Original Research

The Training and Fieldwork Experiences of Community Health Workers Conducting Population-Based, Noninvasive Screening for CVD in LMIC

Authors:

Shafika Abrahams-Gessel ,

Center for Health Decision Science, Harvard School of Public Health, Boston, MA, US
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Catalina A. Denman,

Centro de Estudios en Salud y Sociedad, El Colegio de Sonora, Colonia Centro, Hermosillo, Sonora, MX
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Carlos Mendoza Montano,

Institute of Nutrition of Central America and Panama (INCAP), Ciudad de Guatemala, GT
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Thomas A. Gaziano,

Center for Health Decision Science, Harvard School of Public Health, Boston, MA; Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, US
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Naomi Levitt,

Chronic Diseases Initiative for Africa, Groote Schuur Hospital, Cape Town; Division of Endocrinology and Diabetes, Department of Medicine, University of Cape Town, Cape Town, ZA
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Alvaro Rivera-Andrade,

Institute of Nutrition of Central America and Panama (INCAP), Ciudad de Guatemala, GT
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Diana Munguía Carrasco,

Centro de Estudios en Salud y Sociedad, El Colegio de Sonora, Colonia Centro, Hermosillo, Sonora, MX
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Jabu Zulu,

School of Public Health, University of the Western Cape, Bellville, ZA
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Masuma Akter Khanam,

Centre for Control of Chronic Diseases in Bangladesh, ICDDRB, Mohakali, Dhaka, BD; Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, AU
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Thandi Puoane

School of Public Health, University of the Western Cape, Bellville, ZA
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Abstract

Background: Cardiovascular disease (CVD) is on the rise in low- and middle-income countries and is proving difficult to combat due to the emphasis on improving outcomes in maternal and child health and infectious diseases against a backdrop of severe human resource and infrastructure constraints. Effective task-sharing from physicians or nurses to community health workers (CHW) to conduct population-based screening for persons at risk has the potential to mitigate the impact of CVD on vulnerable populations. CHW in Bangladesh, Guatemala, Mexico, and South Africa were trained to conduct noninvasive population-based screening for persons at high risk for CVD.

Objectives: This study sought to quantitatively assess the performance of CHW during training and to qualitatively capture their training and fieldwork experiences while conducting noninvasive screening for CVD risk in their communities.

Methods: Written tests were used to assess CHW’s acquisition of content knowledge during training, and focus group discussions were conducted to capture their training and fieldwork experiences.

Results: Training was effective at increasing the CHW’s content knowledge of CVD, and this knowledge was largely retained up to 6 months after the completion of fieldwork. Common themes that need to be addressed when designing task-sharing with CHW in chronic diseases are identified, including language, respect, and compensation. The importance of having intimate knowledge of the community receiving services from design to implementation is underscored.

Conclusions: Effective training for screening for CVD in community settings should have a strong didactic core that is supplemented with culture-specific adaptations in the delivery of instruction. The incorporation of expert and intimate knowledge of the communities themselves is critical, from the design to implementation phases of training. Challenges such as role definition, defining career paths, and providing adequate remuneration must be addressed.

Highlights

  • We investigated the training and field work experiences of community health workers.
  • We identified key issues that are important to community health workers for training and fieldwork.
  • We found that community knowledge and relationships are critical.
  • Training must cover core competencies and be customized to individual settings.
How to Cite: Abrahams-Gessel S, Denman CA, Montano CM, Gaziano TA, Levitt N, Rivera-Andrade A, et al.. The Training and Fieldwork Experiences of Community Health Workers Conducting Population-Based, Noninvasive Screening for CVD in LMIC. Global Heart. 2015;10(1):45–54. DOI: http://doi.org/10.1016/j.gheart.2014.12.008
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Published on 01 Mar 2015.
Peer Reviewed

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