Background: Mobile instant messaging (MIM) tools, such as WhatsApp, have transformed global communication practice. In the field of global health, MIM is an increasingly used, but little understood, ...phenomenon.
Objectives: It remains unclear how MIM can be used by rural community health workers (CHWs) and their facilitators, and what are the associated benefits and constraints. To address this gap, WhatsApp groups were implemented and researched in a rural setting in Malawi.
Methods: The multi-site case study research triangulated interviews and focus groups of CHWs and facilitators with the thematic qualitative analysis of the actual conversations on WhatsApp. A survey with open questions and the quantitative analysis of WhatsApp conversations were used as supplementary triangulation sources.
Results: The use of MIM was differentiated according to instrumental (e.g. mobilising health resources) and participatory purposes (e.g. the enactment of emphatic ties). The identified benefits were centred on the enhanced ease and quality of communication of a geographically distributed health workforce, and the heightened connectedness of a professionally isolated health workforce. Alongside minor technical and connectivity issues, the main challenge for the CHWs was to negotiate divergent expectations regarding the social versus the instrumental use of the space.
Conclusions: Despite some challenges and constraints, the implementation of WhatsApp was received positively by the CHWs and it was found to be a useful tool to support distributed rural health work.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background
Over a third of US adults carry a diagnosis of prediabetes, 70% of whom may progress to type 2 diabetes mellitus (“diabetes”). Community health workers (CHWs) can help patients undertake ...healthy behavior to prevent diabetes. However, there is limited guidance to integrate CHWs in primary care, specifically to address CHWs’ dual clinic-based and community-oriented role.
Objective
Using evidence from CHWs’ adaptations of a diabetes-prevention intervention in safety-net hospitals in New York City, we examine the nature, intent, and possible consequences of CHWs’ actions on program fidelity. We propose strategies for integrating CHWs in primary care.
Design
Case study drawing on the Model for Adaptation Design and Impact (MADI) to analyze CHWs’ actions during implementation of CHORD (Community Health Outreach to Reduce Diabetes), a cluster-randomized pragmatic trial (2017–2022) at Manhattan VA and Bellevue Hospital.
Participants
CHWs and clinicians in the CHORD study, with a focus in this analysis on CHWs.
Approach
Semi-structured interviews and focus group discussion with CHWs (
n
=4); semi-structured interviews with clinicians (
n
=17). Interpretivist approach to explain CHWs’ adaptations using a mix of inductive and deductive analysis.
Key Results
CHWs’ adaptations extended the intervention in three ways: by extending social assistance, healthcare access, and operational tasks. The adaptations were intended to improve fit, reach, and retention, but likely had ripple effects on implementation outcomes. CHWs’ focus on patients’ complex social needs could divert them from judiciously managing their caseload.
Conclusions
CHWs’ community knowledge can support patient engagement, but overextension of social assistance may detract from protocolized health-coaching goals. CHW programs in primary care should explicitly delineate CHWs’ non-health support to patients, include multiprofessional teams or partnerships with community-based organizations, establish formal communication between CHWs and clinicians, and institute mechanisms to review and iterate CHWs’ work to resolve challenges in their community-oriented role.
Accredited Social Health Activists (ASHAs) are community health workers tasked to deliver health prevention in communities and link them with the health care sector. This paper examines the social, ...cultural, and institutional influences that either facilitate or impede ASHAs' abilities to deliver services effectively through the lens of the reciprocal determinism framework of social cognitive theory.
We conducted 98 semi-structured, in-depth interviews with ASHAs (n = 49) and their family members (n = 49) in Gurdaspur and Mewat districts. Data were analyzed by comparing and contrasting codes leading to the identification of patterns which were explained with the help of a theoretical framework.
We found that while the work of ASHAs led to some positive health changes in the community, thus providing them with a sense of self-worth and motivation, community norms and beliefs as well as health system attitudes and practices limited their capacity as community health workers.
We outline potential mechanisms for improving ASHA capacity such as improved sensitization about religious, cultural, and gender norms; enhanced communication skills; and sensitization and advocating their work with health and state officials.
Background
Gaps in accessibility and communication hinder diabetes care in poor communities. Combining mobile health (mHealth) and community health workers (CHWs) into models to bridge these gaps has ...great potential but needs evaluation.
Objective
To evaluate a mHealth-based, Participant-CHW-Clinician feedback loop in a real-world setting.
Design
Quasi-experimental feasibility study with intervention and usual care (UC) groups.
Participants
A total of 134 participants (
n
= 67/group) who were all low-income, uninsured Hispanics with or at-risk for type 2 diabetes.
Intervention
A 15-month study with a weekly to semimonthly mHealth Participant-CHW-Clinician feedback loop to identify participant issues and provide participants monthly diabetes education via YouTube.
Main Measures
We used pre-defined feasibility measures to evaluate our intervention: (a) implementation, the execution of feedback loops to identify and resolve participant issues, and (b) efficacy, intended effects of the program on clinical outcomes (baseline to 15-month HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), and weight changes) for each group and their subgroups (at-risk; with diabetes, including uncontrolled (HbA1c ≥ 7%)).
Key Results
CHWs identified 433 participant issues (mean = 6.5 ± 5.3) and resolved 91.9% of these. Most issues were related to supplies, 26.3% (
n
= 114); physical health, 23.1% (
n
= 100); and medication access, 20.8% (
n
= 90). Intervention participants significantly improved HbA1c (− 0.51%,
p
= 0.03); UC did not (− 0.10%,
p
= 0.76). UC DBP worsened (1.91 mmHg,
p
< 0.01). Subgroup analyses revealed HbA1c improvements for uncontrolled diabetes (intervention: − 1.59%,
p
< 0.01; controlled: − 0.72,
p
= 0.03). Several variables for UC at-risk participants worsened: HbA1c (0.25%,
p
< 0.01), SBP (4.05 mmHg,
p
< 0.01), DBP (3.21 mmHg,
p
= 0.01). There were no other significant changes for either group.
Conclusions
A novel mHealth-based, Participant-CHW-Clinician feedback loop was associated with improved HbA1c levels and identification and resolution of participant issues. UC individuals had several areas of clinical deterioration, particularly those at-risk for diabetes, which is concerning for progression to diabetes and disease-related complications.
Clinical Trial
NCT03394456, accessed at
https://clinicaltrials.gov/ct2/show/NCT03394456
This study explored how a community health worker (CHW) within a primary care team with a HealthySteps (HS) Specialist impacted referrals to social determinant of health resources for families with ...children aged birth to 5 years. Medical charts with documentation of HS comprehensive services between January and June 2018 were reviewed at 3 primary care clinics: 2 with an HS Specialist (HSS Only) and 1 with an HS Specialist and CHW (HSS + CHW). Eighty-six referrals were identified, 78 of which had documented outcomes. Outcomes were categorized as successful, unsuccessful, and not documented. The HSS + CHW group had a higher rate of successful referrals (96%) than the HSS Only group (74%). Statistical analysis (χ2 = 8.37, P = .004) revealed a significant association between the referral outcome and having a CHW on a primary care team with an HS Specialist. Therefore, primary care practices should consider adapting their HS model to include CHWs.
Community health workers (CHWs) are central to the global health response to crises like the AIDS epidemic. Yet community health work remains undervalued and undercompensated worldwide owing in large ...part to the gendered and racialized contexts of care work. This paper investigates the possibility of occupational security for CHWs by comparing two cases from South Africa's response to AIDS. The first draws on ethnographic research (2007–2009) in rural KwaZulu‐Natal province and documents the fraught formation of a union representing CHWs. The second examines legal action in the Free State province for a group of CHWs known as the Bophelo House 94, who were arrested and criminally charged in June 2014 after protesting their sudden dismissal by the government. This case comparison finds that collective action has thus far had limited effects on CHWs' position as a nascent occupation. The South African Ministry of Health has obstructed CHW professionalization, and non‐state actors' involvement has been a mixture of benefit and impediment: some social justice agencies have facilitated CHW advocacy, while many AIDS service organizations have cooperated with the state and exacerbated the precarity of CHWs' working conditions. However, the consolidation of CHW work roles—owing to advances in AIDS prevention and treatment—holds promise for future CHW collective organization.
Abstract
Background
Finding effective, accessible treatment options such as professional-delivered cognitive behavioral therapy (CBT) for medically complex individuals is challenging in rural ...communities.
Purpose
We examined whether a CBT-based program intended to increase physical activity despite chronic pain in patients with diabetes delivered by community members trained as peer coaches also improved depressive symptoms and perceived stress.
Methods
Participants in a cluster-randomized controlled trial received a 3-month telephonic lifestyle modification program with integrated CBT elements. Peer coaches assisted participants in developing skills related to adaptive coping, diabetes self-management goal-setting, stress reduction, and cognitive restructuring. Attention controls received general health advice with an equal number of contacts but no CBT elements. Depressive symptoms and stress were assessed using the Centers for Epidemiologic Studies Depression and Perceived Stress scales. Assessments occurred at baseline, 3 months, and 1 year.
Results
Of 177 participants with follow-up data, 96% were African Americans, 79% women, and 74% reported annual income <$20,000. There was a significant reduction in perceived stress in intervention compared to control participants at 3-months (β = −2.79, p = .002 95% CI −4.52, −1.07) and 1 year (β = −2.59, p < .0001 95% CI −3.30, −1.87). Similarly, intervention participants reported significant decreases in depressive symptoms at 3-months (β = −2.48, p < .0001 95% CI −2.48, −2.02) and at 1 year (β = −1.62, p < .0001 95% CI −2.37, −0.86).
Conclusions
This peer-delivered CBT-based program improved depressive symptoms and stress in individuals with diabetes and chronic pain. Training community members may be a feasible strategy for offering CBT-based interventions in rural and under-resourced communities.
Clinical Trial Registration
NCT02538055.
A peer coach-delivered, diabetes self-management program that integrated cognitive behavioral therapy principles improved depressive symptoms and stress in adults with diabetes and chronic pain
Community health workers (CHWs) have strong potential for conducting health initiatives in vulnerable countries. Their continuing activities are essential for positive outcomes. The purpose of this ...study is to understand CHW activities in Kyrgyzstan migrant villages and their impact on individuals and communities.
This study used a mixed-method design. All active CHWs were invited to participate in the survey and the first reflection note regarding their experience and satisfaction with CHW activities. Respondents who agreed to participate in the second reflection notes wrote additional reflection notes. Participatory observational CHW activity report meeting data was collected for additional qualitative analysis. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed thematically.
CHWs started their activities with altruistic and personal motives, such as social recognition and knowledge acquisition. Job-related satisfaction after the activity tended to be high. After performing home visits and resident participatory events, they experienced intrinsic motivation, resource mobilization efforts, increased autonomy, and social recognition. Although the material rewards were small as volunteers, they recognized their positive impact on individuals and communities and gained pride and happiness.
CHWs participating in health promotion projects had training and CHW-nurse network activities and were gradually empowered in the process. When considering the sustainability of CHW activities, it is important to increase self-confidence and strengthen social recognition through empowerment.
•CHWs have strong potential in vulnerable countries.•CHWs started activities with altruistic and personal motives.•CHWs experienced improving ability, intrinsic motivation, and positive impact on the community.•CHWs were gradually empowered over the course of training and network activities.•Strengthening social recognition for CHWs is important.
Introduction: Herd immunity through vaccination is one of the major strategies for overcoming the COVID-19 pandemic, but there are still doubts about vaccines among health workers.
Aims: This study ...aims to assess the relationship between knowledge of the COVID-19 vaccine and the attitudes of health workers.
Methods: This is a cross-sectional study, which involves the distribution of a validated online questionnaire through Google Forms to health workers at Zainoel Abidin General Hospital Banda Aceh. The data consist of general characteristics, 13 questions regarding knowledge, and nine inquiries related to attitudes.
Results: There were 301 respondents, of which 87.4% were females and 48.8% were nurses. Only 27.9% of the health workers have a history of COVID-19 courses, 67.8% have good knowledge about the vaccine, and 70.8% with a positive attitude. There was a significant relationship between the knowledge of the vaccine and health workers' attitudes. Furthermore, gender, age, education level, and training history did not affect the knowledge of vaccination, while profession was the main influential factor.
Conclusion: This study shows that there is a relationship between knowledge of the COVID-19 vaccine and health workers' attitudes. However, stakeholders must always focus on strategies that can increase understanding and practice of disease prevention
Keywords: attitude, COVID-19 vaccine, knowledge, health workers
This study describes program implementation through a research-restaurant partnership and assesses participant satisfaction, program costs, and percent body weight changes.
Participants (n = 60) in a ...virtual synchronous (n = 43) or virtual asynchronous (n = 17) 12-week plant-based nutrition program received restaurant vouchers. Class satisfaction data were collected weekly. Assessments were completed at baseline, 3 months, and 9 months, along with interviews (n = 13) between 3 and 9 months. The costing approach estimated costs per participant. Interviews were coded using a content analysis and constant comparative method.
Participants rated the intervention favorably. Program costs were $198.63/participant, and participants’ willingness to pay postintervention was $101.50 ± $63.90. Participants shared satisfaction with course content, the restaurant partnership, and suggestions for future delivery. No changes in participants’ percent body weight were observed between 3 and 9 months (P = 0.98), indicating maintenance of 3-month weight loss.
A research-restaurant partnership successfully implemented a nutrition program and generated positive feedback. With the lifting of coronavirus disease 2019 pandemic restrictions, future research can now test alternative implementation methods (in person vs online) in other restaurants.
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