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Community Health Research Round-Up, Issue 018
September 10 - October 6, 2019
Community health workers obtain similar results using cell-phone based hearing screening tools compared to otolaryngologists in low resourced settings
Comments: Using screening audiometry (Android-based HearX Group) children 2–16 yrs underwent hearing screening by a community health worker and/or senior otolaryngology resident
Takeaway: Community health workers obtained a similar result to otolaryngology residents 96% of the time (p = 0.16). Profound implications in low-resourced settings where hearing healthcare specialists (audiologists and otolaryngologists) are limited
Effect of a Community Health Worker-Based Approach to Integrated Cardiovascular Risk Factor Control in India: A Cluster Randomized Controlled Trial
Comments: Previous studies have used community health workers (CHWs) to target single cardiovascular risk factors (this SR - RR 006, SMARTHealth India- RR 009, this trial in India - RR 015). This trial tests an integrated approach targeting hypertension, diabetes, & smoking via CHWs.
Takeaway: CHWs have a significant effect on hypertension, an inconclusive effect on diabetes, and no effect on smoking.
Opportunities for community health workers to contribute to global efforts to end tuberculosis
Comments: Helpful commentary outlining a brief history of CHWs in TB treatment (for any skeptics) + directions for future research
Takeaway: “With good training, adequate remuneration, careful supervision, opportunities for self-determination, community engagement, sufficient resources, unwavering political support, and close integration with the formal health system, CHW-based programmes should contribute substantially in our endeavours to end the global TB epidemic.”
A Performance-Based Incentives System for Village Health Workers in Kisoro, Uganda
Comments: A paper of which to be aware. In their recent guideline (which came out at the end of 2018), the WHO suggests not paying CHWs exclusively or predominantly according to performance-based incentives (PBI). The rationale for this recommendation was based on the evidence of potential harm: (1) PBI encouraged uneven focus on certain activities due to their association with higher incentives, especially when CHWs had no basic remuneration, leading to the neglect of other important activities or responsibilities + (2) CHWs expressed dissatisfaction with performance-based incentive models in relation to amounts paid and inconsistent and incomplete payment of incentives. This paper does not address the first concern and, while it does note that CHWs expressed dissatisfaction in precisely the way noted in concern #2, they dismiss these concerns, asserting it is the CHW’s “choice” to earn more or less.
Methods: Descriptive and analytic statistics on 12 months of program data
Takeaway: PBI has been used for seven years in Kisoro, Uganda. See commentary.
‘We are the people whose opinions don’t matter’. A photovoice study exploring challenges faced by community health workers in Uganda
Comments: The latest from our friends at the Learning and new Technologies Research Group, Oxford
Methods: Photovoice, a participatory visual method which involves the capture of photographic images related to issues of social importance.
Takeaway: The photographs and resulting discussions revealed the diverse challenges faced by CHWs, ranging from a lack of appropriate training and equipment, to complex socio-political challenges. It is important to note that although photovoice was generally perceived as a feasible methodology to explore daily challenges from the perspectives of CHWs, a small number of community members expressed concern with how their images might be used due to negative past experiences of non-native researchers capturing their images without gaining their permission.
Development of a tool for assessing quality of comprehensive care provided by community health workers in a community-based care programme in South Africa
Comments: A potentially helpful tool for intervention evaluations or routine support and management of community health workers.
Methods: Development based on literature, direct observation and field testing
Takeaway: Researchers in South Africa have developed a tool for use by non-clinical fieldworkers for assessing the quality of care delivered by community health workers providing comprehensive care in households
Lay Health Worker-Led Cancer Symptom Screening Intervention and the Effect on Patient-Reported Satisfaction, Health Status, Health Care Use, and Total Costs: Results From a Tri-Part Collaboration
Comments: Another NCD application - this study looks at a CHW-led symptom screening intervention for patients with stage 3 or 4 solid tumors or hematologic malignancies who were receiving care in a community oncology practice
Methods: Historic cohort control
Takeaway: There were no survival differences between the groups. Relative to the control group, the intervention group experienced improvements in satisfaction with care, overall health, and mental or emotional health over time; fewer hospitalizations and emergency department visits, and lower median (interquartile range) total health care costs
Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India
Comments: Of interest to the Community Health Academy team. Contextualize w/this systematic review on mobile technologies to support the training of CHWs (RR 016) and thisrelated scoping review (RR 012)
Methods: Prototyping via focus groups analyzed using framework analysis approach
Takeaway: Digital technology appears acceptable and feasible for supporting training of community health workers to deliver evidence-based depression care in rural India.
Enabling Community Health Worker Recognition and Referral of Surgical Diseases: Pilot Study Results of a Pictorial Guide
Comments: One of a host of ‘CHWs improve x capacity when they receive training!’ studies. Yet another illustration of what Berman et al. (1987) note in their seminal paper on CHWs, “CHW programs represent a mode for the organization of services rather than a type of intervention [task]”
Methods: pre-post survey
Takeaway: Baseline familiarity with surgically treatable conditions appears modest among rural Central American populations, and improves with access to a contextualized, pictorial manual focused on recognizing and appropriately referring surgical conditions.