Assessing the knowledge and skill of ASHA community health workers in blood pressure measurement and primary care of hypertension

Abstract

Introduction: India has a high burden of hypertension, and community health workers (CHWs) can contribute to its primary care. Studies of small-scale interventions have shown that trained CHWs can be useful contributors to hypertension care. No assessments are available in India on effectiveness of CHW training when conducted on a large scale. Methods: A study was conducted in Chhattisgarh, where 38,000 Accredited Social Health Activist (ASHA) CHWs had been trained in blood pressure (BP) measurement and counselling skills related to hypertension. The study involved a skill test and a knowledge test with ten points each, administered to two representative samples of trained CHWs – 433 in rural areas and 422 in urban slums. Results: The mean skill score out of 10 was 7.79 (7.59–7.99) and 8.11 (7.93–8.29) for the rural and urban CHWs, respectively. Around 75.3% (71.0–79.1%) of the rural and 80.3% (76.2–83.9%) of urban CHWs were able to score 70% (7 out of 10) or higher in the skill test. The mean knowledge score out of 10 was 8.18 (8.04–8.33) and 8.82 (8.78–8.93) for the rural and urban CHWs, respectively. Around 83.2% (79.3–86.4%) and 95.0% (94.4–96.7%) of the rural and urban CHWs, respectively, were able to score 70% or higher in the knowledge test. Conclusion: The ASHAs in Chhattisgarh demonstrated the necessary competence to contribute to BP measurement and primary care of hypertension. It shows feasibility of training a large number of CHWs in such skills. Efforts to equip and support the 1 million strong cadre of ASHAs across India need to be speeded up.