Can Trained Field Community Workers Identify Stroke Using a Stroke Symptom Questionnaire as well as Neurologists?

Abstract

Background Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by Community Health Workers (CHWs) are required to identify stroke in the community in a resource strapped region such as this. Methods The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire for Verifying Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community dwelling subjects using purposive sampling. Each CHW collected data independently which was validated by a vascular neurologist who directly examined each participant. To assess the effect of audit and feedback, data from the final 10% of the subjects was collected following a second training session for the CHWs. Sensitivity, specificity and Cohen’s kappa was determined for the CHW administered questionnaire against neurovascular assessment. Results Mean age of participants was 56.5 years with 71% of participants being women. The sensitivity and specificity of the questionnaire of detecting stroke was 77.1% (CI: 64.1%–86.9%) and 85.8% (CI: 83.5%–87.5%). The chance corrected agreement using the Cohen’s Kappa statistic was 0.51 (CI: 0.38–0.60). Kappa ranged from 0.37 to 0.58 for each of the seven stroke symptoms. Hemianesthesia (72.9%) and hemiplegia (64.6%) were the most sensitive symptoms. The performance and agreement improved from moderate to substantial after audit and feedback. Conclusion We found a reasonable sensitivity and specificity and moderate agreement between CHW administered QVSFS and assessment by a vascular neurologist. Study Registration Number NCT02073955

Effectiveness of community health worker training programmes for cardiovascular disease management in low-income and middle-income countries: a systematic review

“… 64 65 While most studies that involve CHWs include a component of training, none of them report the content, length or effectiveness of training on CHWs. Studies from South Africa, 66 67 Pakistan, 68 India, 69–71 China, 72 Dominican Republic, 73 Guatemala, 74 Thailand, 75 Mexico 76 and the Mexican–USA border 77 have shown innovative ways of involving CHWs for the prevention and control of CVD and its risk factors. However, these studies did not measure the impact of training on CHW knowledge and skill set.…”

Multilingual Validation of the Questionnaire for Verifying Stroke-Free Status in West Africa

“…Khan et al has recently reported on a translation of the 8-item QVSFS into Urdu with the administration of the questionnaire among 322 community-dwelling Pakistani subjects using ecologically valid pictures and found a sensitivity, specificity and NPV for detection of stroke of 71%, 85.8% and 95% respectively. However in that study comparison of the questionnaire with and without the pictogram was not reported (13). In this study, pictograms were in line diagrams with a strong agreement between the two versions of the questionnaire.…”

A Scoping Review of Community-Based Geriatric Health Assessment and Screening Tools used in South Asia

“…The QVSFS(26) was intended to verify the stroke-free status and Stroke impact scale to assess the post-stroke quality of life. NIMHANS Headache questionnaire(27) was used for headaches and EAR3Q(28) for bowel diseases.…”

“…Four tools - MDRF-IDRS[21], Simple DRS[22], DRS-urban Indians[23], IDRS[24] were for risk scoring of diabetes which had showed moderate sensitivity and specificity. The QVSFS[25]was intended to verify the stroke-free status, NIMHANS Headache questionnaire[26] for headache and EAR3Q[27] for bowel disease, all these tools had high sensitivity and NPV. The EPOCH-2[28] and MNA[29] were assessed cardio-vascular and nutritional status respectively and reported moderate reliability for both.…”