Combating non-communicable diseases: potentials and challenges for community health workers in a digital age, a narrative review of the literature

Mishra, Shiva Raj; Lygidakis, Charilaos; Neupane, Dinesh; Gyawali, Bishal; Uwizihiwe, Jean Paul; Virani, Salim S.; Kallestrup, Per; Miranda, J. Jaime

doi:10.1093/heapol/czy099

Cited by 46 publications

(71 citation statements)

References 27 publications

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“…With recent evidence suggesting that there is value in incorporating digital technologies with CHW programmes, India is currently undergoing a digital transformation with an aim to improve health service delivery. This strategy has the potential to support ASHAs via training, decision support, referrals, and follow-up, thereby helping them deliver a broader range of quality health services [32]. However, there is a need for more evidence about how these technologies may support the workforce and strengthen health systems [33].…”

Section: Discussionmentioning

confidence: 99%

What do Accredited Social Health Activists need to provide comprehensive care that incorporates non-communicable diseases? Findings from a qualitative study in Andhra Pradesh, India

et al. 2019

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BackgroundThe Indian National Program for Cardiovascular Disease, Diabetes, Cancer and Stroke (NPCDCS) was introduced to provide non-communicable disease (NCD) care through primary healthcare teams including Accredited Social Health Activists (ASHAs). Since ASHAs are being deployed to provide NCD care on top of their regular work for the first time, there is a need to understand the current capacity and challenges faced by them.MethodsA desktop review of NPCDCS and ASHA policy documents was conducted. This was followed by group discussions with ASHAs, in-depth interviews with their supervisors and medical officers and group discussions with community members in Guntur, Andhra Pradesh, India. The multi-stakeholder data were analysed for themes related to needs, capacity, and challenges of ASHAs in providing NCD services.ResultsThis study identified three key themes—first, ASHAs are unrecognised as part of the formal NPCDCS service delivery team. Second, they are overburdened, since they deliver several NPCDCS activities without receiving training or remuneration. Third, they aspire to be formally recognised as employees of the health system. However, ASHAs are enthusiastic about the services they provide and remain an essential link between the health system and the community.ConclusionASHAs play a key role in providing comprehensive and culturally appropriate care to communities; however, they are unrecognised and overburdened and aspire to be part of the health system. ASHAs have the potential to deliver a broad range of services, if supported by the health system appropriately.Trial registrationThe study was registered with “Clinical Trials Registry – India” (identifier CTRI/2018/03/012425).

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Section: Discussionmentioning

confidence: 99%

What do Accredited Social Health Activists need to provide comprehensive care that incorporates non-communicable diseases? Findings from a qualitative study in Andhra Pradesh, India

et al. 2019

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“…Key challenges included a lack of evaluation of mHealth outcomes, development of mHealth tools and apps without cultural relevance, lack of access to, and knowledge of, mobile technologies within communities, need for effective training for CHWs to adopt mHealth tools and the need for improved communication between and among health care teams working with CHWs 5 . Similarly, in a recent narrative review of the literature, Mishra et al (2019) 10 identified three benefits and three challenges to incorporating digitalization into CHW practice. Benefits included improved access and quality of services, increased efficiency in training and personnel management, and leveraging of data generated across grass-roots platforms to further research and evaluation 10 .…”

Section: The Current Use Of Digital Technologies In Community-centered Care (Ccc)mentioning

confidence: 99%

“…Similarly, in a recent narrative review of the literature, Mishra et al (2019) 10 identified three benefits and three challenges to incorporating digitalization into CHW practice. Benefits included improved access and quality of services, increased efficiency in training and personnel management, and leveraging of data generated across grass-roots platforms to further research and evaluation 10 . Challenges included funding for CHW programs, digital health literacy of CHWs, and systemic challenges related to motivating CHWs, including adequate CHW supervision 10 .…”

Section: The Current Use Of Digital Technologies In Community-centered Care (Ccc)mentioning

confidence: 99%

“…Digital platforms currently used by CHWs and CCC organizations include mobile-based networking devices, web-applications, videoconference and mobile applications 10 . CHWs currently use mobile phones, tablets and other digital devices 38 in a task-specific manner (e.g., digital blood pressure monitoring devices, glucometers and spirometers) 10,39 . Digital alerts, reminders, notifications, checklists and decision-support tools facilitate compliance to protocols and improve the quality of care provided by CHWs 10,40 .…”

Section: The Current Use Of Digital Technologies In Community-centered Care (Ccc)mentioning

confidence: 99%

“…CHWs currently use mobile phones, tablets and other digital devices 38 in a task-specific manner (e.g., digital blood pressure monitoring devices, glucometers and spirometers) 10,39 . Digital alerts, reminders, notifications, checklists and decision-support tools facilitate compliance to protocols and improve the quality of care provided by CHWs 10,40 . Whereas the continuous monitoring of physiological parameters (e.g., heart rate, blood pressure) has typically been available only in hospital settings due to the need for special equipment and medical expertise, the development of relatively low-cost, non-intrusive sensors are presenting opportunities to enable ubiquitous monitoring of clients’ health and wellbeing.…”

Section: The Current Use Of Digital Technologies In Community-centered Care (Ccc)mentioning

confidence: 99%

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Digital Health-Enabled Community-Centered Care (D-CCC): A Scalable Model to Empower Future Community Health Workers utilizing Human-in-the-Loop AI

Kanduri

et al. 2021

Preprint

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Digital Health-Enabled Community-Centered Care (D-CCC) represents a pioneering vision for the future of community-centered care. Utilizing an artificial intelligence-enabled closed-loop digital health platform designed for, and with, community health workers, D-CCC enables timely and individualized delivery of interventions by community health workers to the communities they serve. D-CCC has the potential to transform the current landscape of manual, episodic and restricted community health worker-delivered care and services into an expanded, digitally interconnected and collaborative community-centered health and social care ecosystem which centers around a digitally empowered community health workforce of the future.

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Decision-support tools via mobile devices to improve quality of care in primary healthcare settings

Agarwal

Glenton

Tamrat

et al. 2021

Cochrane Database of Systematic Reviews

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Background The ubiquity of mobile devices has made it possible for clinical decision‐support systems (CDSS) to become available to healthcare providers on handheld devices at the point‐of‐care, including in low‐ and middle‐income countries. The use of CDSS by providers can potentially improve adherence to treatment protocols and patient outcomes. However, the evidence on the effect of the use of CDSS on mobile devices needs to be synthesized. This review was carried out to support a World Health Organization (WHO) guideline that aimed to inform investments on the use of decision‐support tools on digital devices to strengthen primary healthcare. Objectives To assess the effects of digital clinical decision‐support systems (CDSS) accessible via mobile devices by primary healthcare providers in the context of primary care settings. Search methods We searched CENTRAL, MEDLINE, Embase, Global Index Medicus, POPLINE, and two trial registries from 1 January 2000 to 9 October 2020. We conducted a grey literature search using mHealthevidence.org and issued a call for papers through popular digital health communities of practice. Finally, we conducted citation searches of included studies. Selection criteria Study design: we included randomized trials, including full‐text studies, conference abstracts, and unpublished data irrespective of publication status or language of publication. Types of participants: we included studies of all cadres of healthcare providers, including lay health workers and other individuals (administrative, managerial, and supervisory staff) involved in the delivery of primary healthcare services using clinical decision‐support tools; and studies of clients or patients receiving care from primary healthcare providers using digital decision‐support tools. Types of interventions: we included studies comparing digital CDSS accessible via mobile devices with non‐digital CDSS or no intervention, in the context of primary care. CDSS could include clinical protocols, checklists, and other job‐aids which supported risk prioritization of patients. Mobile devices included mobile phones of any type (but not analogue landline telephones), as well as tablets, personal digital assistants, and smartphones. We excluded studies where digital CDSS were used on laptops or integrated with electronic medical records or other types of longitudinal tracking of clients. Data collection and analysis A machine learning classifier that gave each record a probability score of being a randomized trial screened all search results. Two review authors screened titles and abstracts of studies with more than 10% probability of being a randomized trial, and one review author screened those with less than 10% probability of being a randomized trial. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisatio...

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Combating non-communicable diseases: potentials and challenges for community health workers in a digital age, a narrative review of the literature

Cited by 46 publications

References 27 publications

What do Accredited Social Health Activists need to provide comprehensive care that incorporates non-communicable diseases? Findings from a qualitative study in Andhra Pradesh, India

What do Accredited Social Health Activists need to provide comprehensive care that incorporates non-communicable diseases? Findings from a qualitative study in Andhra Pradesh, India

Digital Health-Enabled Community-Centered Care (D-CCC): A Scalable Model to Empower Future Community Health Workers utilizing Human-in-the-Loop AI

Decision-support tools via mobile devices to improve quality of care in primary healthcare settings

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