Effectiveness of a community health worker (CHW) training in monitoring and care of patients with chronic obstructive pulmonary disease (COPD) in rural Gujarat, India

Abstract

Context: Chronic obstructive pulmonary disease (COPD) is the second leading contributor to the disease burden of India. The current COPD burden cannot be managed effectively just through a physician-based approach. In a primary care setting, community health workers (CHWs) can play an effective role in making COPD care accessible and effective. Aim: Findings of an assessment of a training program for CHWs on COPD have been reported here. Methods: 90 CHWs working as a part of a noncommunicable disease prevention and care program in a rural primary care setting were exposed to a series of five training sessions. The sessions were designed and administered jointly by a team of public health experts and physiotherapists in the year 2017–18. Topics covered were basic clinical aspects of COPD, monitoring a patient with COPD, and basic aspects of pulmonary rehabilitation. The assessment comprised 12 MCQs and short questions, 7 video exercises, 2 case vignettes, and 5 skill assessments through objectively structured clinical examination (OSCE). Statistical Analysis: Mean percentage scores were calculated for each domain of assessment to make it comparable. Results: 70 CHWs with a mean age of 42.2 years completed all the training and underwent the assessment. Mean percentage score (SD) for knowledge was 62% (16.3). In OSCE assessment, scores were best in sputum clearance technique demonstration (92.1%) and the least in dyspnea relieving positions (59.2%). The CHWs had difficulties in identifying signs of respiratory distress (score - 55.1%). No statistically significant association was observed between performance scores and their sociodemographic profile. Conclusion: The results were encouraging and the program may be pilot tested in a government setting particularly using the health and wellness centers (HWC) platform.

Leveraging role of non-physician health workers in prevention and control of non-communicable diseases in India

“…and Gupta A across different regions of country revealed evident gap between NCD related knowledge and skills among ASHA and FHWs. [ 34 35 ]…”

Diagnostic Accuracy of a Two-Stage Sequential Screening Strategy Implemented by Community Health Workers (CHWs) to Identify Individuals with COPD in Rural India

“…Training and involving community health workers (CHWs), who comprise the largest health workforce in rural settings in India, in screening may provide an effective means of early detection. 13 , 14 Thus, this study aimed to test the diagnostic accuracy of a sequential, two-step screening strategy implemented by CHWs, using the Lung Function Questionnaire (LFQ) and pocket spirometry (PS) to detect individuals with COPD in rural India.…”

Community-based management of chronic obstructive pulmonary disease in Nepal—Designing and implementing a training program for Female Community Health Volunteers

“…One of the strengths of this FCHVs training was that the training was based on a comprehensive literature review, stakeholder meetings, utilization of existing nationally endorsed health promotion messages, and tailored to the community of the study area. The training was delivered through presentations, videos, role plays, demonstrations, and group exercises, as recommended by previous studies [19,31]. All these elements increased the effectiveness of the training.…”

“…Recently, CHW-led interventions have shown positive results in preventing and managing NCDs, including type 2 diabetes and hypertension [18]. Training programs for CHWs in monitoring and care of COPD patients in a rural part of India [19], and educational interventions for CHWs to increase awareness on COPD at a community level in Uganda [20] are some of the promising examples of CHWs' engagement in community-based management of COPD in LMICs.…”