Enabling Community Health Worker Recognition and Referral of Surgical Diseases: Pilot Study Results of a Pictorial Guide

Abstract

Background Access to surgical care is a pressing challenge, particularly for vulnerable populations. Informal and formal community health workers (CHWs), including lay people, increasingly function in pivotal roles in primary care, however, remain disconnected from surgical care in most environments. This study examined the degree to which CHW understanding of surgical conditions could be improved through the use of a pictorially based manual. Methods A manual and associated situational problem-solving questionnaire instrument were developed and contextualized through focus groups in Central America. A baseline assessment was obtained. In the program implementation, cohorts of formal and informal CHWs were introduced and trained to use the manual through a short curriculum. Assessment was repeated in program implementation, first with access to relevant manual content only, and then after the teaching session. Participants were also surveyed about manual scheme, usability, and utility. Results A total of 100 subjects (67% female) participated in baseline assessment, and 403 subjects (68% female) were assessed through the program implementation. Baseline problem-solving averaged 11.8 (SD 2.46) out of a possible 20 points. Mean score increased to 15.4 (SD 3.10) when participants had access to relevant surgical manual content and again to 15.9 (SD 3.09, p \ 0.0001) following participation with an instructive curriculum. Participant score while utilizing the manual correlated with amount of education completed (r = 0.26), but baseline score did not. High readability 389 (96%) and high self-reported willingness for use 398 (96%) were noted. Conclusion 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.Please note that this study has eight authors. The international, multisite nature of this study, with core involvement of surgeons, statisticians, and global health researchers from several sites were included in all key phases of the study. Each meets WJS criteria as an author.

Impact of a tuberculosis treatment adherence intervention versus usual care on treatment completion rates: results of a pragmatic cluster randomized controlled trial

“…They found a significant increases in PT knowledge and observed ability to provide cascade training; however, knowledge gains were not sustained, with no difference between participants and non-participants 1 year after the intervention; this result suggests the need for refresher training. Gualy et al [ 34 ] developed and evaluated a pictorial guide to aid community health workers in Honduras to recognize and refer patients with surgical disease. The study, which involved a mixed group of community health workers both formal and informal, examined the effectiveness of the guide either on its own or combined with a curriculum led by medical students; knowledge improved significantly in both scenarios, but effect on patient outcomes was not assessed.…”