Martin Molly A, Mosnaim Giselle S, Rojas Delia, Hernandez Olivia, Sadowski Laura S
Rush University Medical Center, IL, USA.
Prog Community Health Partnersh. 2011 Spring;5(1):95-103. doi: 10.1353/cpr.2011.0004.
Community health workers (CHWs) are frontline public health workers who connect immigrant communities with health care services. Although CHW asthma interventions have been shown to improve some outcomes, their ability to change medication adherence remains unclear.
Our goal was to determine if intensive asthma medication training resulted in objective improvements in asthma medication instruction abilities for immigrant Mexican CHWs.
Eleven CHWs participated in a 15-hour training course conducted in only Spanish. The course covered asthma pathophysiology, reliever and controller medications, medication technique, and self-management skills. Before and after the training, CHWs completed a written asthma knowledge test and were tested on medication delivery technique using a demonstrator metered dose inhaler (MDI), spacer, and dry powder inhaler (DPI). After the training, CHWs performed a standardized role play to assess their ability to deliver medication instruction. At follow-up evaluations, the CHWs described benefits and weaknesses of the training.
Before the training, the median correct medication technique scores were: MDI = 25%, spacer = 0%, and DPI = 0%. After the training, the median scores were: MDI = 69%, spacer = 64%, and DPI = 67% (p < .01). On the role plays, all CHWs were scored as "Demonstrates adequate understanding of a complicated skill" and four were "Ready for the field on a clinical trial." The CHWs described specific application of training skills during the subsequent delivery of an asthma intervention.
This training and follow-up evaluation provide objective evidence of improved asthma medication knowledge, delivery technique, and instruction abilities in immigrant Mexican CHWs. With proper training, CHWs can assist families to understand and correctly use complicated asthma medications.
社区卫生工作者（CHW）是一线公共卫生工作者，他们将移民社区与医疗服务联系起来。虽然CHW哮喘干预措施已被证明能改善一些结果，但其改变药物依从性的能力仍不明确。
我们的目标是确定强化哮喘药物培训是否能客观改善墨西哥移民CHW的哮喘药物指导能力。
11名CHW参加了仅用西班牙语进行的为期15小时的培训课程。该课程涵盖哮喘病理生理学、缓解药物和控制药物、用药技术及自我管理技能。培训前后，CHW完成了一份哮喘知识书面测试，并使用示范定量吸入器（MDI）、储雾罐和干粉吸入器（DPI）对用药技术进行了测试。培训后，CHW进行了标准化角色扮演，以评估他们提供药物指导的能力。在随访评估中，CHW描述了培训的益处和不足。
培训前，正确用药技术的中位数得分分别为：MDI = 25%，储雾罐 = 0%，DPI = 0%。培训后，中位数得分分别为：MDI = 69%，储雾罐 = 64%，DPI = 67%（p <.01）。在角色扮演中，所有CHW的得分均为“对复杂技能有充分理解”，4名CHW的得分是“准备好在临床试验中开展工作”。CHW描述了在随后的哮喘干预中培训技能的具体应用。
这项培训和随访评估提供了客观证据表明墨西哥移民CHW的哮喘药物知识、给药技术和指导能力得到了改善。通过适当培训，CHW可以帮助家庭理解并正确使用复杂的哮喘药物。
