Abrahams-Gessel Shafika, Denman Catalina A, Montano Carlos Mendoza, Gaziano Thomas A, Levitt Naomi, Rivera-Andrade Alvaro, Carrasco Diana Munguía, Zulu Jabu, Khanam Masuma Akter, Puoane Thandi
Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA.
Centro de Estudios en Salud y Sociedad, El Colegio de Sonora, Colonia Centro, Hermosillo, Sonora, México.
Glob Heart. 2015 Mar;10(1):45-54. doi: 10.1016/j.gheart.2014.12.008.
Cardiovascular disease (CVD) is on the rise in low- and middle-income countries and is proving difficult to combat due to the emphasis on improving outcomes in maternal and child health and infectious diseases against a backdrop of severe human resource and infrastructure constraints. Effective task-sharing from physicians or nurses to community health workers (CHW) to conduct population-based screening for persons at risk has the potential to mitigate the impact of CVD on vulnerable populations. CHW in Bangladesh, Guatemala, Mexico, and South Africa were trained to conduct noninvasive population-based screening for persons at high risk for CVD.
This study sought to quantitatively assess the performance of CHW during training and to qualitatively capture their training and fieldwork experiences while conducting noninvasive screening for CVD risk in their communities.
Written tests were used to assess CHW's acquisition of content knowledge during training, and focus group discussions were conducted to capture their training and fieldwork experiences.
Training was effective at increasing the CHW's content knowledge of CVD, and this knowledge was largely retained up to 6 months after the completion of fieldwork. Common themes that need to be addressed when designing task-sharing with CHW in chronic diseases are identified, including language, respect, and compensation. The importance of having intimate knowledge of the community receiving services from design to implementation is underscored.
Effective training for screening for CVD in community settings should have a strong didactic core that is supplemented with culture-specific adaptations in the delivery of instruction. The incorporation of expert and intimate knowledge of the communities themselves is critical, from the design to implementation phases of training. Challenges such as role definition, defining career paths, and providing adequate remuneration must be addressed.
心血管疾病（CVD）在低收入和中等收入国家呈上升趋势，由于在人力资源和基础设施严重受限的背景下，重点关注改善孕产妇和儿童健康以及传染病的治疗效果，因此难以应对。从医生或护士到社区卫生工作者（CHW）进行有效的任务分担，以对高危人群进行基于人群的筛查，有可能减轻心血管疾病对弱势群体的影响。孟加拉国、危地马拉、墨西哥和南非的社区卫生工作者接受了培训，以对心血管疾病高危人群进行非侵入性的基于人群的筛查。
本研究旨在定量评估社区卫生工作者在培训期间的表现，并定性了解他们在社区中进行心血管疾病风险非侵入性筛查时的培训和实地工作经验。
通过书面测试评估社区卫生工作者在培训期间对内容知识的掌握情况，并进行焦点小组讨论以了解他们的培训和实地工作经验。
培训有效地增加了社区卫生工作者对心血管疾病的内容知识，并且在实地工作完成后长达6个月，这些知识大多得以保留。确定了在设计与社区卫生工作者在慢性病方面的任务分担时需要解决的共同主题，包括语言、尊重和报酬。强调了从设计到实施，深入了解接受服务社区的重要性。
在社区环境中进行心血管疾病筛查的有效培训应具有强大的教学核心，并在教学过程中辅以针对特定文化的调整。从培训的设计到实施阶段，纳入对社区本身的专业和深入了解至关重要。必须解决角色定义、确定职业道路和提供适当报酬等挑战。
