Tsolekile Lungiswa P, Schneider Helen, Puoane Thandi
School of Public Health, University of the Western Cape.
Curationis. 2018 Mar 26;41(1):e1-e8. doi: 10.4102/curationis.v41i1.1815.
The current roles and capacity of community health workers (CHWs) in the management and control of non-communicable diseases (NCDs) remain poorly understood.
To assess CHWs' current roles, training and knowledge about diabetes and hypertension in Khayelitsha, Cape Town.
A cross-sectional study of 150 CHWs from two non-governmental organisations contracted to provide NCD care as part of a comprehensive package of services was conducted. An interviewer-administered closed-ended questionnaire was used to determine the roles, training, in-service support, knowledge and presence of NCDs. Descriptive analyses of these domains and multivariate analyses of the factors associated with CHWs' knowledge of hypertension and diabetes were conducted.
The vast majority (96%) of CHWs were female, with a mean age of 35 years; 88% had some secondary schooling and 53% had been employed as CHWs for 4 years or more. Nearly half (47%) reported having an NCD. CHWs' roles in NCDs included the delivery of medication, providing advice and physical assessment. Only 52% of CHWs reported some formal NCD-related training, while less than half of the trained CHWs (n = 35; 44%) had received follow-up refresher training. CHWs' knowledge of diabetes and hypertension was poor. In the multivariate analyses, higher knowledge scores were associated with having an NCD and frequency of supervisory contact (≥1 per month).
The roles performed by CHWs are broad, varied and essential for diabetes and hypertension management. However, basic knowledge about diabetes and hypertension remains poor while training is unstandardised and haphazard. These need to be improved if community-based NCD management is to be successful. The potential of peer education as a complementary mechanism to formal training needs as well as support and supervision in the workplace requires further exploration.
社区卫生工作者（CHW）在非传染性疾病（NCD）管理和控制方面的当前作用及能力仍未得到充分了解。
评估开普敦凯伊利沙地区社区卫生工作者在糖尿病和高血压方面的当前作用、培训及知识水平。
对来自两个签约提供非传染性疾病护理服务（作为综合服务包一部分）的非政府组织的150名社区卫生工作者进行了横断面研究。采用访谈员实施的封闭式问卷来确定其作用、培训、在职支持、知识水平及非传染性疾病的情况。对这些领域进行了描述性分析，并对与社区卫生工作者对高血压和糖尿病知识相关的因素进行了多变量分析。
绝大多数（96%）社区卫生工作者为女性，平均年龄35岁；88%接受过某种中等教育，53%担任社区卫生工作者4年或更长时间。近一半（47%）报告患有非传染性疾病。社区卫生工作者在非传染性疾病方面的作用包括发放药物、提供建议和进行身体评估。只有52%的社区卫生工作者报告接受过一些与非传染性疾病相关的正规培训，而在接受过培训的社区卫生工作者中，不到一半（n = 35；44%）接受过后续进修培训。社区卫生工作者对糖尿病和高血压的知识掌握较差。在多变量分析中，较高的知识得分与患有非传染性疾病以及监督接触频率（每月≥1次）相关。
社区卫生工作者所发挥的作用广泛、多样且对糖尿病和高血压管理至关重要。然而，关于糖尿病和高血压的基本知识仍然较差，同时培训不规范且随意。如果基于社区的非传染性疾病管理要取得成功，这些方面需要得到改善。同伴教育作为正规培训需求以及工作场所支持和监督的补充机制的潜力需要进一步探索。
