使社区卫生工作者能够识别和转介外科疾病：图片指南的试点研究结果。

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

机构信息

Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Operation Smile, Tegucigalpa, Honduras.

出版信息

World J Surg. 2019 Dec;43(12):2949-2958. doi: 10.1007/s00268-019-05173-x.

DOI:10.1007/s00268-019-05173-x

PMID:31511941

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.

摘要

背景

获得外科护理是一个紧迫的挑战，特别是对于弱势群体。非正式和正式的社区卫生工作者（CHW），包括非专业人士，在初级保健中越来越发挥关键作用，但在大多数环境中与外科护理仍然脱节。本研究通过使用基于图像的手册来检查 CHW 对手术条件的理解程度可以提高多少。

方法

手册和相关的情境问题解决问卷工具通过在中美洲的焦点小组开发和上下文化。进行了基线评估。在计划实施中，引入了正式和非正式的 CHW 群体，并通过短期课程接受使用手册的培训。仅在有相关手册内容的情况下，以及在教学课程之后，对计划实施进行了重复评估。还调查了参与者对手册方案、可用性和实用性的看法。

结果

共有 100 名受试者（67%为女性）参加了基线评估，403 名受试者（68%为女性）通过计划实施进行了评估。基线解决问题的平均得分为 20 分中的 11.8（SD 2.46）。当参与者可以访问相关的手术手册内容时，平均得分为 15.4（SD 3.10），并且在参加了有指导课程后，平均得分为 15.9（SD 3.09，p<0.0001）。参与者使用手册时的得分与完成的教育程度相关（r=0.26），但基线得分不相关。手册的高可读性为 389 名（96%），高自我报告的使用意愿为 398 名（96%）。