Parmar Parveen K, Rawashdah Fatma, Al-Ali Nahla, Abu Al Rub Raeda, Fawad Muhammad, Al Amire Khaldoun, Al-Maaitah Rowaida, Ratnayake Ruwan
Department of Emergency Medicine, University of Southern California, Los Angeles, California, USA
International Rescue Committee, Amman, Jordan.
BMJ Open. 2021 Apr 20;11(4):e045455. doi: 10.1136/bmjopen-2020-045455.
Globally, there is emerging evidence on the use of community health workers and volunteers in low-income and middle-income settings for the management of non-communicable diseases (NCDs), provision of out-of-clinic screening, linkage with health services, promotion of adherence, and counselling on lifestyle and dietary changes. Little guidance exists on the role of this workforce in supporting NCD care for refugees who lack access to continuous care in their host country. The goals of this work were to evaluate the current roles of community health volunteers (CHVs) in the management of diabetes and hypertension (HTN) among Syrian refugees and to suggest improvements to the current primary care model using community health strategies.
A participatory, multistakeholder causal loop analysis workshop with representatives from the Ministry of Health of Jordan, non-governmental organisations, United Nations agencies, CHVs and refugee patients was conducted in June 2019 in Amman, Jordan.
This causal loop analysis workshop was used to collaboratively develop a causal loop diagram and CHV strategies designed to improve the health of Syrian refugees with diabetes and HTN living in Jordan.
During the causal loop analysis workshop, participants collaboratively identified and mapped how CHVs might improve care among diagnosed patients. Possibilities identified included the following: providing psychosocial support and foundational education on their conditions, strengthening self-management of complications (eg, foot checks), and monitoring patients for adherence to medications and collection of basic health monitoring data. Elderly refugees with restricted mobility and/or uncontrolled disease were identified as a key population where CHVs could provide home-based blood glucose and blood pressure measurement and targeted health education to provide more precise monitoring.
CHV programmes were cited as a key strategy to implement secondary prevention of morbidity and mortality among Syrian refugees, particularly those at high risk of decompensation.
在全球范围内，越来越多的证据表明，在低收入和中等收入环境中，社区卫生工作者和志愿者可用于管理非传染性疾病（NCDs）、提供门诊外筛查、与卫生服务机构建立联系、促进依从性以及就生活方式和饮食变化提供咨询。对于这支劳动力队伍在支持那些在东道国无法获得持续护理的难民的非传染性疾病护理方面的作用，几乎没有指导意见。这项工作的目标是评估社区卫生志愿者（CHVs）在叙利亚难民糖尿病和高血压（HTN）管理中的当前作用，并建议利用社区卫生策略改进当前的初级保健模式。
2019年6月，在约旦安曼举行了一次参与性、多利益相关方因果循环分析研讨会，与会代表来自约旦卫生部、非政府组织、联合国机构、社区卫生志愿者和难民患者。
本次因果循环分析研讨会用于共同绘制因果循环图，并制定社区卫生志愿者策略，旨在改善生活在约旦的患有糖尿病和高血压的叙利亚难民的健康状况。
在因果循环分析研讨会上，参与者共同确定并绘制了社区卫生志愿者如何改善已确诊患者护理的方式。确定的可能性包括：提供心理社会支持和关于其病情的基础教育，加强并发症的自我管理（如足部检查），以及监测患者的药物依从性和收集基本健康监测数据。行动不便和/或疾病未得到控制的老年难民被确定为社区卫生志愿者可以提供家庭血糖和血压测量以及有针对性的健康教育以进行更精确监测的关键人群。
社区卫生志愿者项目被视为对叙利亚难民实施发病和死亡二级预防的关键策略，特别是对那些有失代偿高风险的难民。
