Learning and New Technologies Research Group, Department of Education, University of Oxford, Oxford, UK.
Division of Research and Health Equity, Omni Med, Mukono, Uganda.
Clin Otolaryngol. 2021 Nov;46(6):1193-1199. doi: 10.1111/coa.13815. Epub 2021 Aug 17.
Community Health Workers are one way to address the shortage of ear and hearing care specialists in low-resource settings. However, there are few reports evaluating training and service delivery by Community Health Workers.
DESIGN, SETTING AND PARTICIPANTS: We trained 13 Community Health Workers in primary ear and hearing care in Mukono District, Uganda. Community Health Workers attended a two-day training workshop and received remote supervision thereafter during service delivery in the community. An ear camp was held at the local health centre every two months, where a local ENT specialist could assess referred cases.
Clinical and diagnostic skills and decision-making were assessed using an Objective Structured Clinical Examination, with scores recorded at baseline and six months. Service delivery was evaluated by analysing the following: (i) number of individuals evaluated; (ii) treatments delivered; (iii) cases referred for specialist opinion; (iv) proportion of appropriately referred cases; and (v) agreement between Community Health Worker and specialist diagnosis.
Observed Structured Clinical Examination scores were high and stable for six months. 312 individuals were screened in the community by the Community Health Workers, with 298 classified as having an abnormality. Care was delivered in the community to 167 of these, and the remaining 131 referred to the ear camp. Diagnostic agreement was 39%, but 98% of referrals were deemed "appropriate" by the ENT specialist. 27 individuals self-presented to the ear camp without prior assessment by a Community Health Worker, and 97% of these were deemed appropriate.
Trained Community Health Workers can play an important role in delivering ear and hearing services. Future work should look to explore this model in other contexts and/or compare it to other models of service delivery.
在资源匮乏的环境中，社区卫生工作者是解决耳科和听力保健专家短缺的一种方法。然而，很少有报道评估社区卫生工作者的培训和服务提供情况。
设计、地点和参与者：我们在乌干达穆科诺区培训了 13 名从事初级耳科和听力保健工作的社区卫生工作者。社区卫生工作者参加了为期两天的培训研讨会，并在社区提供服务期间接受远程监督。每个月在当地卫生中心举办一次耳科营地，当地耳鼻喉科专家可以评估转诊病例。
使用客观结构化临床考试评估临床和诊断技能以及决策能力，在基线和六个月时记录分数。通过分析以下内容来评估服务提供情况：（i）评估的人数；（ii）提供的治疗；（iii）转诊给专家意见的病例；（iv）适当转诊病例的比例；以及（v）社区卫生工作者和专家诊断之间的一致性。
观察到的结构化临床考试成绩在六个月内保持较高且稳定。社区卫生工作者在社区中筛查了 312 人，其中 298 人被归类为异常。对其中 167 人在社区提供了护理，其余 131 人转诊到耳科营地。诊断一致性为 39%，但耳鼻喉科专家认为 98%的转诊是“适当”的。27 人未经社区卫生工作者事先评估自行前往耳科营地，其中 97%被认为是适当的。
经过培训的社区卫生工作者可以在提供耳科和听力服务方面发挥重要作用。未来的工作应该探索这种模式在其他环境中的应用，或与其他服务提供模式进行比较。
