Ram Sharan, Mohammadnezhad Masoud, Ram Komal, Dalmia Prarthana, Pal Moneeta
Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
School of Public Health & Primary Health Care, Fiji National University, Suva, Fiji
Rural Remote Health. 2022 Jun;22(2):6976. doi: 10.22605/RRH6976. Epub 2022 Jun 10.
Community health workers (CHWs) are effective in raising awareness about diabetes mellitus and diabetic retinopathy (DR). In Fiji, CHWs were trained in a 1-day diabetic retinopathy (DR) awareness to provide communities with adequate basic knowledge about diabetes and DR to improve awareness and enhance referrals for DR screening and treatment. This study aimed to explore the impact of this training on CHWs' knowledge of DR and their referral practices related to DR screening in Fiji 2 years post-training.
This qualitative study was conducted in 2021 across three out of the four administrative divisions of Fiji, namely the Western, Northern and Central divisions. A total of 14 CHWs from the three divisions of Fiji participated in this study. All participants had attended a 1-day DR awareness training 2 years before this study. Participants were chosen purposively and were invited to participate in focus group discussion (FGD). The FGDs were audio-recorded and transcribed verbatim, and thematic analysis was conducted to identify and classify recurrent themes.
CHWs indicated that their knowledge about both diabetes and DR improved significantly after the training. This boosted their confidence in talking about these issues and providing clarity regarding referrals for DR screening in their respective communities. Consequently, they have referred a significantly higher number of people for screening both in outreach and to health facilities. Challenges in referral included poverty, high transportation cost and social support needs, which hindered screening. Further, although CHWs felt some degree of integration within the health system, they thought more was needed.
Investing in scalable models such as training CHWs is an important first step in tackling diabetes and DR in communities, particularly at the grassroots level in low-resource settings by increasing the community's knowledge of DR and improving access to screening, diagnosis and treatment.
社区卫生工作者在提高对糖尿病和糖尿病视网膜病变（DR）的认识方面很有成效。在斐济，社区卫生工作者接受了为期一天的糖尿病视网膜病变（DR）认识培训，以便为社区提供有关糖尿病和DR的充分基础知识，以提高认识并加强DR筛查和治疗的转诊。本研究旨在探讨该培训对斐济社区卫生工作者在培训后两年对DR的知识及其与DR筛查相关的转诊实践的影响。
这项定性研究于2021年在斐济四个行政区中的三个进行，即西部、北部和中部行政区。来自斐济这三个行政区的14名社区卫生工作者参与了本研究。所有参与者在本研究前两年都参加了为期一天的DR认识培训。参与者是有目的地挑选出来的，并被邀请参加焦点小组讨论（FGD）。焦点小组讨论进行了录音并逐字转录，并进行了主题分析以识别和分类反复出现的主题。
社区卫生工作者表示，培训后他们对糖尿病和DR的知识都有了显著提高。这增强了他们谈论这些问题的信心，并在各自社区中就DR筛查的转诊提供了清晰的指导。因此，他们在社区宣传和向卫生设施转诊进行筛查的人数明显增加。转诊面临的挑战包括贫困、高昂的交通成本和社会支持需求，这些都阻碍了筛查。此外，尽管社区卫生工作者感到在卫生系统内有一定程度的融入，但他们认为还需要更多努力。
投资于可扩展模式，如培训社区卫生工作者，是在社区中应对糖尿病和DR的重要第一步，特别是在资源匮乏环境的基层，通过增加社区对DR的了解并改善筛查、诊断和治疗的可及性。
