Ram Sharan, Mohammadnezhad Masoud, Ram Komal, Prasad Kirti, Pal Moneeta, Dalmia Prarthana
Center for Public Health Research, Massey University, Wellington, New Zealand.
School of Nursing and Healthcare, University of Bradford, Bradford, UK.
Heliyon. 2022 Nov 4;8(11):e11379. doi: 10.1016/j.heliyon.2022.e11379. eCollection 2022 Nov.
Inequities in access to diabetic retinopathy (DR) services particularly in rural and remote Fiji is concerning. This is because DR when left undiagnosed and untreated for long, can lead to vision loss and permanent blindness. Appropriate channels must be explored to strengthen services and ensure equitable access to healthcare for everyone. This study describes the development and implementation of DR awareness training for community health workers (CHWs) and their subsequent engagement to raise awareness and scale-up DR screening for communities throughout Fiji.
As part of a programme to reduce the incidence of avoidable blindness due to diabetes amongst people living in the Pacific, DR training for primary level nurses was developed and implemented. As these primary level nurses were already inundated by clinical duties and competing health priorities, a shifting of the task was proposed to engage the CHWs who would instead educate communities on diabetes and DR and make referrals for DR screening. A one-day DR awareness training was developed and implemented by the Pacific Eye Institute with funding from the Fred Hollows Foundation New Zealand.
At the end of the DR programme in 2019, the team had achieved their target and trained a total of 823 CHWs giving an 81.32% coverage of the total 1012 registered CHW in the MHMS register. Anecdotal evidence showed a spike in DR referrals and screenings recorded at health facilities. Three key themes emerged related to the involvement of CHWs which include engagement of CHWs, benefits of the engagement, and health system-related challenges.
The use of CHWs who are already integrated into the health system was considered a sustainable intervention to strengthen diabetes and DR services at the primary level of care, particularly if it involves community awareness, health education, and health services facilitation The future of the CHWs will depend on their being integrated more systematically into local health services with strengthened management and supervision.
斐济农村和偏远地区在获得糖尿病视网膜病变（DR）服务方面存在不平等现象，这令人担忧。这是因为DR如果长期未被诊断和治疗，会导致视力丧失和永久性失明。必须探索适当途径来加强服务，并确保每个人都能公平获得医疗保健。本研究描述了针对社区卫生工作者（CHW）开展DR意识培训的开发与实施情况，以及他们随后为提高斐济各地社区的意识并扩大DR筛查所进行的参与。
作为一项旨在降低太平洋地区居民因糖尿病导致可避免失明发生率的计划的一部分，为基层护士开展了DR培训并付诸实施。由于这些基层护士已经被临床职责和相互竞争的卫生重点工作所淹没，因此提议将任务转移给CHW，由他们向社区宣传糖尿病和DR知识，并为DR筛查进行转诊。太平洋眼科研究所在新西兰弗雷德·霍洛基金会的资助下，开发并实施了为期一天的DR意识培训。
在2019年DR项目结束时，该团队实现了目标，共培训了823名CHW，占MHMS登记册中1012名注册CHW总数的81.32%。轶事证据显示，医疗机构记录的DR转诊和筛查数量激增。与CHW的参与相关出现了三个关键主题，包括CHW的参与、参与的益处以及与卫生系统相关的挑战。
利用已经融入卫生系统的CHW被认为是一种可持续的干预措施，可在初级保健层面加强糖尿病和DR服务，特别是如果涉及社区意识、健康教育和卫生服务便利化。CHW的未来将取决于他们能否更系统地融入当地卫生服务，并加强管理和监督。
