Training of Community Health Workers in Diabetes Lead to Improved Outcomes for Diabetes Screening and Management in Low- and Middle-Income Countries: Protocol for a Systematic Review.

BACKGROUND: Diabetes is a growing concern worldwide, particularly in low- and middle-income countries (LMICs). Type 2 diabetes mellitus constitutes a significant proportion of cases and is associated with debilitating microvascular complications. Type 2 diabetes mellitus is steadily increasing among the LMICs where many barriers to health care exist. Thus, task shifting to community health workers (CHWs) has been proposed as a solution to improve diabetes management in these settings. However, CHWs often lack the necessary training to manage diabetes effectively. Thus, a systematic review is required to present evidence of the highest degree for this intervention. OBJECTIVE: This study aims to establish the protocols for a systemic review. METHODS: Using the Participants Intervention Comparator Outcome Time Study Design (PICOTS) framework, this study outlines a systematic review aiming to evaluate the impact of training programs for CHWs in diabetes management in LMICs. Quantitative studies focusing on CHWs, diabetes training, focusing on diabetes management outcomes like hemoglobin A1c levels and fasting blood glucose levels, between January 2000 and December 2023 and found on databases such as PubMed, Ovid MEDLINE, Evidence Based Medicine Reviews, BASE, Google Scholar, and Web of Science will be included. We will include randomized controlled trials but will also include observational studies if we find less than 5 randomized controlled trials. An author committee consisting of 3 reviewers will be formed, where 2 reviewers will conduct the review independently while the third will resolve all disputes. The Cochrane Methods Risk of Bias Tool 2 will be used for assessing the risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation approach for the meta-analysis and narrative synthesis analysis will be used. The results will be presented in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram. RESULTS: The review will begin in May 2024 and conclude in 3 months. CONCLUSIONS: The review will synthesize existing evidence and provide insights into the effectiveness of such programs, informing future research and practice in diabetes care in LMICs. TRIAL REGISTRATION: PROSPERO CRD42022341717; https://tinyurl.com/jva2hpdr. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/57313.

Skills2Care: An innovative, cooperative learning programme for community health workers in South Africa.

BACKGROUND: Community health workers (CHWs) hold potential to support universal health coverage and better health for vulnerable communities. They are integral to the re-engineered Primary Health Care (PHC) strategy, introduced in South Africa in 2011. This study focussed on how to train CHWs in large numbers, especially in resource-limited, rural settings. Skills2Care, a method of cooperative learning for CHWS, has been pioneered in the Eastern Cape of South Africa. AIM: To determine whether Skills2Care could improve the cognitive knowledge of CHWs; to understand their response and attitude to the programme; to explore factors that enabled and inhibited learning and to consider its viability as a training method. SETTING: Research was conducted in 2019 in the Ngqeleni subdistrict of the O.R. Tambo district, in rural Eastern Cape. METHODS: A group-learning model using specifically tailored study modules in booklet format, addressing mother and baby care, was used. A facilitator promoted learning. Knowledge assessment was conducted by pre- and post-study testing using multiple choice questions. Focus group discussions and interviews explored the appropriateness and acceptability of this method, and factors enabling and inhibiting the learning. RESULTS: This method of peer group cooperative learning can significantly increase the cognitive knowledge of CHWs. Test scores indicated a significant (13%) improvement. Focus group discussions indicated that participants valued this method as it increased knowledge and boosted their confidence. CONCLUSION: This innovative approach to district-based, continuing education suggests that CHWs could be trained in large numbers without the need for additional resources.

Online versus in-person training of community health workers to enhance hepatitis B virus screening among Korean Americans: Evaluating cost & outcomes.

From 2014 to 2018, we developed and implemented culturally appropriate interventions delivered by community health workers (CHWs) in Pennsylvania and New Jersey. To determine the most cost-effective approach, we recruited 40 predominantly foreign-born Korean American CHWs and used cluster sampling to assign them into two training groups (online training vs. in-person training). We prospectively assessed the cost of training 40 Korean American CHWs and the cost of subsequent HBV educational workshops delivered by the CHWs. We also assessed these costs relative to the success of each training approach in recruiting participants for HBV screening and vaccination. We found that the training costs per participant were higher for in-person training ($1.71 versus $1.12), while workshop costs per participant were lower for in-person training ($2.19 versus $4.22). Workshop attendee costs were comparable. After accounting for site clustering, there were no significant differences in total costs per participant ($24.55 for the online-trained group and $26.05 for the in-person group). In-person trained CHWs were able to generate higher HBV screening and vaccination rates (49.3% versus 21.4% and 17.0% versus 5.9%, respectively) among their participants compared with online-trained CHWs. Given better outcomes and no differences in costs, in-person training dominated the online training option. Despite the potential for efficiency to be gained with online training, CHWs who attended live training outperformed their online-trained colleagues. Elements of the didactic approach or practice with peers in the live session may have contributed to the superior training effectiveness and, ultimately, improved cost-effectiveness of the in-person approach.

Processos de aprendizagem de adultos na educação profissional em saúde / Learning processes of adults in professional training in health / Procesos de aprendizaje de adultos en la educación profesional en salud

Resumo O estudo tem por objetivo problematizar os processos de aprendizagem de adultos trabalhadores na educação profissional em saúde. Considerando-se que a formação do trabalhador da saúde deve ampliar o horizonte dos alunos para além da biomedicina, tomam-se como referência os estudos de Kastrup sobre cognição inventiva. Estes estudos nos ajudam a pensar uma formação distinta daquela centrada em conteúdos e técnicas. A pesquisa foi desenvolvida com base em análise de documentos produzidos por alunos e professores do Curso de Técnico de Agente Comunitário de Saúde no Rio de Janeiro em 2017. Também são analisadas entrevistas com alunos. As análises mostraram como diferentes estratégias pedagógicas favoreceram a formação de sujeitos-trabalhadores sensíveis e comprometidos com a construção de práticas de saúde que não se constituem apenas no saber biomédico. Percebeu-se que o trabalho realizado possibilitou que os alunos problematizassem as relações entre educação, cultura e saúde, e, com isso, colocassem em questão suas práticas de saúde já naturalizadas. Estas experiências criaram a possibilidade de os alunos 'não serem mais os mesmos' e se fortalecerem na construção de um Sistema Único de Saúde e uma sociedade diversos.

Abstract The present study has the goal of questio-ning the learning processes of adult workers in professional training in health. Considering that the training of health workers should expand the horizons of the students beyond biomedicine, we take as reference the studies by Kastrup on inventive cognition. These studies help us conceive a training that is different from the training focused on content and techniques. The research was developed based on an analysis of documents written by students and teachers of the Community Health Worker Technical Course in Rio de Janeiro, Brazil, in 2017. The interviews performed with the students were also analyzed. The analyses show how different pedagogical strategies favor the training of individuals-workers who are sensible of and engaged with the development of health practices that are not only established within biomedical knowledge. We noticed that the work performed made it possible for the students to question the relationships among education, culture and health, and, therefore, question their already ingrained health practices. These experiences opened the possibility for the students "to no longer be who they were" and strengthen themselves in the development of a diverse Unified Health System (Sistema Único de Saúde, in Portuguese) and a diverse society.

Resumen El estudio tiene como objetivo problematizar los procesos de aprendizaje de adultos trabajadores en la educación profesional en salud. Considerando que la formación del trabajador de la salud debe ampliar el horizonte de los alumnos más allá de la biomedicina, se toman como referencia los estudios de Kastrup sobre cognición inventiva. Estos estudios nos ayudan a pensar en una formación distinta de aquella centrada en contenidos y técnicas. La investigación se desarrolló con base en análisis de documentos elaborados por alumnos y profesores de la Carrera de Técnico de Agente Comunitario de Salud en Rio de Janeiro, Brasil, en el 2017. También se analizan entrevistas con alumnos. Los análisis mostraron cómo diferentes estrategias pedagógicas favorecieron la formación de sujetos-trabajadores sensibles y comprometidos con la construcción de prácticas de salud que no sólo se constituyen por el saber biomédico. Se observó que el trabajo realizado posibilitó que los alumnos problematizasen las relaciones entre educación, cultura y salud, y, de esta manera, cuestionasen sus prácticas de salud ya naturalizadas. Estas experiencias hicieron posible que los alumnos 'nunca más fuesen los mismos' y que se fortalecieran en la construcción de un Sistema Único de Salud y una sociedad diversos.

Sharing Histories-a transformative learning/teaching method to empower community health workers to support health behavior change of mothers.

BACKGROUND: One of the keys to improving health globally is promoting mothers' adoption of healthy home practices for improved nutrition and illness prevention in the first 1000 days of life from conception. Customarily, mothers are taught health messages which, even if simplified, are hard to remember. The challenge is how to promote learning and behavior change of mothers more effectively in low-resource settings where access to health information is poor, educational levels are low, and traditional beliefs are strong. METHODS: In addressing that challenge, a new learning/teaching method called "Sharing Histories" is in development to improve the performance of female community health workers (CHWs) in promoting mothers' behaviors for maternal, neonatal and child health (MNCH). RESULTS: This method builds self-confidence and empowerment of CHWs in learning sessions that are built on guided sharing of their own memories of childbearing and child care. CHWs can later share histories with the mother, building her trust and empowerment to change. For professional primary health care staff who are not educators, Sharing Histories is simple to learn and use so that the method can be easily incorporated into government health systems and ongoing CHW programs. CONCLUSIONS: I present here the Sharing Histories method, describe how it differs from other social and behavior change methods, and discuss selected literature from psychology, communications, and neuroscience that helps to explain how and why this method works as a transformative tool to engage, teach, transform, and empower CHWs to be more effective change agents with other mothers in their communities, thereby contributing to the attainment of the Sustainable Development Goals.