Integrated care by community health workers in Malawi: Rehabilitation and blood pressure monitoring

Athenie Galvez; Jordan Waite; Kyle Jureidini; Kathryn C Nesbit; Athenie Galvez; Jordan Waite; Kyle Jureidini; Kathryn C Nesbit

doi:10.3934/publichealth.2021009

AIMS Public Health

2021, Volume 8, Issue 1: 110-123. doi: 10.3934/publichealth.2021009

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Research article

Integrated care by community health workers in Malawi: Rehabilitation and blood pressure monitoring

1.
Presidio Sport & Medicine, San Francisco, CA, USA
2.
Orthopedic and Neurological Rehabilitation, Los Gatos, CA, USA
3.
Body Mechanix Physical Therapy, Simi Valley, CA, USA
4.
UCSF/SFSU Graduate Program in Physical Therapy, San Francisco, CA, USA

Received: 25 November 2020 Accepted: 26 January 2021 Published: 28 January 2021

Background
Community health workers (CHWs) are essential providers of integrated care for people in low-resourced settings with a high burden from noncommunicable diseases (NCDs).

Aims
The purpose of this study was to evaluate a CHW training program in rural Malawi integrating blood pressure (BP) monitoring into rehabilitation care.

Methods
This was a retrospective cross-sectional study. The participants were a convenience sample of home-based palliative care CHWs at the local hospital (n = 59). Data collected included: a written pre- and post-knowledge test, skills competency checklist and a post-training program survey. Descriptive frequencies and paired t-tests (a = 0.05) were used for quantitative analyses. Themes in narrative responses in the post-training survey were analyzed qualitatively.

Results
Participant knowledge regarding BP monitoring procedures improved significantly on the post-test (M = 8.24, SD = 1.654) compared to the pre-test (M = 6.59, SD = 1.683), Z (49) = −5.569, p < 0.001. The pre-and post-tests were scored 0–10 points. All participants demonstrated competency in 100% of the skills. Participants reported the lack of transportation, teamwork and resources as barriers to their work. They reported trainings and opportunities to collaborate as facilitators to their work.

Discussion
This study demonstrated the effectiveness of a training program for CHWs which integrated BP monitoring with rehabilitation care for people with NCDs. This retention of knowledge and application to clinical practice serve as strong indicators of the feasibility and sustainability of the CHW training and care delivery program in resource-limited settings.

Conclusion
Our findings help demonstrate that training CHWs can be an effective way to help bridge the gap in health care access for people with disabilities in resource-limited countries.
- community health workers,
- integrated care,
- palliative care,
- noncommunicable disease
Citation: Athenie Galvez, Jordan Waite, Kyle Jureidini, Kathryn C Nesbit. Integrated care by community health workers in Malawi: Rehabilitation and blood pressure monitoring[J]. AIMS Public Health, 2021, 8(1): 110-123. doi: 10.3934/publichealth.2021009

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Abstract

Background

Community health workers (CHWs) are essential providers of integrated care for people in low-resourced settings with a high burden from noncommunicable diseases (NCDs).

Aims

The purpose of this study was to evaluate a CHW training program in rural Malawi integrating blood pressure (BP) monitoring into rehabilitation care.

Methods

This was a retrospective cross-sectional study. The participants were a convenience sample of home-based palliative care CHWs at the local hospital (n = 59). Data collected included: a written pre- and post-knowledge test, skills competency checklist and a post-training program survey. Descriptive frequencies and paired t-tests (a = 0.05) were used for quantitative analyses. Themes in narrative responses in the post-training survey were analyzed qualitatively.

Results

Participant knowledge regarding BP monitoring procedures improved significantly on the post-test (M = 8.24, SD = 1.654) compared to the pre-test (M = 6.59, SD = 1.683), Z (49) = −5.569, p < 0.001. The pre-and post-tests were scored 0–10 points. All participants demonstrated competency in 100% of the skills. Participants reported the lack of transportation, teamwork and resources as barriers to their work. They reported trainings and opportunities to collaborate as facilitators to their work.

Discussion

This study demonstrated the effectiveness of a training program for CHWs which integrated BP monitoring with rehabilitation care for people with NCDs. This retention of knowledge and application to clinical practice serve as strong indicators of the feasibility and sustainability of the CHW training and care delivery program in resource-limited settings.

Conclusion

Our findings help demonstrate that training CHWs can be an effective way to help bridge the gap in health care access for people with disabilities in resource-limited countries.

Limitations

One possible limitation of this study is the lack of generalizability due to administration of the training in one group of CHWs in Malawi. Although all trainings, tests, and surveys were administered in the participants' native language, they were unfamiliar with the written testing format due to their cultural and educational background. Because the authors of the study were present while administering all aspects of training and testing, participants' responses to the post-test survey may have been biased.

Conflict of interests

The authors declare that they have no competing interest.

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