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Effectiveness of a community health worker (CHW) training in monitoring and care of patients with chronic obstructive pulmonary disease (COPD) in rural Gujarat, India
Ashish V Gupta1, Ajay G Phatak2, Meha U Patel1, Neha Das3, Nirav P Vaghela1, Harihara Prakash1, Shyamsudar J Raithatha4
1 K M Patel Institute of Physiotherapy, Karamsad, Anand, Gujarat, India
2 Central Research Services, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
3 Community Medicine, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
4 Community Medicine and Extension Programmes Department, H M Patel Centre for Medical Care and Education, Karamsad, Anand, Gujarat, India
Correspondence Address:
Dr. Shyamsudar J Raithatha
Address - 8, Aamrakunj Twins Bungalows, Opp. Santram Society, Karamsad Vidhyanagar Road, Karamsad, Anand - 388 325, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jfmpc.jfmpc_1193_19
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Context: Chronic obstructive pulmonary disease (COPD) is the second leading contributor to the disease burden of India. The current COPD burden cannot be managed effectively just through a physician-based approach. In a primary care setting, community health workers (CHWs) can play an effective role in making COPD care accessible and effective. Aim: Findings of an assessment of a training program for CHWs on COPD have been reported here. Methods: 90 CHWs working as a part of a noncommunicable disease prevention and care program in a rural primary care setting were exposed to a series of five training sessions. The sessions were designed and administered jointly by a team of public health experts and physiotherapists in the year 2017–18. Topics covered were basic clinical aspects of COPD, monitoring a patient with COPD, and basic aspects of pulmonary rehabilitation. The assessment comprised 12 MCQs and short questions, 7 video exercises, 2 case vignettes, and 5 skill assessments through objectively structured clinical examination (OSCE). Statistical Analysis: Mean percentage scores were calculated for each domain of assessment to make it comparable. Results: 70 CHWs with a mean age of 42.2 years completed all the training and underwent the assessment. Mean percentage score (SD) for knowledge was 62% (16.3). In OSCE assessment, scores were best in sputum clearance technique demonstration (92.1%) and the least in dyspnea relieving positions (59.2%). The CHWs had difficulties in identifying signs of respiratory distress (score - 55.1%). No statistically significant association was observed between performance scores and their sociodemographic profile. Conclusion: The results were encouraging and the program may be pilot tested in a government setting particularly using the health and wellness centers (HWC) platform.
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