Mobile health technology-enabled community health workers as pesticide interventionists in rural Suriname

OBJECTIVE: To bolster access for vulnerable communities to urgent pesticide-related health information and services using a mobile health technology-enabled community health worker (CHW) strategy. DESIGN AND METHODS: The project was designed to demonstrate the effectiveness of mobile health technology–enabled CHWs in promoting safe pesticide use in pesticide-induced suicide-prone communities in Suriname. The team focused on three interconnected components: message mapping, validation, and delivery testing. The text messages were tested to assess content, literacy, and the ability to solicit a recipient response to determine the effectiveness of mobile technology as a health intervention tool. RESULTS: Thirty-nine text messages addressed the following key themes: pesticide miss/overuse, pesticide accessibility contributing to its use as an attempted or successful suicide strategy, and pesticide handling and disposal. For each of these themes, at least three messages were developed. Most text messages emphasized safe pesticide handling as the root cause of both misuse and access. (The pesticide awareness and education campaign will be expanded country-wide.) CONCLUSION: The mobile health technology- enabled CHWs functioning as pesticide interventionists demonstrated that bidirectional text messaging was a promising awareness and education intervention strategy. Focusing on safe handling was a reasonable target for intervention in the absence of a comprehensive national pesticide policy governing import, distribution, access, handling, and disposal. Of note is that none of the messages to date directly focused on suicide, confirming the strategy to address suicide prevention as a holistic public health issue under a safe pesticide use “umbrella” rather than as an isolated, stigma-provoking problem.

Focus group results of a community-based breast cancer train-the-trainer curriculum in Grenada

OBJECTIVE: To determine the effectiveness of a two-week breast cancer Community-Based Train-the-Trainer program for Lay Community Health Workers (LCHWs) in Grenada. The curriculum was designed to teach laywomen about the LCHW role, how to conduct a community health assessment, and knowledge about breast cancer. DESIGN AND METHODS: A qualitative research design was used. One focus group interview was performed on 10 LCHWs after the completion of the training. A structured interview guided the discussion. The focus group took place at the same location as the training. Data was analyzed using framework analysis. All participants were female. The majority of the participants were over the age of 30. Half have less than a secondary school education, one a bachelor degree, and three have some college education. RESULT: Four themes emerged from the data: service, ethics, commitment to the program and practical knowledge. The LCHWs reported being satisfied with the training and expressed being appropriately prepared after the two-week training. The focus group showed that the LCHWs understood the principles and methods underlying health assessments, understood the role of the LCHWs and their relationship to their community. The LCHWs discussed how they felt confident in teaching other women about breast health. They understood breast cancer, and felt that the hands-on element of the training was helpful. The LCHWs felt that the positive trainer-trainee relations during the training contributed to their confidence in assuming the LCHW role. CONCLUSIONS: These findings suggest that Train-the-Trainer education programs can be an effective methodology to train LCHWs.

Adapting and disseminating a community-collaborative, evidence-based HIV/AIDS prevention programme: lessons from the history of CHAMP

In recent years, calls for the scaling-up, or more broad dissemination of evidence-based HIV prevention programmes, have increased. This paper responds to the call for increasing applicable knowledge about programme dissemination by reviewing the history of a major evidence-based human immunodeficiency virus (HIV) prevention and mental health promotion programme that has been adapted successfully and pilot-tested across four settings - including two major cities, as well as in the United States, Trinidad and Tobago and South Africa - to date. This programme, entitled CHAMP (the Collaborative HIV Prevention & Adolescent Mental Health Project), is distinctive primarily for its emphasis on community collaboration and power-sharing, and also its incorporation of individual, family and community-level interventions. The history of programme development, including theoretical foundations and results across sites, is discussed with a particular emphasis on the implications of CHAMP'S dissemination thus far.

Redefining national and regional views on health

The Windward Islands Research and Education Foundation (WINDREF) was founded in 1994 in Grenada, West Indies, to develop worldwide multi-diciplinary research and education programmes that would advance the understanding of health and the environment. The WINDREF resource centre coordinates international collaborative research in the areas of medicine, veterinary medicine, anthropology, marine and terrestrial biology, and ethics. Offering academic opportunities to scientists from the Caribbean and around the world, it encourages the development of the understanding of local and international communities. It believes in the sharing of relevant scientific information with these communities. WINDREF's emphasis on internationalism and its commitment to community service and participation makes it unique among most developing and developed countries' research institutions. In the past six years, WINDREF has covered an impressive list of projects, ranging from non-communicable diseases, such as diabetes and alcoholism, to communicable diseases including HIV/AIDS, dengue fever, and nutritional parasites. Work has also focused on the use of medicinal plants and studies of the Mona monkey population. WINDREF has played a role in both undergraduate and graduate education and has established and maintained wide Caribbean and international collaboration and links (AU)

Traditional medicine in Belize. The original primary health care

While completing the clinical portion of my bachelor's in nursing degree in southern Belize in Central America, I had the unique opportunity to converse with and observe traditional healers in their natural surroundings, lush rain forests abounding with medicinal plants. The rain forests play a vital role in the lives of the several thousand Mopan and Ketchi Maya who live in southern Belize. Their strong cultural identity is rooted in tradition, especially among the older generations.(Au)

Knowledge and attitude of primary health care workers and care givers in the parish of Trelawny towards schizophrenia and the impact of schizophrenia on the family

This is a cross sectional study conducted in the parish of Trelawny which investigated the knowledge and attitude of Primary Health Care (PHC) workers and care givers of schizophrenic patients towards schizophrenia, and the impact of schizophrenia on the family. The study population comprised the total population of care givers of schizophrenic patients and primary health care workers in the parish of Trelawny. Care givers numbered 84 and primary health care workers numbered 60. It was observed that the majority of care givers were females and over 50 percent were over the age of 50 years. PHC workers were all female with a wide range of working experience of under one year to over 34 years. Community Health Aides accounted for 57.7 percent of these PHC workers. On the average, knowledge and attitude of PHC workers could be regarded as fair. Knowledge of PHC workers when compared with that of care givers differed significantly but attitude scores did not. It was observed that the knowledge and attitude of PHC workers with family members affected with schizophrenia, when compared with PHC workers without, scores did not differ significantly statistically.(AU)

Formal handling routines: child rearing practices in Jamaica

The objective of this study was to describe the use of the formal handling routine in young children with and without a disability in a rural community in Jamaica. In all, 52 care-givers were interviewed and videotapes of some care-givers carrying out their routine were made and analyzed. Results showed that Jamaican care-givers are carrying out these routines because of tradition and to influence the child's growth. The formal handling routine included "sopping", "stretching", "active exercises", "shaping", "massage" and "catching-up" and are carried out once or twice a day from birth until the child is able to move around by itself. Care-givers of a child with a disability started at a later age with the routine and continued it longer. On noticing that their child's reaction during the routine was different in comparison to other children they adjusted the way of carrying out the routine according to the child's reaction and also carried it out more frequently. Jamaican care-givers seem to be experienced in exercising their children, and spend much time on it and have a lot of knowledge about influencing their child's development. This knowledge and experience can be utilized by community rehabilitation workers in exercising children with a disability (AU)

Growth monitoring: the role of community health volunteers

A community volunteer programme was initiated in rural Jamaica in May 1990. The main aim of the programme was to monitor the growth of children less than 36 months of age through community health volunteers (CHVs) and improve their nutritional status. At the end of the second year the programme was evaluated to determine effectiveness. The results of the evaluation indicated that almost all (95.6 percent) of the children were covered by the CHVs. In addition the participation rate was high (78.5 percent). However, only 50 percent of the children were adequately covered. Nonetheless, 81 percent of them gained adequate weight. Indeed, malnutrition levels declined by 34.5 percent. The annual cost per child per year for the total programme was fairly moderate (US$14.5) with growth monitoring accounting for nearly half (42.7). The results suggest that CHVs can play an important role in primary health care programmes in developing countries(AU)

Evaluation of the community health aide education programme on the knowledge, personal and social qualities, work qualities, employment status and self esteem of ten Jamaican women - abstract

A community health aid programme was designed to provide a group of young Jamaican women with employment opportunities as well as to image on the health of their respective communities. It is known that community health workers have the potential to facilitate access, dispel myths, and model health behaviours. Ten selected women experienced a four (4) month training programme which included a didactic educational programme and was evaluated on knowledge of anatomy and physiology, first aid, hygiene, basic nursing skills, and principles of community health. Clinical experiences were provided in five different agencies for a two week period including the Sickle Cell Unit, The St. John's Ambulance Health Care for the Elderly, Hyacinth Lightbourne Visiting Nursing Services, Social and Preventive Medicine Clinic - University of the West Indies, and the St. Margaret's Day Care Centre. Clinics supervisors evaluated Community Health Aide students on their communication skills, personal qualities, work qualities and habits. Communuity health aides involved the community by presenting projects on diabetes, sexually transmitted diseases and aids, health services referral, and the health environment. Individual interviews as well as quantitative assessment indicated initial positive effects on self esteem for the most successful graduates, with a follow-up one year completion to be completed. Recommendations include the development of student selection criteria, student internships, a full-time coordinate, honoraria for guest speaker, and a clinical focus on populations such as the elderly, toddlers, young adults, or problem relating to family planning, AIDS, sickle cell, or services such as home care. Further recommendations included the maintenance of uniforms, community based projects and public graduation rituals. (AU)

Work, gender, and culture in the Jamaican community health aide programme

This dissertation explores the relationship among the organization of work in primary health care, the workplace culture of the Jamaican community health aides, and their domestic culture. Collected during twelve months of fieldwork in St. James parish in 1987 and 1988, the data include field notes from participant observation with community health aides, transcrips of tape recorded interviews with twenty aides, and information found in manuals and reports of the Ministry of Health and the Department of Social and Preventive Medicine at the University of the West Indies. National and international political and economic forces, the position of women in Jamaica, and contradictions in primary health care policy coverage in the Jamaican health service where they shape the organization of work in primary health care and give rise to the constraints and possibilities the community health aides find in their work. Fraught with conflicts and ambiguities, the organization of work in primary health care provides the space for, and necessitates, the workplace culture that emerges in the ideology and daily practices of the community health aides. With women predominating at every level in primary health care in Jamaica, domestic culture is a resource in the aides' response to the organization of their work and the workplace culture that emerges. Four features define the community health aides' workplace culture: 1) the aides'ability to construct an identity as mediators between the health service and the community from their marginal position in the hierarchial organization of primary health care; 2) the aides' ability to negotiate a compromise between the competing demands for staff in the health centers and community work, a compromise they turn to advantage in maintaining their claim to unique knowledge of their communities; 3) the aides' ability to cope, on the basis of their commitment to primary health care and their empathy with people, with material contradictions in their workplace; the permeability of the aides' workplace to their domestic culture which supports them in their struggle for control over their work and a better daily life while it enhances the delivery of primary health care. (AU)

Parent evaluation of a community-based rehabilitation project in St. Catherine, Jamaica - abstract

Two hundred and seventeen families with disabled children in St. Catherine were surveyed to determine their views of a community-based rehabilitation programme in which they are visited by community workers (CWs). All were able to give a disability diagnosis and the pattern of distribution resembled the actual distribution. The respondents gave positive answers to questions about the home visits, the CWs, and the activities conducted. They felt satisfied with the information given, though 65 percent requested more, particularly on education, behaviour, speech and medical aspects. Sixty-seven per cent had changed their attitudes and 70 percent their practices since the programme. Ninety-five percent said they would recommend a home visiting programme to other parents. The least satisfactory finding was the low percentage (48 percent) of parents who had attended parent training and meetings (AU)

Assessment of community health aides

A research project funded by the Commonwealth Caribbean Medical Research Council (CCMRC) began in February 1987, to study aspects of the situation in connection with 508 Community Health Aides (CHAs) employed in Government Service of Jamaica. There were in the service 1,328 CHAs in 1978, reduced to 1,183 in 1982 and to 1,168 in 1984. By 1985/86 the numbers were further reduced, reaching the low figure of 508. This report deals specifically with the responses of 615 members of the community who were interviewed, and questionnaires were returned from all parishes in the four administrative health areas in Jamaica. The responses from community members are very important in the assessment of community health aides as members of the community health team. A number of useful and practical suggestions were reflected in their responses regarding service from community health aides (AU)

Survey of community health aides in Jamaica (1987-1988)

The community health aide (CHA) programme was initiated in 1967, and, by the early 1980s, 1,328 CHAs had been trained and over 1,100 remained in the service. The aim of the programme was to train CHAs to assist in the delivery of basic health care. During the restructuring of the health services in 1985-1986, many CHAs were made redundant. As part of a large study aimed at assessing the current status of the CHA programme, this paper reports results of interviews with 415 CHAs still in service in 1987-1988 and 134 showed that they continued to perform duties in the community and in health centres with emphasis on the maternal and child health services and the management of diabetics and hypertensives. The survey of CHAs no longer employed as such showed that the majority remained unemployed though many continued to use their skills on a voluntary basis. These CHAs felt that home visiting had been reduced and environmental health was being neglected since they left, and that problems were not being regularly reported to the professionals at the health centres. It was recommended that all CHAs be offered training in the taking of blood pressure levels and in the giving of insulin injections to diabetics. Recommendations included improved methods of selection, longer training, greated community outreach, especially to the elderly, post-training evaluation, regular assessment of the CHAs' performance, and improved upward mobility opportunities and job security (AU)

The use of community health aides as perceived by their supervisors in Jamaica, West Indies (1987/88)

A research project funded by the Commonwealth Caribbean Medical Research Council (CCMRC) began in February 1987, to study aspects of the situation in connection with the 508 community health aides employed in the Government Service of Jamaica. This report deals specifically with the role of supervisors (public health nurses and midwives) in relation to community health aides (CHAs) employed in the government primary health care service, Jamaica. There were 77 supervisors interviewed, and questionnaires were returned from all four administrative health areas in Jamaica. The supervisors reported that they could supervise more CHAs in the community setting than in the clinic setting alone. In-service training was an integral part of CHA programme, and there was regular evaluation of the CHAs, with at least an annual evaluation in keeping with the policy of the agency. Resource persons from other sectors assist in continuing education programmes for the CHAs. The study outlines the main weaknesses and the strengths of the community health aide programme, and highlights the fact that CHA is a valuable member of the health team and does contribute significantly to primary health care (AU)

Attitudes, practices and knowledge of health professionals on breast feeding in Kingston, Jamaica

In order to assess attitudes practices and knowledge of different categories of health professionals towards breast feeding, 30 doctors, 76 nurses and 22 community health aides (CHAs) answered a self-administered questionnaire. The results indicated that the health workers, in general, have positive views on breast feeding even though some practices interfering with breast feeding still continue. In contrast, knowledge about breast feeding physiology, management, and contraindications was generally poor, suggesting that training on the subject may not be adequate. Doctors had better knowledge than other health professionals, indicating that they are not sharing their knowledge with those who have closer contact with breast feeding mothers. Some actions are suggested to maintain the health workers' positive attitudes to breast feeding, and improve popular practices and knowledge. (AU)

A community-based rehabilitation programme for pre-school disabled children in Guyana

The limitation of the traditional institutionally-based model of rehabitlitation and the competing rationale for introducing a community-based model of services are examined. Problems with the World Health evaluation of CBR are discussed. The results of a CBR programme with 53 pre-school disabled children in rural areas of Guyana are presented. Quantitative and qualitative methods are combined to analyse the results. Portage and Griffiths pre/post test results showed improvement as a result of the training programme. Noticeable changes in the attitudes of the parents toward the child, the community and towards themselves are presented. The effective involvment of the community is analysed. (AU)

Community-based health workers: head start or false start towards health for all?

Health service delivery programs using minimally-trained community-based health workers (CHWs) have been estabished in many developing countries in recent years. These programs are expected to improve the cost-effectiveness of health care systems by reaching large numbers of previously underserved people with high-impact basic services at low cost. The reported experience with these programs has been mixed, raising questions about whether the community health worker is an optimal vehicle for extending primary health care. This review of six large-scale community-based worker programs suggests that they have succeeded in some of their objectives but not in others. CHWs increase the coverage and equity of service delivery at low cost compared with alternative modes of service organization. However, they do not consistently provide services likely to have substantial health impact and the quality of services they provide is sometimes poor. Large-scale CHW systems require substantial increases in support for training, management, supervision, and logistics. The evidence suggests that, in general, their potential has not been achieved in large routine programs. Further development of these programs is needed to reinforced their successes and assure that they are adequately supported as an integral component of the basic health system.(AU)

Nutrition handbook for community workers

Illustrated handbook containing information on nutrition and health for community workers. Topics covered include: working with the community; planning food and nutrition education programmes; techniques of good communication; food and good health; buying, storing and preparing foods; nutrition during pregnancy and breastfeeding; breast feeding; young child feeding; malnutrition in young children; diarrhoea; feeding other groups; health problems related to food and nutrition; and improving health and nutrition in the community. Information on coping with disasters, domestic energy conservation and a glossary of terms used in the handbook are appended(AU)