Enhancing cervical cancer knowledge among women of reproductive age: a dialogue-based community health education intervention in rural Kisumu County, Kenya.

BACKGROUND: Cervical cancer is a leading cause of cancer death among women of reproductive age despite being treatable if it is diagnosed early. Early diagnosis is possible through regular screening through the public health system. However, screening rates remain low in many low- and middle-income countries, including Kenya, where the screening rate currently stands at 16-18%. The low screening rates are attributed to, among other factors, low knowledge about cervical cancer and the available screening options among women of reproductive age. The current study evaluated the effectiveness of dialogue-based community health education by trained community health volunteers (CHVs) in improving cervical cancer knowledge among women of reproductive age (WRA) in rural Kisumu County. METHODS: This was a longitudinal pre- and post-intervention study with a control group. The knowledge of women of reproductive age was assessed at baseline in both the intervention and control groups, followed by dialogue-based community health education in the intervention arm. A final end-line knowledge assessment was performed. The scores at baseline and at the end of the study were compared to assess changes in knowledge due to the intervention. The proportion of WRA with improved knowledge was also calculated, and statistical significance was considered at p ≤ 0.05. RESULTS: There was no significant difference between the participants in the two arms, except for the level of education (p = 0.002). The knowledge of the WRA in the intervention arm improved significantly (p < 0.001) following the dialogue-based educational intervention by the trained CHVs. None of the demographic characteristics were associated with knowledge. CONCLUSION: Dialogue-based educational intervention significantly improved the knowledge of the WRA in the intervention arm, showing its potential to address the knowledge gap in the community.

Results from the Delivery of a Community Health Worker Training to Advance Competencies in Cancer Genomics.

INTRODUCTION: Less than half of eligible Black women are assessed for genetic risk and only 28% engage in recommended hereditary breast and ovarian cancer (HBOC) risk-reducing interventions. CHWs are trusted individuals that work as a liaison between health systems and the community to improve access to services and support cancer prevention efforts, though they are an overlooked resource to support genetic risk assessment. To address the need and training gaps for CHWs, we developed and assessed an online training program to build CHW's competencies in cancer genomics and use of health information technologies to navigate high-risk individuals to appropriate genetic services. METHODS: The curriculum and 10 training modules were developed through engaging a panel of experts in a three-round Delphi process. Recruitment focused on CHWs who worked in clinical settings or groups providing outreach or health services to Black women. We assessed: changes in knowledge and attitudes about HBOC and genomics, as well as the perceptions about the quality and implementation of the training. RESULTS: Forty-six individuals expressed interest in the training after recruitment. Thirty eight individuals were eligible for the training and 26 completed the course. We found improvements in knowledge and genomics competencies immediately post-course, but the majority of these improvements were not sustained at 3-month follow-up. The training was highly rated for its relevance to CHW work and overall delivery. Top rated sessions included HBOC overview and family history collection. On average, participants reported discussing HBOC with 17 individuals at 3-month follow-up. CONCLUSION: Championing a diverse cancer and genomics workforce can help address the goals of the National Cancer Plan to improve early detection and health equity. Through this training, CHWs gained critical cancer and genomics knowledge that was then applied to their primary roles.

The Vicious Worm education tool improves the knowledge of community health workers on Taenia solium cysticercosis in Rwanda.

The pork tapeworm Taenia solium causes human taeniasis and cysticercosis when ingested as viable cysts and eggs, respectively. Despite its high health burden in low-income countries, knowledge of the parasite in endemic areas such as Rwanda is often limited. Here, we assess whether The Vicious Worm education software can increase knowledge in endemic areas of Rwanda. A cross-sectional mixed-methods study was conducted to evaluate knowledge about T. solium among community health workers trained using the Vicious Worm education software. Knowledge was assessed before, immediately after, and four weeks after the training. The health workers perceptions of the software were analysed thematically. A total of 207 community health workers were recruited from Nyamagabe district in Southern Province, Rwanda. Participants were composed of males (33.5%) and females (66.5%), aged between 22 and 68 years, and most (71%) had only completed primary education. Knowledge of cysticercosis at baseline was low, particularly knowledge of human cysticercosis and neurocysticercosis. The overall knowledge score increased significantly after training and was maintained four weeks after the training. Overall, insufficient knowledge was associated with neurocysticercosis-related questions, which after the training, remained relatively lower compared to questions of other categories. Participants reported the software to be user-friendly and educational. Digital illiteracy and the lack of smartphones were among the critical challenges highlighted in responses. This study has shown gaps in knowledge regarding T. solium infections within rural Rwanda, particularly neurocysticercosis. Health education using the Vicious Worm education software should be considered in integrated control programs.

Effects of instructional video and community radio broadcasting interventions to improve knowledge and behavior of antibiotic use in the COVID-19 era.

BACKGROUND: Antibiotic overuse is a serious health issue. It has been demonstrated that improper antibiotic use is linked to a lack of knowledge in the public. To encourage judicious antibiotic use in the COVID-19 ERA, it is critical to provide accessible and secure therapies. OBJECTIVES: This study aimed to assess the effects of instructional video and community radio broadcasting interventions on knowledge and behavior of antibiotic use. METHODS: Adults over the age of 20 were enrolled in a quasi-experimental study. A total of 369 representatives were divided into two groups: 185 participants in the control group and 184 participants in the intervention group. Data were collected twice, before and after the educational program by community health workers. Both descriptive and inferential statistics were used to analyze the data. RESULTS: The participants' average age was 56.4 ± 0.6 years. Most of the respondents were female (264, 71.5%) and had only received an elementary education (186, 50.4%). A mean difference score was produced for the control and intervention groups. Both groups experienced a statistically significant gain in mean difference score of knowledge following the educational program (3.42 ± 4.18, [95% CI 2.81-4.02] vs 5.42 ± 4.97, [95% CI 4.69-6.14]) (P < 0.001). A mean difference score was produced with behavior (1.78 ± 3.45, [95% CI 1.28-2.28] vs 2.77 ± 3.06, [95% CI 2.28-3.27]) (P < 0.001). A mean difference in knowledge score between the groups was greater, with the intervention group scoring higher; all significant variables were controlled by multivariable regression analysis (1.31 [95% CI 0.53-2.09]) (P = 0.001). Similarly, a mean difference behavior score (1.34 [95% CI 0.82-1.86]) (P < 0.001). CONCLUSION: The integration of an educational poster, instructional video, and community radio broadcasting interventions about antibiotic use through CHWs in local communities is beneficial. This program should be implemented at the national level to promote rational drug use. Future studies should investigate how the educational program affects antibiotic use rates in the long term.

Development of a Hereditary Breast and Ovarian Cancer and Genetics Curriculum for Community Health Workers: KEEP IT (Keeping Each other Engaged Program via IT) Community Health Worker Training.

We developed a curriculum for community health workers (CHWs) using an innovative, community-engaged focus group and Delphi process approach. Equipping CHWs with knowledge of hereditary breast and ovarian cancer syndrome (HBOC) and genetics could help enhance identification of women at risk for HBOC, referral, and navigation through genetic services. We conducted focus groups with five CHWs and a three-round Delphi process with eight experts. In the first round of the Delphi process, participants rated and commented on draft curriculum modules. The second round involved live video discussion to highlight points of confusion and concern in the modules. The curriculum was revised and refined based on quantitative and qualitative data and reassessed by the experts in Round 3. Ultimately, agreement was achieved on eight of 10 modules when assessing for clarity of learning objectives, seven out of 10 when assessing for adult learning theory, and nine out of 10 when assessing for participants' ability to learn desired knowledge. We plan to virtually deliver this curriculum to CHWs to enhance their HBOC and genomic competencies. By equipping CHWs to understand and participate in genomics education, we can enable more equitable participation in genomics-informed clinical care and research. Beyond this curriculum, the Delphi methodology can further be used to design content for new CHW curriculums.

Treinamento aos agentes comunitários de saúde frente à assistência aos usuários de álcool / Entrenamiento de agentes de salud con respecto a la asistencia a usuarios de alcohol / Community health agent training regarding assistance to alcohol users

Objetivo: avaliar as percepções, conhecimentos e atitudes antes e após a realização de um treinamento aos Agentes Comunitários de Saúde (ACS). Método: estudo quase experimental e quantitativo, realizado no interior do estado de São Paulo. Para a coleta de dados foi utilizado ficha de identificação sociodemográfica, Seaman & Manello e Short Alcohol and Alcohol Problems Perception Questionnaire, aplicados em 31 ACS de serviços de Atenção Primária à Saúde. O estudo foi submetido e aprovado pelo Comitê de Ética. Resultados: as percepções foram positivas, mas ainda existem dificuldades para trabalhar na prática, os conhecimentos apresentaram mudanças em relação aos sinais e sintomas relacionados ao uso de álcool e as atitudes. Não foram observadas mudanças significativas após o treinamento. Conclusão: o treinamento é uma estratégia que possibilita mudanças nas práticas de saúde para a assistência integral e que deve ser incorporada nas rotinas das unidades de Atenção Primária à Saúde (APS).

Objetivo: evaluar percepciones, conocimientos, y actitudes antes y después de un entrenamiento de Agentes Comunitarios de Salud (ACS). Método: estudio cuasiexperimental y cuantitativo, realizado en el interior del estado de São Paulo. Para colectar a los datos se utilizó un formulario de identificación sociodemográfica, el Seaman & Manello y el Short Alcohol and Alcohol Problems Perception Questionnaire, aplicados a 31 ACS en servicios de atención primaria a la salud. El estudio fue aprobado por el comité de ética. Resultados: las percepciones fueran positivas, pero hay dificultades en la práctica del trabajo. Los conocimientos cambiaron con respecto a las señales y síntomas relacionados al uso de alcohol y a las actitudes. No se observó cambios significativos después del entrenamiento. Conclusión: el entrenamiento posibilita cambios en las prácticas de salud para la asistencia integral, y debe ser incorporado en las rutinas de las unidades de atención primaria a la salud (APS).

Objective: To evaluate the perceptions, knowledge, and attitudes, before and after a training session provided to community health workers (CHW). Method: Quasi-experimental, quantitative study, carried out in the countryside of the state of São Paulo. For data collection, we used Seaman and Manello's sociodemographic identification form and the Short Alcohol and Alcohol Problems Perception Questionnaire, applied to 31 CHWs of primary health care services. The study was submitted and approved by the research ethics committee. Results: Perceptions were positive, but there are still practical obstacles regarding the actual work. The knowledge related to signs and symptoms of alcohol use and related attitudes was changed, as were the attitudes. There were no significant changes after training. Conclusion: training is a strategy that enables changes in health practices for integral care. It should be incorporated in the routine of Primary Health Care (PHC) units.

Conhecimento dos agentes comunitários de saúde sobre o aleitamento materno / Knowledge of community health workers about breastfeeding / Conocimiento de los trabajadores comunitarios de la salud sobre la lactancia materna

Objetivo: analisar o conhecimento sobre aleitamento materno e os fatores associados a esse entendimento entre agentes comunitários de saúde. Método: estudo quantitativo, descritivo-analítico, transversal, realizado com 153 ACS de Senhor do Bonfim, Bahia. Para a verificação das variáveis associadas ao conhecimento sobre aleitamento, realizou-se análise bivariada (Odds Ratio, Intervalo de Confiança 95% e Testes Qui-quadrado/Fisher) e análise ajustada através da Regressão Logística Múltipla (Stepwise). Resultados: o estudo mostrou que os agentes comunitários de saúde apresentam elevado nível de conhecimento sobre aleitamento materno. Houve associação entre o conhecimento sobre aleitamento materno e ter filhos, trabalhar na Estratégia de Saúde da Família, ter participado de capacitação e alto conhecimento sobre as atribuições gerais da profissão. Conclusão: Os profissionais possuem adequado entendimento sobre a temática. Todavia, importantes equívocos foram observados e caso repassados para a comunidade podem prejudicar a instalação e manutenção do aleitamento materno(AU)

Objective: to analyze knowledge about breastfeeding and the factors associated with this understanding among community health agents. Method: quantitative, descriptive-analytical, cross-sectional study, carried out with 153 CHAs from Senhor do Bonfim, Bahia. To verify the variables associated with knowledge about breastfeeding, bivariate analysis was carried out (Odds Ratio, 95% Confidence Interval and Chi-square/Fisher Tests) and adjusted analysis using Multiple Logistic Regression (Stepwise). Results: the study showed that community health agents have a high level of knowledge about breastfeeding. There was an association between knowledge about breastfeeding and having children, working in the Family Health Strategy, having participated in training and high knowledge about the general responsibilities of the profession. Conclusion: Professionals have an adequate understanding of the topic. However, important mistakes were observed and, if passed on to the community, they could harm the installation and maintenance of breastfeeding(AU)

Objetivo: analizar el conocimiento sobre lactancia materna y los factores asociados a ese entendimiento entre agentes comunitarios de salud. Método: estudio cuantitativo, descriptivo-analítico, transversal, realizado con 153 ACS del Senhor do Bonfim, Bahía. Para verificar las variables asociadas al conocimiento sobre lactancia materna, se realizó análisis bivariado (Odds Ratio, Intervalo de Confianza del 95% y Pruebas Chi-cuadrado/Fisher) y análisis ajustado mediante Regresión Logística Múltiple (Stepwise). Resultados: el estudio demostró que los agentes comunitarios de salud tienen un alto nivel de conocimiento sobre la lactancia materna. Hubo asociación entre conocimiento sobre lactancia materna y tener hijos, trabajar en la Estrategia Salud de la Familia, haber participado en capacitaciones y alto conocimiento sobre las responsabilidades generales de la profesión. Conclusión: Los profesionales tienen un conocimiento adecuado del tema. Sin embargo, se observaron errores importantes que, de transmitirse a la comunidad, podrían perjudicar la instalación y el mantenimiento de la lactancia materna(AU)

Tobacco Knowledge, Attitudes, and Services Among Latino/a Community Health Workers.

BACKGROUND: Tobacco-related illnesses are among the leading preventable causes of death for Latinos/as in the United States. Latino/a groups are less likely to receive advice to quit from health professionals or use tobacco cessation strategies. The position of community health workers (CHWs) warrants further attention to address tobacco-related disparities in Latino/a communities. The objective of this study was to describe CHWs' roles to inform future smoking cessation training to ensure relevance and accessibility. METHODS: A needs assessment survey, including a 10-item tobacco knowledge questionnaire, was conducted with 29 Latino/a CHWs serving Latino/a communities in a metropolitan area to assess their roles, tobacco related services, attitudes, and knowledge. RESULTS: All CHWs were Spanish-speaking and mainly employed part time (55%) in community organizations (67%). They offered various services, primarily health education. Most of the CHWs (58.6%) assessed and discussed tobacco use, yet half (51.7%) reported low confidence in this area. Some CHWs (41%) expressed that their clients/patients would use evidence-based nicotine replacement therapies as a smoking cessation treatment if offered and identified "Financial Cost" (31%) as a deterrent of use. CHWs' score on a tobacco knowledge questionnaire indicated low knowledge in areas related to tobacco (4.03 out of 10; SD = 1.92). CONCLUSIONS: CHWs reported low tobacco related knowledge and confidence, and would benefit from tailored tobacco cessation training to decrease tobacco cessation disparities.

Training and Dissemination of Lung Cancer Education Curriculum Among Community Health Advisors in the Deep South: a Program Evaluation.

Lung cancer is the leading cause of cancer mortality in the USA. In the rural Black Belt region of Alabama, high rates of lung cancer incidence and mortality coupled with disproportionate lack of access to health services stresses the need for navigating high risk and disproportionately affected groups towards successfully obtaining lung cancer screenings. We utilized our well-accepted Community Health Advisor (CHA) model for education and awareness. This study seeks to evaluate the results of the Alabama Lung Cancer Awareness, Screening, and Education (ALCASE) training on CHAs, program evaluation, and lessons learned. A total of 202 participants were eligible and enrolled for CHA training. One hundred thirty CHAs were included for the final analyses. Descriptive statistics were computed; differences in pre-test and post-test scores were compared across demographic characteristics of the participants using paired t-test/one-way ANOVA. Of the 130 CHAs, 46% were 65 years or older; 98% were African Americans, and 87% were female; 17% of participants were cancer survivors. The mean post-test scores were 2.2 points greater than mean pre-test scores, and the difference was significant (mean (SD): pre-test = 20.8 (2.8) versus post-test = 23 (2.2); p = 0.001). No notable difference in pre-test and post-test scores were observed by CHA's demographic characteristics except by their county of residence or work (p = 0.0019). We demonstrate the capability and value of successfully recruiting and training motivated community members to be able to serve educators to better reach medically underserved and historically excluded communities.

Cardiovascular Disease and Stroke-Focused Competency Assessment Tools for Community Health Workers in the United States: A Scoping Review.

Cardiovascular disease (CVD) and stroke are major contributors to chronic disease burden in the United States. Despite the high prevalence of stroke, 90% of all stroke events are preventable and can be attributed to seven key modifiable risk factors (MRFs)-high blood pressure (BP), high cholesterol, diabetes mellitus (DM), smoking, obesity, unhealthy diet, and physical inactivity. In the United States, stroke prevention interventions led by community health workers (CHWs) have been proven to be highly effective in preventing the onset of MRFs. We conducted a scoping review of the competency assessment methods used in CVD and stroke-focused CHW training programs. We searched six online databases: PubMed, Cochrane, CINAHL, Embase, Web of Science, and HaPI, from all available years until January 2021. Of the 1,774 initial articles found, we identified 30 eligible articles to be included in the review. Nine of these studies used previously validated instruments, whereas the remaining 21 studies used tools from the training curriculum or independently developed instruments. Only five of these validated tools reported psychometric properties; none of them were designed for the CHW population. Our scoping review of literature revealed that CHW-specific competency assessment methods were limited, with few or no domain-referenced tools on CVD or stroke risk factors that complied with established measurement standards. We conclude that there is an urgent need for the development of a comprehensive and valid assessment instrument in CVD and stroke prevention to evaluate CHW performance and optimize their credibility, representing important first steps toward integrating CHWs into health care systems.

Lung cancer awareness training experiences of community health workers in KwaZulu-Natal, South Africa.

BACKGROUND: Lung cancer is the leading cause of cancer mortality worldwide. Awareness interventions in the developing world remain scarce. Community health workers (CHWs) are a critical component towards ensuring efficient delivery of healthcare services in low- and middle-income countries. AIM: This study explored the experiences of CHWs of their training as lung cancer awareness intervention implementers. SETTING: The study was conducted in a resource-poor setting, with CHWs from previously disadvantaged communities. METHODS: On the last day of training, 10 CHWs were requested to voluntarily participate in a focus group discussion regarding their experiences of the training, utilising a discussion guide. RESULTS: The participants expressed positive experiences with the training. They cited the amenable and conducive learning environment established by the facilitator. The participants felt empowered through the newly acquired knowledge and wanted to help their communities. However, some participants expressed a desire to have other forms of learning incorporated in future training. The participants were also cognisant of existing gaps in their own knowledge that could be elaborated upon in preparation for potential questions by the community. Some participants confirmed their role as agents of change. CONCLUSION: The authors propose large-scale intervention studies of lung cancer awareness utilising the CHW programme to gather conclusive evidence regarding their effectiveness at a community level.Contribution: This article provides insight into the training of community health workers on lung cancer awareness and future research on the integration of the intervention into already existing programmes.

Evaluation of an Interventional Health Education Project: Screening of Breast Cancer and Health Education (SHE).

There is an increasing incidence of breast cancer in India, especially among younger women. The study's main objective was to create awareness related to breast cancer and breast self-examination by community health workers and assess the effectiveness of improving knowledge and practice. Secondary objective was to conduct clinical breast examination (CBE) of women and prompt referral. METHODS: An outcome evaluation of the Educational Interventional project was conducted in a hilly district of Uttarakhand. Twenty Accredited Social Health Activists (ASHA) were identified and trained in breast cancer awareness, the procedure of breast self-examination, and screening methods. These ASHA's further created awareness among study participants (women above 30 years). A structured questionnaire on knowledge and practice was administered before and after educational intervention by ASHA workers. Clinical Breast Examination (CBE) camps were held for women at high risk for breast cancer who were referred to the Division of Breast Surgery, AIIMS Rishikesh, for further management. RESULT: One thousand sixty-one females participated in health education sessions by ASHAs. There was an improvement in knowledge and practice regarding Breast Self-examination after health education intervention. A low prevalence of risk factors for breast cancer was found among attendees of the CBE camp. 3.2% of participants had abnormalities on breast examination needing further workup. CONCLUSION: In the pre-test assessment, we found a low awareness and practice regarding breast cancer which increased significantly among women after behavioral change intervention. The prevalence of risk factors for breast cancer was very low. Trained community health workers were found to be effective in raising awareness, selective screening, and prompt referral.

Engaging Female Community Health Volunteers (FCHVs) for cardiovascular diseases risk screening in Nepal.

INTRODUCTION: Non-Communicable Diseases (NCDs) have become the leading public health problems worldwide and the cardiovascular diseases (CVDs) is one of the major NCDs. Female Community Health Volunteers (FCHVs) in Nepal are the key drivers to implementing frontline health services. We explored the potential for engaging FCHVs for CVD risk screening at the community level in Nepal. METHODS: We used multiple approaches (quantitative and qualitative) for data collection. The trained FCHVs administered CVD risk screening questionnaire among 491 adults in rural and urban areas and calculated the CVD risk scores. To maintain consistency and quality, a registered medical doctor also, using the same risk scoring chart, independently calculated the CVD risk scores. Kappa statistics and concordance coefficient were used to compare these two sets of risk screening results. Sensitivity and specificity analyses were conducted. Two focus group discussions among the FCHVs were conducted to determine their experiences with CVD risk screening and willingness to engage with CVD prevention and control efforts. RESULTS: The mean level of agreement between two sets of risk screening results was 94.5% (Kappa = 0.77, P<0.05). Sensitivity of FCHV screening was 90.3% (95% CI: 0.801-0.964); and the specificity was 97% (95% CI: 0.948, 0.984). FCHVs who participated in the FGDs expressed a strong enthusiasm and readiness to using the CVD risk screening tools. Despite their busy workload, all FCHVs showed high level of motivation and willingness in using CVD risk screening tools and contribute to the prevention and control efforts of NCDs. The FCHVs recommended needs for providing additional training and capacity building opportunities. CONCLUSION: We conclude that there is a potential for engaging FCHVs to use simple CVD risk screening tools at the community level. The findings are promising, however, further studies engaging larger number of FCHVs and larger population would warrant feasibility of such tools within the existing healthcare systems in Nepal.

Feasibility of Training Community Health Workers in the Detection of Oral Cancer.

Importance: Visual screening for oral cancer has been found to be useful in a large randomized clinical trial in Kerala, India, showing substantial reduction in mortality. To address the shortage of medical personnel in resource-deficient regions, using the services of community health workers has been proposed as a strategy to fill the gap in human resources in health care. Objective: To assess the feasibility of community health workers in screening and early detection of oral cancer using a mobile application capturing system. Design, Setting, and Participants: A cross-sectional study using a household sample was conducted in 10 areas of Gautam Budhnagar district, Uttar Pradesh, India, from January 31, 2020, to March 31, 2021, to assess the feasibility of identification of oral lesions by community health workers using a mobile phone application compared with diagnosis by trained dentists in a screening clinic. Men and women aged 30 years or older as well as tobacco users younger than 30 years were eligible for screening. Interventions: Screening by trained community health workers vs dentists. Results: A total of 1200 participants were screened by the community health workers during their home visits; of these, 1018 participants (526 [51.7%] men; mean [SD] age, 35 [16] years) were also referred and screened by the dentists a clinic. There was near-perfect agreement (κ = 0.9) between the findings of the community health workers and the dentists in identifying the positive or negative cases with overall sensitivity of 96.69% (95% CI, 94.15%-98.33%) and specificity of identification of 98.69% (95% CI, 97.52%-99.40%). Conclusions and Relevance: In this cross-sectional study, trained community health workers were able after initial supervision by qualified dentists to perform oral cancer screening programs. These findings suggest that community health workers can perform this screening in resource-constrained settings.

Culturally Relevant Online Cancer Education Supports Tribal Primary Care Providers to Reduce Their Cancer Risk and Share Information About Cancer.

BACKGROUND: Culturally relevant education is an opportunity to reduce health disparities, and online learning is an emerging avenue for health promotion. In 2014-2019, a team based at the Alaska Native Tribal Health Consortium developed, implemented, and evaluated culturally relevant online cancer education modules with, and for, Alaska's tribal primary care providers. The project was guided by Indigenous Ways of Knowing and the principles of community-based participatory action research and was evaluated in alignment with empowerment theory. About 265 unique learners completed 1,898 end-of-module evaluation surveys between March 2015 and August 2019, and 13 people completed a follow-up survey up to 28 months post module completion. KEY FINDINGS: Learners described the modules as culturally respectful and informative and reported feeling more knowledgeable and comfortable talking about cancer as a result of the modules. About 98% of the learners planned to reduce their cancer risk because of the modules, and all follow-up survey respondents had reduced their risk, including by quitting smoking, getting screened for cancer, eating healthier, and exercising more. About 98% of the learners planned to share information with their patients, families, friends, and community members because of the modules, with all follow-up survey respondents indicating that they had shared information about cancer from the modules. IMPLICATIONS FOR PRACTICE AND FURTHER RESEARCH: Culturally relevant online modules have the capacity for positive behavioral change and relatively high correlations between intent and behavior change. Future research could determine which aspects of the modules catalyzed reduced cancer risk and increased dissemination of cancer information.

Educação problematizadora em curso técnico para agentes comunitários de saúde: experiência de produção de significados no trabalho em saúde / The problematizing education approach in a technical course for community health workers: An experience of meaning production in health work

Resumo Este estudo de caso de abordagem qualitativa analisou o significado da experiência de formação do agente comunitário de saúde (ACS) em município do Sul do Brasil, a partir do referencial teórico da educação problematizadora de curso técnico dos Ministérios da Educação e Saúde. Foram realizadas entrevistas com ACS que finalizaram o curso e gestores da saúde e educação envolvidos com o desenvolvimento e acompanhamento pedagógico do curso (n=17), análise dos portfólios dos educandos e Projeto Pedagógico de curso. Material textual foi interpretado pela análise de conteúdo apoiada pelo software Visual Qualitative Data Analysis (ATLAS.ti). As aprendizagens no curso agregaram conhecimentos que facilitaram a abordagem/orientação do ACS às famílias, melhoraram sua habilidade de comunicação e interpessoais, ampliaram o entendimento de saúde incluindo determinantes sociais do processo saúde-doença, preparando-os para lidar com problemas complexos, o que trouxe segurança, confiança e tranquilidade ao processo de trabalho. Educação problematizadora, valorizando metodologias ativas de ensino-aprendizagem-avaliação, produziu aprendizados conectados com as vivências desses profissionais. O curso também qualificou o pertencimento do ACS à equipe. Desafios foram observados em relação ao entendimento/execução dessas metodologias ativas. Pesquisas sobre o tema da formação e avaliação do trabalho do ACS que envolvam a percepção da equipe e usuários são recomendadas.

Abstract This qualitative case study analyzed the meaning of the experience of training the community health worker (CHW) in a city in the south of Brazil, based on the problematizing education approach proposed by the Ministries of Education and Health for a technical course. Interviews were conducted with CHWs who completed the course and health and education managers involved in the development and pedagogical supervision of the course (n=17). The students' portfolios and the course's Pedagogical Project were analyzed. The textual material was interpreted by content analysis supported by the ATLAS.ti software. The course enhanced the CHWs' knowledge on how to approach and guide families, improved their communication and interpersonal skills, and broadened their understanding of health by including social determinants of the health-disease process, preparing them to deal with complex problems. This brought security, confidence and tranquility to the work process. The problematizing education approach, which greatly values active teaching-learning-assessment methodologies, promoted learning connected with the experiences of the CHWs. The course also fostered the CHWs' feeling of belonging to a team. Challenges were observed regarding the understanding/execution of the active methodologies. Research on the training of CHWs and on the assessment of their work, involving the perception of teams and users, is recommended.

Conhecimento de agentes comunitários de saúde sobre pessoas com deficiência visual / Conocimientos de agentes comunitarios de salud sobre personas con discapacidad visual / Knowledge of community health agents about visually impaired people

Resumo Objetivo Avaliar o conhecimento de agentes comunitários de saúde sobre pessoas com deficiência visual antes e após capacitação acerca da temática. Métodos Estudo descritivo e longitudinal, desenvolvido em três Unidades Básicas de Saúde em um município do interior do Ceará, entre os meses de dezembro de 2019 e maio de 2020. Participaram 13 agentes comunitários de saúde que trabalhavam nas referidas instituições. Os dados obtidos pela aplicação do questionário foram analisados pelo programa Statistical Package for the Social Sciences e Epi-Info. Resultados Os agentes comunitários de saúde eram, em sua maioria, mulheres com idade entre 41 e 50 anos (46,15%) e casados (69,23%). Mais da metade dos participantes estudaram apenas até o ensino médio (61,54%), e o mesmo número participou de curso técnico para agentes comunitários de saúde. Em relação ao tempo de trabalho como agentes comunitários de saúde, poucos exerciam essa função há mais de 20 anos (38,46%) e aproximadamente metade trabalhava na zona rural (53,85%). Foi observada aprendizagem após realização da capacitação, pois ocorreu acréscimo de respostas adequadas sobre termos comuns à temática, uma vez que os participantes da pesquisa passaram a compreender os conceitos de pessoa com deficiência, inclusão e acessibilidade. Foi possível observar que nenhum participante tinha treinamento sobre a temática, sendo relevante a capacitação ofertada por esse estudo. Conclusão Após realização da capacitação, foi possível observar aumento no número de respostas corretas, sensibilização e conscientização sobre a importância da temática, já que possuíam pessoas com deficiência em suas áreas de atuação.

Resumen Objetivo Evaluar los conocimientos de agentes comunitarios de salud sobre personas con discapacidad visual antes y después de una capacitación acerca del tema. Métodos Estudio descriptivo y longitudinal, llevado a cabo en tres Unidades Básicas de Salud en un municipio del interior del estado de Ceará, entre los meses de diciembre de 2019 y mayo de 2020. Participaron 13 agentes comunitarios de salud que trabajaban en las instituciones mencionadas. Los datos obtenidos tras la aplicación del cuestionario fueron analizados con el programa Statistical Package for the Social Sciences y Epi-Info. Resultados Los agentes comunitarios de salud eran mayormente mujeres entre 41 y 50 años de edad (46,15 %) y casados (69,23 %). Más de la mitad de los participantes estudiaron solamente hasta la educación secundaria (61,54 %) y el mismo número participó en un curso técnico para agentes comunitarios de salud. Con relación al tiempo de trabajo como agentes comunitarios de salud, pocos ejercían esa función hace más de 20 años (38,46 %) y aproximadamente la mitad trabajaba en la zona rural (53,85 %). Se observó el aprendizaje luego de la capacitación, pues hubo un incremento de respuestas correctas sobre términos comunes del tema, dado que los participantes del estudio comenzaron a comprender los conceptos sobre personas con discapacidad, inclusión y accesibilidad. Fue posible verificar que ningún participante había sido capacitado sobre el tema, por lo que la capacitación ofrecida por este estudio resultó relevante. Conclusión Luego de realizar la capacitación, fue posible observar un aumento en el número de respuestas correctas, sensibilización y concientización sobre la importancia de la temática, ya que en sus áreas de actuación había personas con discapacidad.

Abstract Objective Evaluate community health agents' knowledge about visually impaired people before and after training on the topic. Methods Descriptive and longitudinal study, developed in three primary health care services in a city in the interior of Ceará, between December 2019 and May 2020. The participants were 13 community health agents who worked at these institutions. The data obtained by applying the questionnaire were analyzed using Statistical Package for the Social Sciences and Epi-Info. Results most community health agents were women between 41 and 50 years of age (46.15%) and married (69.23%). More than half of the participants had only obtained a high school degree (61.54%), and the same number had taken a technical course for community health agents. As for their length of experience as community health agents, few had been working in this function for more than 20 years (38.46%) and about half worked in rural areas (53.85%). Learning was observed after the training, as the number of correct answers on common terms related to the topic increased, considering that the research participants began to understand the concepts of disabled people, inclusion and accessibility. It could be observed that none of the participants had been trained on the subject, showing the relevance of the training offered in this study. Conclusion After the training, an increase in the number of correct answers could be observed, as well as increased awareness about the importance of the topic, as there were people with disabilities in their activity areas.

O CUIDADO EM SAÚDE BUCAL NA GESTAÇÃO: CONHECIMENTOS E ATITUDES DE AGENTES COMUNITÁRIOS DE SAÚDE / ORAL-HEALTH CARE IN PREGNANCY: KNOWLEDGE AND ATTITUDES OF COMMUNITY AGENTS OF HEALTH

Objetivo: Descrever conhecimentos e práticas dos ACS, no tocante ao cuidado em saúde bucal (SB) na gestação. Métodos: Estudo transversal, com 157 ACS, vinculados às Unidades de Saúde da Atenção Básica (AB) em Vitória da Conquista-Bahia. Utilizou-se formulário com três blocos: perfil sociodemográfico; formação profissional; conhecimentos e atitudes referentes à SB na gestação. Resultados: Verificaram-se incertezas quanto aos cuidados odontológicos seguros na gestação: 52,9% apontaram apenas tratamento não-cirúrgico; 34% julgam anestesia necessária; 54,8% excluem radiografia). No tocante aos determinantes de SB da criança: 65,6% acreditam que antibiótico aumenta risco de cárie; 48,7% acreditam que cárie é causada por produtos açucarados. Observou-se ausência de abordagem na visita domiciliar (38,2%); busca ativa para pré-natal odontológico (30,6%); participação no planejamento de atividades educativas (43,9%). Conclusão: Existem fragilidades no tocante aos conhecimentos/práticas do ACS sobre a SB do binômio mãe-bebê. Evidencia-se necessidade da educação permanente como dispositivo de instrumentalização do processo de trabalho ACS.

Objective: To describe ACS knowledge and practices regarding oral health (OH) care during pregnancy. Methods: Cross-sectional study with 157 ACS, from Basic Health Care Units (AB) in Vitória da Conquista-Bahia. It was used a form with three parts: sociodemographic profile; professional qualification; knowledge and attitudes about OH during pregnancy. Results: There were uncertainties regarding safe dental care during pregnancy: 52.9% reported only non-surgical treatment; 34% consider anesthesia necessary; 54.8% excluded radiography). Regarding the OH determinants of the child: 65.6% believe that antibiotic increases risk of caries; 48.7% believe that sugary products cause caries. There was no approach at home visit (38.2%); active search for prenatal dentistry (30.6%); participation in the planning of educational activities (43.9%). Conclusion: There are weaknesses regarding ACS knowledge/practices about OH of the mother-baby binomial. Permanent education is necessary as an instrument to improve ACS practices in oral health care during pregnancy and childhood.

Fundamental Elements in Training Patient Navigators and Their Involvement in Promoting Public Cervical Cancer Screening Knowledge and Practices: A Systematic Review.

BACKGROUND: Cervical cancer screening remains unsatisfactory in some regions due to hindrances. This study aims to explore fundamental elements in training patient navigators and their involvement in promoting screening knowledge and practices. METHODS: This systematic review study included only English published articles between 2014 and 2019 from PubMed/Medline, EBSCO, Science Direct, and Wiley online library. RESULTS: Healthcare professionals trained patient navigators in 3 days regarding screening basics, along with group discussions and role-plays. They delivered effective health education and navigation assistance. CONCLUSION: The group education session facilitated by patient navigators, coupled with navigation care, resulted in a high screening rate.