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Item Acceptability and feasibility of community-based provision of urine pregnancy tests to support linkages to reproductive health services in Western Kenya: a qualitative analysis(BMC, 2022-09-01) Kibel, Mia; Thorne, Julie; Kerich, Caroline; Naanyu, Violet; Yego, Faith; Christoffersen‑Deb, Astrid; Bernard, Caitlin; Obstetrics and Gynecology, School of MedicineBackground: The majority of women living in rural Kenya access antenatal care (ANC) late in pregnancy, and approximately 20% have an unmet need for family planning (FP). This study aimed to determine whether training community health volunteers (CHVs) to deliver urine pregnancy testing (UPT), post-test counselling, and referral to care was an acceptable and feasible intervention to support timely initiation of ANC and uptake of FP. Methods: We applied community-based participatory methods to design and implement the pilot intervention between July 2018 and May 2019. We conducted qualitative content analysis of 12 pre-intervention focus group discussions (FGDs) with women, men, and CHVs, and of 4 post-intervention FGDs with CHVs, each with 7-9 participants per FGD group. Using a pragmatic approach, we conducted inductive line-by-line coding to generate themes and subthemes describing factors that positively or negatively contributed to the intervention's acceptability and feasibility, in terms of participants' views and the intervention aims. Results: We found that CHV-delivered point of care UPT, post-test counselling, and referral to care was an acceptable and feasible intervention to increase uptake of ANC, FP, and other reproductive healthcare services. Factors that contributed to acceptability were: (1) CHV-delivery made UPT more accessible; (2) UPT and counselling supported women and men to build knowledge and make informed choices, although not necessarily for women with unwanted pregnancies interested in abortion; (3) CHVs were generally trusted to provide counselling, and alternative counselling providers were available according to participant preference. A factor that enhanced the feasibility of CHV delivering UPT and counselling was CHV's access to appropriate supplies (e.g. carrying bags). However, factors that detracted from the feasibility of women actually accessing referral services after UPT and counselling included (1) downstream barriers like cost of travel, and (2) some male community members' negative attitudes toward FP. Finally, improved financial, educational, and professional supports for CHVs would be needed to make the intervention acceptable and feasible in the long-term. Conclusion: Training CHVs in rural western Kenya to deliver UPT, post-test counselling, and referral to care was acceptable and feasible to men, women, and CHVs in this context, and may promote early initiation of ANC and uptake of FP. Additional qualitative work is needed to explore implementation challenges, including issues related to unwanted pregnancies and abortion, the financial burden of volunteerism on CHVs, and educational and professional supports for CHVs.Item Assessing Village Health Workers’ Ability to Perform and Interpret Rapid Diagnostic Tests for Malaria 4 Years after Initial Training: A Cross-Sectional Study(American Society of Tropical Medicine and Hygiene, 2021) Miller, James S.; Mbusa, Rapheal Kisolhu; Baguma, Stephen; Patel, Palka; Matte, Michael; Ntaro, Moses; Bwambale, Shem; Kenney, Jessica; Guiles, Daniel; Mulogo, Edgar Mugema; Stone, Geren S.; Medicine, School of MedicineVillage health workers (VHWs) in Bugoye subcounty, Uganda, provide integrated community case management (iCCM) care to children younger than 5 years for malaria, pneumonia, and diarrhea. We assessed the longevity of VHWs' skills in performing and reading malaria rapid diagnostic tests (RDTs) 4 years after initial training, comparing VHWs who had completed initial iCCM training 1 year before the study with VHWs who had completed training 4 years before the study. Both groups received quarterly refresher trainings. Trained interviewers observed 36 VHWs reading six mock RDTs each and performing an RDT as part of a larger skills assessment exercise. VHWs read 97% of mock RDTs correctly; of the 36 VHWs, 86% read all six mock RDTs correctly. Most VHWs scored either 12/13 or 13/13 on the RDT checklist (39% and 36%, respectively), with 25% scoring 11/13 or lower. For reading mock RDTs, VHWs in the first group (initial training 4 years before study) read 97% of mock RDTs correctly, whereas those in the second group (initial training 1 year before study) read 96% of mock RDTs correctly; the first group had a mean of 5.83 RDTs read correctly, compared with 5.77 RDTs read correctly in the second group (P = 0.83). For performing an RDT, the first group completed a mean of 12.0 steps correctly, compared with a mean of 12.2 correct steps in the second group (P = 0.60). Overall, VHWs demonstrated proficiency in reading RDTs accurately and performing RDTs according to protocol at least 4 years after initial iCCM training.Item Design and Implementation of the Diabetes Impact Project: A Multisector Partnership to Reduce Diabetes Burden in Indianapolis Communities(Wolters Kluwer, 2023) Staten, Lisa K.; Weathers, Tess D.; Nicholas, Celeste; Grain, Tedd; Haut, Dawn P.; Duckett-Brown, Patrice; Halverson, Paul K.; Caine, Virginia; Community and Global Health, School of Public HealthContext: Community-level health disparities have not arisen suddenly but are the result of long-term systemic inequities. This article describes the design and implementation of a community-engaged multisector partnership to address health disparities by reducing the diabetes burden in 3 Indianapolis communities through the implementation of evidence-based strategies across the prevention continuum. Program: The project has 5 foundational design principles: engage partners from multiple sectors to address community health, focus on geographic communities most affected by the health disparity, practice authentic community engagement, commit for the long term, and utilize a holistic approach spanning the prevention continuum. Implementation: The design principles are incorporated into the following project components in each community: (1) health system community health workers (hCHWs), (2) neighborhood CHWs (nCHWs), (3) community health promotion initiatives, and (4) resident steering committees, as well as a backbone organization responsible for overall coordination, project communication, evaluation, and partnership coordination. Evaluation: This complex multilevel intervention is being evaluated using data sources and methodologies suited to each project component and its purpose overall. Each component is being evaluated independently and included holistically to measure the impact of the project on the health and culture of health in the communities. Key Performance Indicators were established upon project initiation as our common metrics for the partnership. Because complex interventions aiming at population-level change take time, we evaluate Diabetes Impact Project-Indianapolis Neighborhoods (DIP-IN), assuming its impact will take many years to achieve. Discussion: Health disparities such as the diabetes prevalence in project communities have not arisen suddenly but are the result of long-term systemic inequities. This complex issue requires a complex holistic solution with long-term commitment, trusted partnerships, and investment from diverse sectors as seen in this project. Implications for policy and practice include the need to identify stable funding mechanisms to support these types of holistic approaches.Item Impact of community health workers on diabetes management in an urban United States Community with high diabetes burden through the COVID pandemic(Elsevier, 2024-02-09) Hansotte, Elinor; Andrea, Sarah B.; Weathers, Tess D.; Stone, Cynthia; Jessup, Alisha; Staten, Lisa K.; Global Health, School of Public HealthObjective: Community Health Worker (CHW) interventions are promising approaches to increasing access to health care, garnering better health outcomes, and decreasing health inequities for historically marginalized populations. This study examines the impact of a health system-based CHW program embedded in the Diabetes Impact Project - Indianapolis Neighborhoods (DIP-IN), a large, place-based, multi-year intervention to reduce diabetes burden. We assessed the CHW program's effectiveness in managing glucose control and reducing diabetes-associated complications across the COVID timeline. Methods: We examined the association between the CHW intervention and diabetes management in 454 CHW patients and 1,020 propensity score-matched comparison patients. Using electronic medical records for encounters between January 1, 2017, and March 31, 2022, we estimated the CHW program effect using a difference-in-difference approach through generalized linear mixed models. Results: Participation was associated with a significant reduction (-0.54-unit (95 % CI: -0.73, -0.35) in glycosylated hemoglobin (A1C) on average over time that was beyond the change observed among comparison patients, higher odds of having ≥ 2 A1C measures in a year (OR = 2.32, 95 % CI: 1.79, 3.00), lower odds of ED visits (OR: 0.88; 95 % CI: 0.73, 1.05), and lower odds of hospital admission (OR: 0.81; 95 % CI: 0.60,1.09). When analyses were restricted to a pre-pandemic timeframe, the pattern of results were similar. Conclusion: This program was effective in improving diabetes management among patients living in diabetes-burdened communities, and the effects were persistent throughout the pandemic timeline. CHW programs offer crucial reinforcement for diabetes management during periods when routine healthcare access is constrained.Item Impact of Community Health Workers on Elderly Patients' Advance Care Planning and Health Care Utilization: Moving the Dial(Lippincott, Williams & Wilkins, 2017-04) Litzelman, Debra K.; Inui, Thomas S.; Griffin, Wilma J.; Perkins, Anthony; Cottingham, Ann H.; Wendholt, Kathleen M.; Ivy, Steven S.; Medicine, School of MedicineBACKGROUND: Advance care planning (ACP) is recommended for all persons to ensure that the care they receive aligns with their values and preferences. OBJECTIVE: To evaluate an ACP intervention developed to better meet the needs and priorities of persons with chronic diseases, including mild cognitive impairment. RESEARCH DESIGN: A year-long, pre-post intervention using lay community health workers [care coordinator assistants (CCAs)] trained to conduct and document ACP conversations with patients during home health visits with pre-post evaluation. SUBJECTS: The 818 patients were 74.2 years old (mean); 78% women; 51% African American; 43% white. MEASURES: Documentation of ACP conversation in electronic health record fields and health care utilization outcomes. RESULTS: In this target population ACP documentation rose from 3.4% (pre-CCA training) to 47.9% (post) of patients who had at least 1 discussion about ACP in the electronic health record. In the 1-year preintervention period, there were no differences in admissions, emergency department (ED) visits, and outpatient visits between patients who did and did not have ACP discussion. After adjusting for prior hospitalization and ED use histories, ACP discussions were associated with a 34% less probability of hospitalization (hazard ratios, 0.66; 95% confidence interval, 0.45-0.97), and similar effects are apparent on ED use independent of age and prior ED use effects. CONCLUSIONS: Patients with chronic diseases including mild cognitive impairment can engage in ACP conversations with trusted home health care providers. Having ACP conversation is associated with significant reduction in seeking urgent health care and in hospitalizations.Item Indiana community health workers: challenges and opportunities for workforce development(BMC, 2022) Rodriguez, Natalia M.; Ruiz, Yumary; Meredith, Ashley H.; Kimiecik, Carlyn; Adeoye‑Olatunde, Omolola A.; Kimera, Lynnet Francesca; Gonzalvo, Jasmine D.; Medicine, School of MedicineBackground: An interest in, and the need for, Community Health Workers (CHWs) in the United States is growing exponentially. CHWs possess a unique ability to relate to and build trust with communities in order to improve clinical outcomes, while building individual and community capacity. Given their critical role in addressing social determinants of health, expanding the CHW workforce is crucial. However, creating CHW jobs, facilitating training and certification, and establishing sustainable financing models to support this workforce has been challenging. Methods: A mixed-methods study consisting of an online survey and focus group discussions assessed the strengths, practices, and challenges to CHW workforce sustainability and expansion in the state of Indiana, including perspectives from both CHWs and employers. Results: Across 8 topics, mixed data analysis revealed 28 findings that were both complementary and unique across focus group and survey results. Results highlighted CHW skills and attributes, illustrated the recruitment and hiring process, and provided insight into measuring outcomes and outputs. Findings also indicated a need to build position validation, professional development, and billing and reimbursement capacity. Conclusion: Building and sustaining the CHW workforce will require creating an evidence base of roles and impact, increasing awareness of existing reimbursement mechanisms, and sharing best practices across employer organizations to promote optimal recruitment, training, supervision, career development, and funding strategies.