Nesbit K1, Clark A2
1University of California/San Francisco State University, Physical Therapy, San Francisco, United States, 2Fitzpatrick Physical Therapy, Placerville, United States
Background: A rehabilitation training program has been ongoing in Malawi in the context of critical rehabilitation health care provider shortages, knowledge gaps in community health worker basic training and increasing numbers of people living with chronic illnesses.
Purpose: The purpose of this study is to evaluate the effectiveness of a rehabilitation training program for community health workers in a resource limited setting over a five-year period.
Methods: This is a retrospective cross-sectional study over a five-year period. Participants were home-based palliative care community health workers at St. Gabriel's Hospital in Namitete, Malawi (2013: n=20, 2014: n= 20, 2015: n=20, 2016: n=60, 2017: n=60). Data was collected from the annual trainings as well as the between-training follow up home visits. Data from the annual trainings included: 1) pre- and post- knowledge tests, 2) skill competency checks, and 3) observation of the application of skills in the home setting. Data from the follow up home visits included: 1) skill competency checks, 2) observations of caregiver education, 3) surveys of community health workers perceptions, and 4) information regarding patient goals, adaptations in the village and any questions about the training. Descriptive and comparison statistical methods were used to analyze the results.
Results: Over the five-years of trainings, attendance was 99%. Participants showed significantly greater knowledge on the post-test than on the pre- test in four of the five years of annual training (2013: p 0.001, 2014: p 0.001, 2015: p=0.007, 2016: p 0.001). 100% of the participants demonstrated competency in all rehabilitation skills in all five years of training (20 skills in the first three years, 32 skills in the fourth year, and 20 skills in the fifth year). 100% of participants demonstrated the ability to apply what was learned in the culminating home visit on the last day of each annual training. Overall, in the follow up home visits, the community health workers reported that the skills learned helped the patient, the caregiver and themselves (>85% responded “some” or “a lot”). Information from the follow up home visits was used to inform the next annual training curriculum resulting in a focus on the patient with a stroke, caregiver education and case management.
Conclusion(s): The results of this study show that community health workers who participated in a rehabilitation training program over the past five years have improved their knowledge, skill competency and ability to implement what they have learned to patient care in the village.
Implications: With a growing number of physical therapists and physical therapy student programs involved in global health, we are increasingly held accountable to provide effective services. The literature is lacking in evaluation of community health worker rehabilitation training. This study showed the effectiveness of a rehabilitation training over a five-year period and is a model for responsible assessment of rehabilitation training programs in resource limited settings.
Keywords: Education, Community Health Worker, Palliative Care
Funding acknowledgements: Rupley-Church International Relations Grant (2013-2017)
Purpose: The purpose of this study is to evaluate the effectiveness of a rehabilitation training program for community health workers in a resource limited setting over a five-year period.
Methods: This is a retrospective cross-sectional study over a five-year period. Participants were home-based palliative care community health workers at St. Gabriel's Hospital in Namitete, Malawi (2013: n=20, 2014: n= 20, 2015: n=20, 2016: n=60, 2017: n=60). Data was collected from the annual trainings as well as the between-training follow up home visits. Data from the annual trainings included: 1) pre- and post- knowledge tests, 2) skill competency checks, and 3) observation of the application of skills in the home setting. Data from the follow up home visits included: 1) skill competency checks, 2) observations of caregiver education, 3) surveys of community health workers perceptions, and 4) information regarding patient goals, adaptations in the village and any questions about the training. Descriptive and comparison statistical methods were used to analyze the results.
Results: Over the five-years of trainings, attendance was 99%. Participants showed significantly greater knowledge on the post-test than on the pre- test in four of the five years of annual training (2013: p 0.001, 2014: p 0.001, 2015: p=0.007, 2016: p 0.001). 100% of the participants demonstrated competency in all rehabilitation skills in all five years of training (20 skills in the first three years, 32 skills in the fourth year, and 20 skills in the fifth year). 100% of participants demonstrated the ability to apply what was learned in the culminating home visit on the last day of each annual training. Overall, in the follow up home visits, the community health workers reported that the skills learned helped the patient, the caregiver and themselves (>85% responded “some” or “a lot”). Information from the follow up home visits was used to inform the next annual training curriculum resulting in a focus on the patient with a stroke, caregiver education and case management.
Conclusion(s): The results of this study show that community health workers who participated in a rehabilitation training program over the past five years have improved their knowledge, skill competency and ability to implement what they have learned to patient care in the village.
Implications: With a growing number of physical therapists and physical therapy student programs involved in global health, we are increasingly held accountable to provide effective services. The literature is lacking in evaluation of community health worker rehabilitation training. This study showed the effectiveness of a rehabilitation training over a five-year period and is a model for responsible assessment of rehabilitation training programs in resource limited settings.
Keywords: Education, Community Health Worker, Palliative Care
Funding acknowledgements: Rupley-Church International Relations Grant (2013-2017)
Topic: Education: methods of teaching & learning; Service delivery/emerging roles; Disability & rehabilitation
Ethics approval required: No
Institution: San Francisco State University Office of Research and Sponsored Programs
Ethics committee: Human and Animal Protections Unit
Reason not required: Determined to be not human research and does not require IRB Review or approval on March 16, 2018
All authors, affiliations and abstracts have been published as submitted.
