title: The training and fieldwork experiences of community health workers conducting population-based, noninvasive screening for CVD in LMIC.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is on the rise in low- and middle-income countries and is proving difficult to combat due to the emphasis on improving outcomes in maternal and child health and infectious diseases against a backdrop of severe human resource and infrastructure constraints. Effective task-sharing from physicians or nurses to community health workers (CHW) to conduct population-based screening for persons at risk has the potential to mitigate the impact of CVD on vulnerable populations. CHW in Bangladesh, Guatemala, Mexico, and South Africa were trained to conduct noninvasive population-based screening for persons at high risk for CVD.
  
  
  OBJECTIVE
  This study sought to quantitatively assess the performance of CHW during training and to qualitatively capture their training and fieldwork experiences while conducting noninvasive screening for CVD risk in their communities.
  
  
  METHODS
  Written tests were used to assess CHW's acquisition of content knowledge during training, and focus group discussions were conducted to capture their training and fieldwork experiences.
  
  
  RESULTS
  Training was effective at increasing the CHW's content knowledge of CVD, and this knowledge was largely retained up to 6 months after the completion of fieldwork. Common themes that need to be addressed when designing task-sharing with CHW in chronic diseases are identified, including language, respect, and compensation. The importance of having intimate knowledge of the community receiving services from design to implementation is underscored.
  
  
  CONCLUSIONS
  Effective training for screening for CVD in community settings should have a strong didactic core that is supplemented with culture-specific adaptations in the delivery of instruction. The incorporation of expert and intimate knowledge of the communities themselves is critical, from the design to implementation phases of training. Challenges such as role definition, defining career paths, and providing adequate remuneration must be addressed.
authors.affiliation: Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA. Electronic address: Shafika_Abrahams-Gessel@Harvard.Edu.
authors.forename: Shafika
authors.initials: S
authors.lastname: Abrahams-Gessel
authors.affiliation: Centro de Estudios en Salud y Sociedad, El Colegio de Sonora, Colonia Centro, Hermosillo, Sonora, México.
authors.forename: Catalina A
authors.initials: CA
authors.lastname: Denman
authors.affiliation: Institute of Nutrition of Central America and Panama (INCAP), Ciudad de Guatemala, Guatemala.
authors.forename: Carlos Mendoza
authors.initials: CM
authors.lastname: Montano
authors.affiliation: Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gaziano
authors.affiliation: Chronic Diseases Initiative for Africa, Groote Schuur Hospital, Cape Town, South Africa; Division of Endocrinology and Diabetes, Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Naomi
authors.initials: N
authors.lastname: Levitt
authors.affiliation: Institute of Nutrition of Central America and Panama (INCAP), Ciudad de Guatemala, Guatemala.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Rivera-Andrade
authors.affiliation: Centro de Estudios en Salud y Sociedad, El Colegio de Sonora, Colonia Centro, Hermosillo, Sonora, México.
authors.forename: Diana Munguía
authors.initials: DM
authors.lastname: Carrasco
authors.affiliation: School of Public Health, University of the Western Cape, Bellville, Republic of South Africa.
authors.forename: Jabu
authors.initials: J
authors.lastname: Zulu
authors.affiliation: Centre for Control of Chronic Diseases in Bangladesh, ICDDRB, Mohakali, Dhaka, Bangladesh; Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Masuma Akter
authors.initials: MA
authors.lastname: Khanam
authors.affiliation: School of Public Health, University of the Western Cape, Bellville, Republic of South Africa.
authors.forename: Thandi
authors.initials: T
authors.lastname: Puoane
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003150:Community Health Workers / Q000193:education; D054521:Cultural Competency; D003906:Developing Countries; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D011203:Poverty; D016730:Program Development