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

Abstract

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.

Community Health Worker-Led Cardiovascular Disease Risk Screening and Referral for Care and Further Management in Rural and Urban Communities in Rwanda

“…The potential of community health workers to screen community members using mHealth tool was recently assessed and proved in Kenya [14]. In the present study it was found that the observed agreement between the CHW-generated 10-year CVD risk characterization and the nurse-generated 10-year CVD risk characterization for either overall study participants, rural study participants, or urban study participants is fair, as the computed kappa statistics are in range of 0.21-0.40 [19], and statistical significance was observed only for overall study participants and rural study participants. These results are far lower than those found in Nepal where the agreement between CHV-generated 10-year CVD risk characterization and doctor-generated 10-year CVD risk characterization for either overall study participants, rural study participants, or urban study is substantial as the computed kappa statistics were in range of 0.61-0.80 [19], and were all statistically significant.…”

“…For instance, one of the previous studies conducted in four countries-Bangladesh, Guatemala, Mexico, and South Africa-proved that trained CHWs successfully used non-laboratory tools to screen for cardiovascular disease risk and produced results that were highly congruent with those produced by trained health professionals (physicians and nurses) [3]. A recent study conducted in one of the low-income countries, Nepal, proved that community health volunteers (CHVs)-led CVD risk screening works and reported a concordance between CVD risk scores generated by CHVs and CVD risk scores generated by doctors [19]. It was also proved in regions of rural Kenya that CHWs can use mHealth tool to screen for CVD risk factors [14].…”

Diabetic foot problem in Nepal

“…They are frontline workers in the Nepalese healthcare system and are trusted by community members. There are over 51,000 members in Nepal as of the end of 2020 (20). They can be trained in annual diabetic foot screening and foot education.…”

Payment and Motivation: Female Community Health Volunteers in Nepal

“…FCHV's role was noticeable during emergencies such as the 2015 earthquake and COVID-19 (Horton et al, 2020;Prajwal et al, 2020). Various research shows the scope of FCHV is to prevent noncommunicable diseases (Basnet et al, 2021;Rawal et al, 2022). Their title as volunteers renders them speechless against misuse.…”