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Effectiveness of community health worker training programmes for cardiovascular disease management in low-income and middle-income countries: a systematic review
  1. Marwa Abdel-All1,2,
  2. Barbara Putica2,
  3. Deversetty Praveen3,
  4. Seye Abimbola1,2,
  5. Rohina Joshi1,2,4
  1. 1 The George Institute for Global Health, Sydney, New South Wales, Australia
  2. 2 Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  3. 3 The George Institute for Global Health, Hyderabad, Telangana, India
  4. 4 Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Marwa Abdel-All; mabdel-all{at}


Introduction Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs.

Methods A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project’s Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers.

Results The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before–after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention.

Conclusion The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.

  • cardiovascular disease
  • community health worker
  • training
  • low-income and middle-income countries

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  • Contributors BP drafted the protocol under the supervision of RJ. BP and MAA performed the search, extracted the data and contributed towards the interpretation of the results. MAA wrote the first draft. RJ conceived the research question, supervised the review and approved the final version of the manuscript. DP and SA provided critical input towards the manuscript. All the authors reviewed the final draft.

  • Funding This study was not funded by any agency

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All the data are included in the systematic review and the supplementary files. There are no extra data available.

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