Effectiveness of an Enhanced Community Health Volunteers Model in Improving Screening and Linkages for Non-Communicable Diseases in Nyeri County, Kenya

Abstract

Non-communicable diseases (NCDs) account for 63% of deaths worldwide. Of these, fifty per cent of hospital admissions and over eighty per cent occur in LMICs. The Kenyan government prioritized communicable disease management more than NCDs. Consequently, this affected the ill-equipped health systems, resulting in an upsurge in NCD morbidity and mortality. The study assessed how a modified CHV model worked in Nyeri County for NCD screening and linkages. This study utilized a mixed-method quasi-experimental study with a non-equivalent pre- and post-test method. Ten community units were sampled using a multi-stage cluster sampling technique. Each unit comprised 30 CHVs systematically chosen to participate in the study, with 150 CHVs in the interventional arm and 150 CHVs in the control group. Ten CHVs were purposively selected to participate in Key Informant Interviews, and six FGDs comprised of 10 discussants were carried out among selected community units. Data was collected and stored in the Kobo App, and later, quantitative data was analyzed using SPSS version 26.0. Interviews and group discussions were audio-recorded, and verbatim transcription and content thematic analysis were done via N-Vivo software version 12. The study showed that n=184 (61.3%) were females and n=218(72.7%) were aged 40 years and beyond, with n=215(71.7 %) having achieved a secondary level of education. Further, the study demonstrated that screening and linkage were higher in the intervention group (M =33.12, SD =2.50) (p =0.015). There existed a significant disparity in capacity from pre-intervention 48.75 % (SD±5.7) to 68.28 % (SD±7.6) and p <0.001. Physical activity contributed to NCD-related mortality (p =0.609) with notable behavioral modifiable risk factors (p=0.102). CHVs in the intervention group had a higher understanding of their role in the health workforce (M =3.49, SD =0.64) (P =0.010). Notably, CHVs in the intervention group understood that they work voluntarily (M =3.41, SD =0.59) (p =0.001). As part of their routine work, CHVs in the intervention group (M =3.27, SD =0.50) monitored their client's progress (p <0.001). Therefore, CHV training and orientation are essential to enhancing this capacity (P=0.001). The interventional group scored higher (p<0.001) concerning community knowledge and perceptions of roles and equally scored higher (P=0.002) in integrating with local structures. In addition, CHV perception of roles and influence was high in the intervention group (M =4.27, SD =0.49) (p<0.001). Average knowledge scores were higher in the intervention group (70%) p <0.001, and perception and roles about CHVs have influenced their performance (P=<0.001). All discussants highlighted traditional beliefs, culture, religion, myths, workload and inadequate training, together with misconceptions about their role and NCDs, as significant barriers and challenges to practical CHV work. However, gender and poor communication were significantly highlighted as barriers. The findings highlight that CHVs play a crucial role but need optimization through leveraging skills training and embracing community-based intervention and strategies. Therefore, continuous capacity building, innovative mobile app development and utilization, reinforced policy formulation together with communication, social mobilization, equitable resource allocation and community engagement programs will improve NCD screening and linkages, which later translates to timely diagnosis, treatment, referrals, promote care and add knowledge through publications in peer-reviewed journals and articles.