Role development of community health workers for cardiovascular disease prevention in India

Cardiovascular disease (CVD) is the leading cause of mortality in India. Since community health workers (CHWs) have historically played a pivotal role in improving maternal and child health, it has been hypothesized that they have the potential to mitigate the impact of CVD in countries such as India. Project SEHAT is a cluster RCT to test the hypothesis that CHWs can improve the control of cardiovascular risk factors in a community in West Bengal, India. This study sought to quantitatively assess the training outcomes of CHWs recruited for Project SEHAT, and qualitatively assess their recruitment, training and fieldwork experiences. CHWs were recruited through a 2 step process-a written test and an interview. Upon completion of training, their knowledge and experiences were assessed. All intervention CHWs scored >80% on the knowledge test, implying a high rate of knowledge retention. Important themes identified during a focus group discussion with CHWs included satisfaction with a 2 step recruitment process, emphasis on communication skills, a preference for audio-visual aids in training and recognition of the importance of a supportive supervisory framework. Respect from society and a positive impact on people was consistently cited as the most satisfying aspects of the job, followed by financial compensation. Recruitment and training processes for CHWs in CVD programs should be more standardized to enable replication, scalability and adequate assessment of their potential to mitigate CVD mortality in countries such as India.