| Identifying high-risk individuals using risk scores or CGT and facilitating referrals for diagnosis and treatment. |
Epidemiological surveillance and community-health system connection. |
Iran / CHWs screen individuals to identify those at high-risk for diabetes and refer them to rural community centers / Along with other roles, a decrease in FBG levels was shown 1515. Javanparast S, Baum F, Labonte R, Sanders D, Heidari G, Rezaie S. A policy review of the community health worker programme in Iran. J Public Health Policy 2011; 32:263-76.,1616. Azizi F, Gouya MM, Vazirian P, Dolatshahi P, Habibian S. The diabetes prevention and control programme of the Islamic Republic of Iran. East Mediterr Health J 2003; 9:1114-21.,1717. Farzadfar F, Murray CJL, Gakidou E, Bossert T, Namdaritabar H, Alikhani S, et al. Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study. Lancet 2012; 379:47-54.,7373. Javanparast S, Baum F, Labonte R, Sanders D, Rajabi Z, Heidari G. The experience of community health workers training in Iran: a qualitative study. BMC Health Serv Res 2012; 12:291.. |
Using screening tool validated to regional ethnocultural parameters. Referral follow-up to identify local barriers for reaching health care in community centers. |
Though limited evidence specific to diabetes, screening of individuals and other interventions by CHWs improved NCD outcomes. Local challenges in ensuring patient follow-up must be addressed. |
| Bangladesh, Guatemala, Mexico, and South Africa / CHWs screened community members at high-risk for CVD and provided either urgent or non-urgent referrals / Lower follow-up rate among those receiving non-urgent referrals 1818. Levitt NS, Puoane T, Denman CA, Abrahams-Gessel S, Surka S, Mendoza C, et al. Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa. Glob Health Action 2015; 8:26318.. |
| India / CHWs conduct CGT as one input in a CVD risk assessment tool; mobile EDSS calculates CVD risk, refers high-risk patients to physicians, and provides decision support to physicians for medication prescription / No significant effect on blood pressure levels 2222. Peiris D, Praveen D, Mogulluru K, Ameer MA, Raghu A, Li Q, et al. SMARThealth India: a stepped-wedge, cluster randomised controlled trial of a community health worker managed mobile health intervention for people assessed at high cardiovascular disease risk in rural India. PLoS One 2019; 14:e0213708.. |
Acceptance of increased clinical role by relevant medical institutions and the community. |
It has the potential to improve epidemiological surveillance and increase referral follow-up rates. |
| Counseling to improve nutrition, physical activity, medication adherence, and disease-specific knowledge. |
Facilitate behavior changes and type 2 diabetes self-management. |
Iran / CHWs hold training sessions on healthy diet and lifestyle habits for those at high-risk for diabetes; CHWs followed-up those with type 2 diabetes diagnosis to ensure medication supply, adherence and check for new symptoms / Along the epidemiological surveillance, this program. has been shown to decrease FBG 1515. Javanparast S, Baum F, Labonte R, Sanders D, Heidari G, Rezaie S. A policy review of the community health worker programme in Iran. J Public Health Policy 2011; 32:263-76.,1616. Azizi F, Gouya MM, Vazirian P, Dolatshahi P, Habibian S. The diabetes prevention and control programme of the Islamic Republic of Iran. East Mediterr Health J 2003; 9:1114-21.,1717. Farzadfar F, Murray CJL, Gakidou E, Bossert T, Namdaritabar H, Alikhani S, et al. Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study. Lancet 2012; 379:47-54.,7373. Javanparast S, Baum F, Labonte R, Sanders D, Rajabi Z, Heidari G. The experience of community health workers training in Iran: a qualitative study. BMC Health Serv Res 2012; 12:291.. |
Physical activity and medical nutritional therapy goals developed according to the population’s lifestyle factors, customs, culture, and preferences. Diabetes education programs tailored to integrate regional perceptions of the disease. |
Evidence differs in terms of length of study, a combination of interventions, and training of CHWs. However, improvements in biochemical markers and treatment adherence has been reported. Transcultural adaptations of behavioral interventions and goals may improve outcomes. |
| Mexico / CHWs provided psychosocial support, counseling for medication adherence, and basic education on the disease for individuals with type 2 diabetes and/or hypertension / Significant improvement of disease control and treatment adherence 4141. Newman PM, Franke MF, Arrieta J, Carrasco H, Elliott P, Flores H, et al. Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study. BMJ Glob Health 2018; 3:e000566.. |
| Guatemala / CHWs conducted weekly home visits to monitor treatment adherence, monitored patients’ progress at clinics, and held group meetings for diabetics / After 4 months, biochemical markers improved, but no change in health behavior or diabetes knowledge were shown 4242. Micikas M, Foster J, Weis A, Lopez-Salm A, Lungelow D, Mendez P, et al. A community health worker intervention for diabetes self-management among the Tz'utujil Maya of Guatemala. Health Promot Pract 2015; 16:601-8.. |
| Brazil / CHWs trained in motivational interviewing and behavioral action-planning conducted home visits for patients with poorly controlled diabetes / After 6 months, physical activity and biochemical markers improved, but no change in dietary habits 4343. do Valle Nascimento TMR, Resnicow K, Nery M, Brentani A, Kaselitz E, Agrawal P, et al. A pilot study of a community health agent-led type 2 diabetes self-management program using motivational interviewing-based approaches in a public primary care center in São Paulo, Brazil. BMC Health Serv Res 2017; 17:32.. |
| Pakistan / Lay health workers delivered home health education every 3 months focusing on improving diet, increasing physical activity, and decreasing smoking; another intervention involved training general practitioners in hypertension management / Treatment with both interventions combined had the greatest effect on reducing blood pressure and was the most cost-effective 4545. Jafar TH, Hatcher J, Poulter N, Islam M, Hashmi S, Qadri Z, et al. Community-based interventions to promote blood pressure control in a developing country: a cluster randomized trial. Ann Intern Med 2009; 151:593-601.,4646. Jafar TH, Islam M, Bux R, Poulter N, Hatcher J, Chaturvedi N, et al. Cost-effectiveness of community-based strategies for blood pressure control in a low-income developing country: findings from a cluster-randomized, factorial-controlled trial. Circulation 2011; 124:1615-25.. |
| Providing support to use integrative medicine alternatives in environments with pluralistic health systems. |
Connections with integrative medicine. |
No published evidence formally assigning CHWs to this role in LMIC. |
Understanding traditional systems of care and concerns or difficulties in seeking allopathic care. Include CHW-led integrative health care interventions. The most widely used therapies among patients with diabetes are nutritional/dietary and herbal supplements, nutritional advice, spiritual healing, and relaxation techniques (yoga). |
There are no previous studies regarding this role. However, there is potential to improve community-health system connection and health system utilization in environments with integrative health care options. |
