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. 2024 Apr 28;21(5):562.
doi: 10.3390/ijerph21050562.

Undesirable Levels of Practice Behaviours and Associated Knowledge amongst Community Health Workers in Rural South India Responsible for Type 2 Diabetes Screening and Management

Anirudh G Gudlavalleti  1   2 , Giridhara R Babu  3 , Varun Agiwal  4 , G V S Murthy  1 , Nicolaas C Schaper  2 , Onno C P van Schayck  2
Affiliations

Undesirable Levels of Practice Behaviours and Associated Knowledge amongst Community Health Workers in Rural South India Responsible for Type 2 Diabetes Screening and Management

Anirudh G Gudlavalleti et al. Int J Environ Res Public Health. .

Abstract

Background: Type 2 diabetes (T2DM) poses an enormous global health care challenge, especially among rural communities. Healthcare in these areas can be inadequate and inaccessible due to socio-demographic barriers. To overcome this situation, many low- and middle-income countries are resorting to task shifting, using community health workers (CHWs) for diabetes management. However, its successful implementation depends on the practice behaviours and knowledge of these workers.

Objective: This cross-sectional study aimed to evaluate the proficiency of CHWs involved in diabetes screening and management in rural South India by identifying the existing practice behaviours and knowledge gaps.

Methods: Employing a customised questionnaire, developed through inputs from experts and government officials, we assessed practice behaviours and the corresponding knowledge base of 275 CHWs. Analytical methodologies consisted of descriptive statistics, logistic regression, and mosaic plots for comprehensive data interpretation.

Results: The study showcased significant deficiencies in both practice behaviours (97%) and knowledge (95%) with current mean levels ranging from 48 to 50%, respectively, among the participants. The identified areas of insufficiency were broadly representative of the core competencies required for effective diabetes management, encompassing diabetes diagnosis and referral, HbA1c testing, diabetes diet, diabetes type and self-management, microvascular complications and their screening, peripheral neuropathy management, and diabetes risk assessment. In several areas, correct practice behaviour was reported by a relatively large number of CHWs despite incorrect answers to the related knowledge questions such as referral to the health centres, self-management, and calculation of diabetes risk assessment.

Conclusion: This study highlights widespread deficiencies (97% CHWs) in diabetes management practices and knowledge (95% CHWs). To overcome these deficiencies, a thorough needs assessments is vital for effective CHW training. Training of CHWs should not only identify prior knowledge and/or behaviour but also their interrelationship to help create a robust and flexible set of practice behaviours.

Keywords: South-East Asia; community health workers; health worker diabetes behaviour; health worker diabetes knowledge; health worker diabetes practice.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure A1
Figure A1
Mosaic Plots Depicting the Strong Relationship between Correct Practice Behaviour and In-correct Knowledge.
See this image and copyright information in PMC

References

    1. International Diabetes Federation . IDF Diabetes Atlas. 10th ed. International Diabetes Federation; Brussels, Belgium: 2021. [(accessed on 5 May 2022)]. Available online: www.diabetesatlas.org.
    1. The World Bank Group Population, Total—India. 2022. [(accessed on 1 August 2022)]. Available online: https://data.worldbank.org/indicator/SP.POP.TOTL?locations=IN.
    1. Anjana R.M., Deepa M., Pradeepa R., Mahanta J., Narain K., Das H.K., Adhikari P., Rao P.V., Saboo B., Kumar A., et al. Prevalence of diabetes and prediabetes in 15 states of India: Results from the ICMR–INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017;5:585–596. doi: 10.1016/S2213-8587(17)30174-2. Correction to Lancet Diabetes Endocrinol. 2017, 5, e5. - DOI - PubMed
    1. Statistics Division M of H & FW Rural Health Statistics. New Delhi. [(accessed on 3 July 2022)];2021 Available online: https://hmis.nhp.gov.in/downloadfile?filepath=publications/Rural-Health-....
    1. Gudlavalleti M.V.S., Shukla R., Bandyopadhyay S., Anchala R., Gudlavalleti A.S.V., Jotheeswaran A., Ramachandra S.S., Singh V., Vashist P., Allagh K., et al. Perception of care and barriers to treatment in individuals with diabetic retinopathy in India: 11-city 9-state study. Indian J. Endocrinol. Metab. 2016;20:S33–S41. doi: 10.4103/2230-8210.179772. - DOI - PMC - PubMed