Evaluation of a training program of hypertension for accredited social health activists (ASHA) in rural India

Marwa Abdel-All, Amanda Gay Thrift, Michaela Riddell, Kavumpurathu Raman Thankappan Thankappan, Gomathyamma Krishnakurup Mini, Clara K. Chow, Pallab Kumar Maulik, Ajay Mahal, Rama Guggilla, Kartik Kalyanram, Kamakshi Kartik, Oduru Suresh, Roger George Evans, Brian Oldenburg, Nihal Thomas, Rohina Joshi

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Hypertension is a major risk factor for cardiovascular disease, a leading cause of premature death and disability in India. Since access to health services is poor in rural India and Accredited Social Health Activists (ASHAs) are available throughout India for maternal and child health, a potential solution for improving hypertension control is by utilising this available workforce. We aimed to develop and implement a training package for ASHAs to identify and control hypertension in the community, and evaluate the effectiveness of the training program using the Kirkpatrick Evaluation Model. Methods: The training program was part of a cluster randomised feasibility trial of a 3-month intervention to improve hypertension outcomes in South India. Training materials incorporated details on managing hypertension, goal setting, facilitating group meetings, and how to measure blood pressure and weight. The 15 ASHAs attended a five-day training workshop that was delivered using interactive instructional strategies. ASHAs then led community-based education support groups for 3 months. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results using tests on knowledge at baseline, post-training and post-intervention, observation of performance during meetings and post-intervention interviews. Results: The ASHAs' knowledge of hypertension improved from a mean score of 64% at baseline to 76% post-training and 84% after the 3-month intervention. Research officers, who observed the community meetings, reported that ASHAs delivered the self-management content effectively without additional assistance. The ASHAs reported that the training materials were easy to understand and useful in educating community members. Conclusion: ASHAs can be trained to lead community-based group educational discussions and support individuals for the management of high blood pressure. Trial Registration: The feasibility trial is registered with the Clinical Trials Registry - India (CTRI) CTRI/2016/02/006678 (25/02/2016).

Original languageEnglish
Article number320
Number of pages11
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
Publication statusPublished - 2 May 2018

Keywords

  • ASHA
  • Hypertension
  • India
  • Kirkpatrick evaluation model
  • Training evaluation

Cite this

Abdel-All, Marwa ; Thrift, Amanda Gay ; Riddell, Michaela ; Thankappan, Kavumpurathu Raman Thankappan ; Mini, Gomathyamma Krishnakurup ; Chow, Clara K. ; Maulik, Pallab Kumar ; Mahal, Ajay ; Guggilla, Rama ; Kalyanram, Kartik ; Kartik, Kamakshi ; Suresh, Oduru ; Evans, Roger George ; Oldenburg, Brian ; Thomas, Nihal ; Joshi, Rohina. / Evaluation of a training program of hypertension for accredited social health activists (ASHA) in rural India. In: BMC Health Services Research. 2018 ; Vol. 18, No. 1.
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title = "Evaluation of a training program of hypertension for accredited social health activists (ASHA) in rural India",
abstract = "Background: Hypertension is a major risk factor for cardiovascular disease, a leading cause of premature death and disability in India. Since access to health services is poor in rural India and Accredited Social Health Activists (ASHAs) are available throughout India for maternal and child health, a potential solution for improving hypertension control is by utilising this available workforce. We aimed to develop and implement a training package for ASHAs to identify and control hypertension in the community, and evaluate the effectiveness of the training program using the Kirkpatrick Evaluation Model. Methods: The training program was part of a cluster randomised feasibility trial of a 3-month intervention to improve hypertension outcomes in South India. Training materials incorporated details on managing hypertension, goal setting, facilitating group meetings, and how to measure blood pressure and weight. The 15 ASHAs attended a five-day training workshop that was delivered using interactive instructional strategies. ASHAs then led community-based education support groups for 3 months. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results using tests on knowledge at baseline, post-training and post-intervention, observation of performance during meetings and post-intervention interviews. Results: The ASHAs' knowledge of hypertension improved from a mean score of 64{\%} at baseline to 76{\%} post-training and 84{\%} after the 3-month intervention. Research officers, who observed the community meetings, reported that ASHAs delivered the self-management content effectively without additional assistance. The ASHAs reported that the training materials were easy to understand and useful in educating community members. Conclusion: ASHAs can be trained to lead community-based group educational discussions and support individuals for the management of high blood pressure. Trial Registration: The feasibility trial is registered with the Clinical Trials Registry - India (CTRI) CTRI/2016/02/006678 (25/02/2016).",
keywords = "ASHA, Hypertension, India, Kirkpatrick evaluation model, Training evaluation",
author = "Marwa Abdel-All and Thrift, {Amanda Gay} and Michaela Riddell and Thankappan, {Kavumpurathu Raman Thankappan} and Mini, {Gomathyamma Krishnakurup} and Chow, {Clara K.} and Maulik, {Pallab Kumar} and Ajay Mahal and Rama Guggilla and Kartik Kalyanram and Kamakshi Kartik and Oduru Suresh and Evans, {Roger George} and Brian Oldenburg and Nihal Thomas and Rohina Joshi",
year = "2018",
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Abdel-All, M, Thrift, AG, Riddell, M, Thankappan, KRT, Mini, GK, Chow, CK, Maulik, PK, Mahal, A, Guggilla, R, Kalyanram, K, Kartik, K, Suresh, O, Evans, RG, Oldenburg, B, Thomas, N & Joshi, R 2018, 'Evaluation of a training program of hypertension for accredited social health activists (ASHA) in rural India' BMC Health Services Research, vol. 18, no. 1, 320. https://doi.org/10.1186/s12913-018-3140-8

Evaluation of a training program of hypertension for accredited social health activists (ASHA) in rural India. / Abdel-All, Marwa; Thrift, Amanda Gay; Riddell, Michaela; Thankappan, Kavumpurathu Raman Thankappan; Mini, Gomathyamma Krishnakurup; Chow, Clara K.; Maulik, Pallab Kumar; Mahal, Ajay; Guggilla, Rama; Kalyanram, Kartik; Kartik, Kamakshi; Suresh, Oduru; Evans, Roger George; Oldenburg, Brian; Thomas, Nihal; Joshi, Rohina.

In: BMC Health Services Research, Vol. 18, No. 1, 320, 02.05.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Evaluation of a training program of hypertension for accredited social health activists (ASHA) in rural India

AU - Abdel-All, Marwa

AU - Thrift, Amanda Gay

AU - Riddell, Michaela

AU - Thankappan, Kavumpurathu Raman Thankappan

AU - Mini, Gomathyamma Krishnakurup

AU - Chow, Clara K.

AU - Maulik, Pallab Kumar

AU - Mahal, Ajay

AU - Guggilla, Rama

AU - Kalyanram, Kartik

AU - Kartik, Kamakshi

AU - Suresh, Oduru

AU - Evans, Roger George

AU - Oldenburg, Brian

AU - Thomas, Nihal

AU - Joshi, Rohina

PY - 2018/5/2

Y1 - 2018/5/2

N2 - Background: Hypertension is a major risk factor for cardiovascular disease, a leading cause of premature death and disability in India. Since access to health services is poor in rural India and Accredited Social Health Activists (ASHAs) are available throughout India for maternal and child health, a potential solution for improving hypertension control is by utilising this available workforce. We aimed to develop and implement a training package for ASHAs to identify and control hypertension in the community, and evaluate the effectiveness of the training program using the Kirkpatrick Evaluation Model. Methods: The training program was part of a cluster randomised feasibility trial of a 3-month intervention to improve hypertension outcomes in South India. Training materials incorporated details on managing hypertension, goal setting, facilitating group meetings, and how to measure blood pressure and weight. The 15 ASHAs attended a five-day training workshop that was delivered using interactive instructional strategies. ASHAs then led community-based education support groups for 3 months. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results using tests on knowledge at baseline, post-training and post-intervention, observation of performance during meetings and post-intervention interviews. Results: The ASHAs' knowledge of hypertension improved from a mean score of 64% at baseline to 76% post-training and 84% after the 3-month intervention. Research officers, who observed the community meetings, reported that ASHAs delivered the self-management content effectively without additional assistance. The ASHAs reported that the training materials were easy to understand and useful in educating community members. Conclusion: ASHAs can be trained to lead community-based group educational discussions and support individuals for the management of high blood pressure. Trial Registration: The feasibility trial is registered with the Clinical Trials Registry - India (CTRI) CTRI/2016/02/006678 (25/02/2016).

AB - Background: Hypertension is a major risk factor for cardiovascular disease, a leading cause of premature death and disability in India. Since access to health services is poor in rural India and Accredited Social Health Activists (ASHAs) are available throughout India for maternal and child health, a potential solution for improving hypertension control is by utilising this available workforce. We aimed to develop and implement a training package for ASHAs to identify and control hypertension in the community, and evaluate the effectiveness of the training program using the Kirkpatrick Evaluation Model. Methods: The training program was part of a cluster randomised feasibility trial of a 3-month intervention to improve hypertension outcomes in South India. Training materials incorporated details on managing hypertension, goal setting, facilitating group meetings, and how to measure blood pressure and weight. The 15 ASHAs attended a five-day training workshop that was delivered using interactive instructional strategies. ASHAs then led community-based education support groups for 3 months. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results using tests on knowledge at baseline, post-training and post-intervention, observation of performance during meetings and post-intervention interviews. Results: The ASHAs' knowledge of hypertension improved from a mean score of 64% at baseline to 76% post-training and 84% after the 3-month intervention. Research officers, who observed the community meetings, reported that ASHAs delivered the self-management content effectively without additional assistance. The ASHAs reported that the training materials were easy to understand and useful in educating community members. Conclusion: ASHAs can be trained to lead community-based group educational discussions and support individuals for the management of high blood pressure. Trial Registration: The feasibility trial is registered with the Clinical Trials Registry - India (CTRI) CTRI/2016/02/006678 (25/02/2016).

KW - ASHA

KW - Hypertension

KW - India

KW - Kirkpatrick evaluation model

KW - Training evaluation

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U2 - 10.1186/s12913-018-3140-8

DO - 10.1186/s12913-018-3140-8

M3 - Article

VL - 18

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 1

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ER -