改善农村老年人慢性病管理的志愿者培训项目实施与评估

Implementation and evaluation of the peer-training program for village health volunteers to improve chronic disease management among older adults in rural Thailand

目的本研究旨在为泰国乡村卫生志愿者(village health volunteers,VHVs)制订一项同伴培训项目,以改善农村地区老年人的慢性疾病管理状况。方法该研究以社区参与性研究(community-based participatory research,CBPR)为指导,由社区组织、医疗服务机构、VHVs、患有慢性病的老年人及医疗保健需求较高的人士等各利益相关者共同参与制订VHVs同伴培训项目。该培训项目共需3天时间,每周1次,为期3周,包括知识分享、同伴支持和赋能、健康素养和健康行为、老年慢性病患者的一般护理程序、信息共享和沟通、家庭访视6个环节。2021年1月至4月,泰国清莱农村28名拥有5年以上老年人照顾经验的VHVs完成了该同伴培训项目。采用健康素养与健康行为(the Health Literacy and Health Behavior-3E2S,HLHB-3E2S)问卷、非传染性疾病管理问卷(the Management of Non-Communicable Diseases Questionnaire,MNCDQ)和自信心问卷,分别在项目实施前后对VHVs进行调查,并通过访谈收集他们对项目的态度和意见。结果培训项目实施后,VHVs的HLHB-3E2S问卷得分(49.39±5.54比52.35±4.26)、MNCDQ问卷得分(44.10±6.27比50.60±4.84)、自信心问卷得分(22.28±2.46比23.21±1.81)均提高(P<0.05)。访谈结果显示,同伴培训项目增强了VHVs的医疗保健服务能力,包括健康教育、慢性病管理、领导力技巧,并改善了他们与医疗卫生工作者的关系。结论同伴培训项目是提高VHVs能力的一项切实可行的策略。医务工作者应当为VHVs提供持续的培训计划,以提高其照顾社区老年慢性病患者的能力、信心和满意度。

Objectives This study aimed to investigate the effect of a peer-training program for village health volunteers(VHVs)to improve chronic disease management among older adults in rural Thailand.Methods The study was guided by community-based participatory research(CBPR).The peer-training program was developed by engaging diverse stakeholders,including community organizations,healthcare services,VHVs,older adults with chronic illnesses,and folk scholars in remote communities with high healthcare needs.The peer-training program comprised a three-day training workshop that convened once a week for three weeks with the following six sessions:knowledge sharing,peer support and empowerment,health literacy and health behavior,the general caring procedure for older adults with chronic illnesses,information sharing and communication,and home visit.From January to April 2021,a total of 28 VHVs completed the peer training program in a rural area in Chiang Rai province,Thailand.The Health Literacy and Health Behavior-3E2S(HLHB-3E2S),the Management of Non-Communicable Diseases Questionnaire(MNCDQ),and a self-confidence questionnaire were used to survey pre(week 1)and post-intervention(week 12),respectively.Then VHVs were interviewed to collect attitudes,and opinions about the intervention.Results After the intervention,the HLHB-3E2S scores(49.39±5.54 vs.52.35±4.26,P=0.001),the MNCDQ scores(44.10±6.27 vs.50.60±4.84,P<0.001),and the self-confidence questionnaire scores(22.28±2.46 vs.23.21±1.81,P=0.01)of VHVs significantly increased.VHVS also reported that the peer-training program enhanced their healthcare services,including health education,chronic disease management,leadership skills,and improving their relationship with healthcare providers.Conclusion Peer training programs are a practical strategy to improve VHVs’capacities.Healthcare professionals should provide a continuous training program for VHVs with their peers to increase capacities,confidence,and satisfaction in caring for the older adults with chronic diseases in the community.