The Interventional Capacity of Community Health Volunteers for Screening and Linkages of Non-Communicable Diseases in Nyeri County, Kenya

Non-communicable diseases (NCDs) account for 63% of mortalities. Approximately 80% of these NCD-related deaths occur in LMICs. A quasi-experimental study utilizing a non-equivalent pre-and post-test was conducted from May 2022 to March 2023 with 370 study participants. Multistage cluster and random sampling were used to select ten community units, and therefore, 150 CHVs were chosen for the control unit, and 150 were used to form the interventional group. Data was collected from the KOBO app. Six (6) homogenous FGDs comprised ten members, and 10 KII were conducted across study sites. Quantitative data was analyzed using SPSS version 28.0, and qualitative data was audio-recorded, transcribed, and analyzed via N-Vivo 12. The study shows that 59.3% of respondents have minimal information, and 92.7% (n = 139) have no clear understanding of NCDs, with a pre-intervention capacity of 48.8%. Independent sample t-test showed a significant difference in capacity from a pre-intervention average of 48.75 (SD ± 5.7)%, which increased to 68.28 (SD ± 7.6)%, p < 0.001. A well-designed community interventional model plays a pivotal role in grassroots healthcare delivery but requires optimization for NCD management.

Nursing student volunteers and their level of involvement during the COVID-19 pandemic:a systematic review

Objective:Many strategic efforts were made to address nurses'shortage in controlling Coronavirus disease 2019(COVID-19),including recruiting student health volunteers.This review aimed to explore the contribution and involvement of nursing student volunteers during COVID-19.Methods:A systematic review was registered in PROSPERO International CRD42021283069.Electronic databases for ar ticle search included:SCOPUS,EBSCO MEDLINE,Pub Med,Pro Quest,Springer,Sage Pub,and hand searching.The critical appraisal study quality using The Joanna Briggs Institutes.Data extraction and synthesis used Population,Intervention,Comparison,Outcome,and Design(PICO and D)framework with thematic analysis.Results:Twelve studies were enrolled from 2545 retrieved,with 4 synthesized themes:(1)determinant of the involvement of nursing student volunteers during COVID-19,which includes 3 subthemes:motivations,perception,and barriers,(2)expectations and actual condition of nursing students as volunteers,(3)the need for nursing student volunteers,and(4)the impact and level of student volunteers'contribution.All student volunteers contribute to providing direct or indirect services to patients.Conclusions:This review provides an overview of nursing student volunteers'needs useful in developing competency frameworks and the role of culturally sensitive volunteers in education and training.In the future,student volunteers could choose the appropriate volunteer program and location according to their competence.

Unveiling the brain’s symphony:exploring the necessity and sufficiency of neural networks in behavior control

Since the pioneering work by Broca and Wernicke in the 19th century,who examined individuals with brain lesions to associate them with specific behaviors,it was evident that behaviors are complex and cannot be fully attributable to specific brain areas alone.Instead,they involve connectivity among brain areas,whether close or distant.At that time,this approach was considered the optimal way to dissect brain circuitry and function.These pioneering efforts opened the field to explore the necessity or sufficiency of brain areas in controlling behavior and hence dissecting brain function.However,the connectivity of the brain and the mechanisms through which various brain regions regulate specific behaviors,either individually or collaboratively,remain largely elusive.Utilizing animal models,researchers have endeavored to unravel the necessity or sufficiency of specific brain areas in influencing behavior;however,no clear associations have been firmly established.

Factors Affecting Disease Risk Perception and Self-Management Behaviors among Japanese Long-Term Overseas Volunteers

Introduction: Many overseas volunteers have worked in low and middle-income countries. However traveling abroad and staying in an unfamiliar environment with inadequate medical infrastructure exposes volunteers to a wide range of health risks. The aim of this study was to clarify the relationships among disease knowledge and symptoms, disease risk perception, and self-management skills. Methods: This was a questionnaire survey of 189 Japanese who were preparing to volunteer abroad. A factor analysis was conducted on 13 items (six general risk events and seven major diseases) of risk perception. Correlation analysis was performed between the identified risk perception factors and disease knowledge and symptoms. Risk perception scores by factors from the seven disease items were compared between the Self-management Score (SMS) group and disease knowledge and risk of symptoms group, using T-tests. St. Luke’s International University Ethics Committee (19-A092) approved this study. Results: Many participants expected to suffer from digestive diseases (69.3%) and dermatitis (55%) in the field. On the other hand, few expected high risk of malaria (26.5%) or dengue fever (36%). Factor analysis yielded robust factor loadings creating a “Dread” and an “Unknown” factor accounting for 62.2% of total variance. Strong correlation was not found between SMS and disease risk perception. A weak negative correlation was observed in dengue fever, digestive disorders, and dermatitis (r = −0.20 to −0.25, p < 0.001) on the “Unknown” factor. A high SMS score was associated with a lower “Unknown” factor score for malaria, diarrhea, dermatitis, and dental disorders. In addition, higher disease knowledge was significantly associated with higher “Dread” factor score for dental disorders. Conclusions: Self-management skills and disease knowledge will enable higher risk awareness of common diseases and high lethality diseases.

Enhancement of motor functional recovery in thoracic spinal cord injury: voluntary wheel running versus forced treadmill exercise

Spinal cord injury necessitates effective rehabilitation strategies, with exercise therapies showing promise in promoting recovery. This study investigated the impact of rehabilitation exercise on functional recovery and morphological changes following thoracic contusive spinal cord injury. After a 7-day recovery period after spinal cord injury, mice were assigned to either a trained group(10 weeks of voluntary running wheel or forced treadmill exercise) or an untrained group. Bi-weekly assessments revealed that the exercise-trained group, particularly the voluntary wheel exercise subgroup, displayed significantly improved locomotor recovery, more plasticity of dopaminergic and serotonin modulation compared with the untrained group. Additionally, exercise interventions led to gait pattern restoration and enhanced transcranial magnetic motor-evoked potentials. Despite consistent injury areas across groups, exercise training promoted terminal innervation of descending axons. In summary, voluntary wheel exercise shows promise for enhancing outcomes after thoracic contusive spinal cord injury, emphasizing the role of exercise modality in promoting recovery and morphological changes in spinal cord injuries. Our findings will influence future strategies for rehabilitation exercises, restoring functional movement after spinal cord injury.

Increased excitatory amino acid transporter 2 levels in basolateral amygdala astrocytes mediate chronic stress–induced anxiety-like behavior

The conventional perception of astrocytes as mere supportive cells within the brain has recently been called into question by empirical evidence, which has revealed their active involvement in regulating brain function and encoding behaviors associated with emotions.Specifically, astrocytes in the basolateral amygdala have been found to play a role in the modulation of anxiety-like behaviors triggered by chronic stress. Nevertheless, the precise molecular mechanisms by which basolateral amygdala astrocytes regulate chronic stress–induced anxiety-like behaviors remain to be fully elucidated. In this study, we found that in a mouse model of anxiety triggered by unpredictable chronic mild stress, the expression of excitatory amino acid transporter 2 was upregulated in the basolateral amygdala. Interestingly, our findings indicate that the targeted knockdown of excitatory amino acid transporter 2 specifically within the basolateral amygdala astrocytes was able to rescue the anxiety-like behavior in mice subjected to stress. Furthermore, we found that the overexpression of excitatory amino acid transporter 2 in the basolateral amygdala, whether achieved through intracranial administration of excitatory amino acid transporter 2agonists or through injection of excitatory amino acid transporter 2-overexpressing viruses with GfaABC1D promoters, evoked anxiety-like behavior in mice. Our single-nucleus RNA sequencing analysis further confirmed that chronic stress induced an upregulation of excitatory amino acid transporter 2 specifically in astrocytes in the basolateral amygdala. Moreover, through in vivo calcium signal recordings, we found that the frequency of calcium activity in the basolateral amygdala of mice subjected to chronic stress was higher compared with normal mice.After knocking down the expression of excitatory amino acid transporter 2 in the basolateral amygdala, the frequency of calcium activity was not significantly increased, and anxiety-like behavior was obviously mitigated. Additionally, administration of an excitatory amino acid transporter 2 inhibitor in the basolateral amygdala yielded a notable reduction in anxiety level among mice subjected to stress. These results suggest that basolateral amygdala astrocytic excitatory amino acid transporter 2 plays a role in in the regulation of unpredictable chronic mild stress-induced anxiety-like behavior by impacting the activity of local glutamatergic neurons, and targeting excitatory amino acid transporter 2 in the basolateral amygdala holds therapeutic promise for addressing anxiety disorders.

English Training for College Student Volunteers at Sports Events

This paper studies English training for student volunteers at large scale sports events with a comprehensive investigation of the undergraduate student volunteers from Capital University of Physical Education who have taken part in large scale sports events.By examining the current volunteer training situation,the author finds that there is a sever lack of professional and systematical English training for student volunteers at large scale sports events.The study shows focusing on sports events knowledge and requirements of the volunteers’specific job is crucial to the service level of the volunteers.The study concludes that the problem can be solved by developing new course books,innovating new flexible training methods,and offering more comprehensive training content.The recommended training methods include intensive group training,computer aided teaching,task training and on-the-spot training to make them fit their work soon.

Volunteers as caregivers for elderly with chronic diseases:An assessment of demand and cause of demand

Objective:We sought to examine the demand of volunteers on long-term care of elderly patients with chronic diseases.Further,we evaluated patients'reasons to want long-term care volunteers as well as socioeconomic factors affecting these needs.Methods:Questionnaires were distributed to 516 elderly with chronic diseases from nursing homes,hospitals,and elderly living with relatives.Patient questions dealt with basic socioeconomic questions,their reasons to want care volunteers,and the nature of chronic disease,and their motivation to volunteer and which sorts of activities they perform while volunteering.Results:73.4%of the elderly patients with chronic diseases desired to have volunteers for long-term care.The most desired services were care visits,transportation,and leisure/recreation activities.The number of chronic diseases they had,their marital status,education level,and social support system were all statistically important.Conclusion:The data presented here suggest that the government should actively advocate for volunteer service for elderly with chronic diseases.Additional support is needed in terms of financial support,incentive measures,professional training for volunteers,and supervision of volunteers.Such developments are needed to improve volunteer service standards.

Nerve compression and pain in human volunteers with narrow vs wide tourniquets

AIM: To assess the clinical effects and the morphological grade of nerve compression.METHODS: In a prospective single-center randomized, open study we assessed the clinical effects and the morphological grade of nerve compression during 20 min of either a silicon ring(group A) or pneumatic tourniquet(group B) placement variantly on the upper non-dominant limb in 14 healthy human volunteers. Before and during compression, the median and radial nerves were visualized in both groups by 3 Tesla MR imaging, using high resolutional(2.5 mm slice thickness) axial T2-weighted sequences. RESULTS: In group A, Visual analog pain scale was 5.4 ± 2.2 compared to results of group B, 2.9 ± 2.5, showing a significant difference(P = 0.028). FPS levels in group A were 2.6 ± 0.9 compared to levels in group B 1.6 ± 1, showing a significant difference(P = 0.039). Results related to measureable effect on median and radial nerve function were equal in both groups. No undue pressure signs on the skin, redness or nerve damage occurred in either group. There was no significant difference in the diameters of the nerves without and under compression in either group on T2 weighted images.CONCLUSION: Based on our results, no differences between narrow and wide tourniquets were identified. Silicon ring tourniquets can be regarded as safe for short time application.

Identification of Behavior of Voluntary Traceability and Analysis of Its Determinants: A Case Study of Hog Slaughtering and Processing Firms in Zhejiang Province,China

In recent years, the Chinese government has highlighted the importance of adopting hog safety/quality traceability, and a growing amount of research continues to entice firms to adopt traceability systems. In this study, a survey was conducted on a sample of pig slaughtering and processing firms in Zhejiang, China through personal interviews and emails. The aim of this study was to examine the determinants of firm behavior on the implementation of voluntary traceability systems with more stringent standards and controls than those of the mandatory system in China. The results revealed that motivation based on product quality improvement, capital ability and role perception （business type） had significantly positive relationships with a firm＇s voluntary traceability. Other incentives, such as operation improvement, recall risk reduction, reduced occurrence of safety issues, and technical strength were not found to be supportive in our study. This study provides an opportunity to better understand the determinants of firm behavior on voluntary traceability, particularly in light of the fact that some Chinese firms are facing the threat of criminal action for the use of illegal additives and the abuse of Clenbuterol. Policy recommendations on encouraging the implementation of pork safety voluntary traceability by hog slaughtering and processing firms are also discussed.

A study on the correlation between function motivation and professional identity among nursing volunteers

Objective:The objective of this study is to understand the status quo of function motivation and professional identity among nursing volunteers and explore the correlation between the two.Materials and Methods:A total of 3375 nursing volunteers from Nightingale Volunteer Service Group in Shanxi Province were investigated by using Occupational Identity Scale and Volunteer Functional Motivation Scale.Results:A total of 3375 questionnaires were issued and 3330 were recovered,among which 3324 were valid,with an effective recovery rate of 99.82%(3324/3330).The overall score of professional identity of nurses was 110.31±18.71,and the score of each dimension was 32.17±6.62 for professional cognitive evaluation dimension,22.77±3.74 for professional social support,21.31±4.09 for professional social skills,22.78±3.79 for professional frustration coping,and 11.32±2.03 for professional self-reflection.The total score of function motivation was 157.12±29.92.The above five dimensions of nurse’s professional identity scale were positively correlated with the total score of function motivation of nursing volunteers(r=0.044,0.035,0.034,0.035,and 0.042,respectively,all P<0.05).Conclusion:The functional motivation and professional identity of nursing volunteers in Shanxi Province are in the middle level in China.Therefore,it is necessary for the hospital to stimulate nursing staff’s enthusiasm about participation by carrying out multi-channel and multi-form volunteer service projects,enhance their professional identity,and make them better give back nursing professional skills to the society.

Changes of microcirculation in healthy volunteers and patients with septic shock in Xining

Objective: The purpose of this study is to investigate the characteristic of microcirculation in healthy volunteers and patients with septic shock in both Xining(2 260 m) and Nanjing(10 m). Methods: A total of 62 cases, 33 healthy volunteers, 22 cases in Xining,(2 260 m above sea level) and 11 cases in Nanjing(10 m above sea level); and 29 septic shock, 13 cases in Xining and 16 cases in Nanjing were collected. The total vessel density(TVD), perfused vessel density(PVD), proportion of perfused vessel(PPV) and microcirculation flow index(MFI) of both healthy volunteers and septic shock had been investigated by using sidestream dark field(SDF). Analyzed and managed the image data by using AVA3.0 software. Results: In the healthy volunteers in Xining area(22 cases),the volume of TVD(15.59 ± 2.58 mm/mm^2), PVD(15.58 ± 2.58 mm/mm^2) and PPV(96.60% ± 4.63%) were significant higher than the volume of TVD(10.0 ± 2.10 mm/mm^2), PVD(10.81 ± 2.38 mm/mm^2) and PPV(84.24% ± 8.00%) of the volunteers(11 cases) in Nanjing(11 cases). But the MFI(2.17 ± 0.31) of the healthy volunteers in the Xining was significant lower(P<0.05) than the MFI(3.21 ± 0.34) in the healthy volunteers of Nanjing. In the septic shock group(13 cases) in the Xining, the volume of TVD(5.44 ± 1.94 mm/mm^2), PVD(4.18 ± 1.61 mm/mm^2), PPV(42.14%± 5.38%) and MFI(1.05 ± 0.32) compared with the volume of the healthy volunteers in Xining, the TVD(15.59 ± 2.58 mm/mm^2), PVD(5.58 ± 2.58 mm/mm^2), PPV(96.60% ± 4.63%) and MFI(2.17 ± 0.30) were significant lower(P<0.05). In the healthy volunteers compare with septic shock group in Nanjing area, the TVD(6.80±1.72 vs 10.00±2.10, P<0.05), PVD(5.86±1.58 vs10.81±2.38,P<0.05), PPV(45.42±4.86 vs 84.24±4.86, P<0.05), MFI(1.28±0.28 vs 3.21±0.34 P<0.05), there was significant decreased. In the septic shock group in the Xining compared with the septic shock in Nanjing, there was no significant difference. 10 of 13 patients with septic shock were survived in Xining. 13 of 16 patients with septic shock were survived in Nanjing. Conclusion: The changes of physiological and pathophysiological characteristic in microcirculation induced by hypoxia would be useful for clinical treatment of septic shock at high altitude.

Medical students as disaster volunteers:A strategy for improving emergency department surge response in times of crisis

Disasters resulting in mass casualty incidents can rapidly overwhelm the Emergency Department(ED).To address critical manpower needs in the ED’s disaster response,medical student involvement has been advocated.Duke-National University of Singapore Medical School is in proximity to Singapore General Hospital and represents an untapped manpower resource.With appropriate training and integration into ED disaster workflows,medical students can be leveraged upon as qualified manpower.This review provides a snapshot of the conceptualization and setting up of the Disaster Volunteer Corps-a programme where medical students were recruited to receive regular training and assessment from emergency physicians on disaster response principles to fulfil specific roles during a crisis,while working as part of a team under supervision.We discuss overall strategy and benefits to stakeholders,emphasizing the close symbiotic relationship between academia and healthcare services.

Impact of endoscopy-based research on quality of life in healthy volunteers

AIM:To study the impact of an endoscopy-based long-term study on the quality of life in healthy volunteers(HV).METHODS:Ten HV were included into a long-term prospective endoscopy-based placebo-controlled trial with 15 endoscopic examinations per person in 5 different drug phases.Participants completed short form-36(SF-36) and visual analog scale-based questionnaires(VAS) for different abdominal symptoms at days 0,7 and 14 of each drug phase.Analyses wereperformed according to short-and long-term changes and compared to the control group.RESULTS:All HV completed the study with duration of more than 6 mo.Initial quality of life score was comparable to a general population.Analyses of the SF-36 questionnaires showed no significant changes in physical,mental and total scores,either in a short-term perspective due to different medications,or to potentially endoscopic procedure-associated long-term cumulative changes.Analogous to SF-36,VAS revealed no significant changes in total scores for pathological abdominal symptoms and remained unchanged over the time course and when compared to the control population.CONCLUSION:This study demonstrates that quality of life in HV is not significantly affected by a longterm endoscopy-based study with multiple endoscopic procedures.

Rural nurses’ perceptions of a volunteer program in an acute setting: Volunteers delivering person-centred care for patients with dementia and delirium

Community volunteers were recruited and trained to deliver person-centred care to patients with dementia or delirium in an acute hospital setting, in a small rural Australian hospital. The volunteer program was grounded in action research methodology, and modelled on a previous research project. As a form of evaluation, interviews were conducted with nursing staff eight weeks after implementation of the volunteer program to explore their opinions. Data were analysed through a collaborative process and findings revealed strong benefits from the perspectives of the nursing staff. These benefits included overall improved patient care and improved time management for nursing tasks.

Oral Pharmacokinetics of Mirodenafil in Mexican Healthy Volunteers

Mirodenafil is a 5-phosphodiesterase inhibitor that is currently marketed in Korea for the treatment of erectile dysfunction;however, no information in other populations is available. It has been described that Mirodenafil is metabolized by CYP3A4, a metabolic pathway in which interethnic differences have been reported. The purpose of this study was to characterize the oral pharmacokinetics of Mirodenafil in Mexicans. Seventeen male healthy volunteers were enrolled in this study. After an overnight fast, volunteers received an oral 100 mg dose and blood samples were collected at selected times during 24 h. Plasma was stored frozen and analyzed by an HPLC method. Pharmacokinetic parameters obtained were: Cmax 331.129 ± 32.689 ng/mL, tmax 1.574 ± 0.293 h, AUC24h 883.293 ± 104.088 ng·h/mL, AUC￥ 976.477 ± 108.812 ng·h/mL and t1/2 1.807 ± 0.171 h. Parameter values observed in this study are similar to those reported in Koreans. Since efficacy and safety studies of Mirodenafil have been conducted in Koreans, it is expected that dosage regime to employ in Mexicans should be similar to the approved for Korean population.

Expression of mRNA of chemokines and chemokine receptors and cytokines amount in the blood of healthy volunteers

Background: Chemokines are small proteins that activate immune system in normal and pathological conditions. The induction of chemotaxis is a well-established role of chemokines. Moreover chemokines are important mediators of angiogenesis, implantation of fetus, and maturation of immune cells. In human body many types of cells express chemokines and cytokines at level of gene and protein. In blood cells chemokine and chemokine receptors mRNA level is a one of crucial points of chemokine system condition. The aim of the study was to evaluate the relationship between plasma concentration of cyto- kines and chemokines/chemokine receptors mRNA level in blood of healthy volunteers. Results: Gene expression of eotaxin, eotaxin-2, IL-8, MIP-1α, MIP- 1β, RANTES, CCR1, CCR3, CCR5, CXCR1, and CXCR2 was measured in peripheral blood cells, as well as the concentration of IL-1β, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12 (p70), IL-13, IL-15, IL-17, eotaxin, FGF-2, G-CSF, GM-CSF, IFN-γ, IP-10, MCP-1, MIP-1α, MIP-1β, PDGF-BB, RANTES, TNF-α, and VEGF was evaluated in the plasma of 19 healthy individuals. We studied rela- tionship between mRNA levels of chemokines/recaptors and cytokine concentration in blood of healthy volunteers. Conclusion: These data are allowed to assess chemokines impact in the cytokine regulation of healthy subjects. These results indicate that chemokines and their receptors is diverse and redundant system of immune reactivity in response to internal and external challenges.

Influence of heat treatment on microstructure,mechanical and corrosion behavior of WE43 alloy fabricated by laser-beam powder bed fusion

Magnesium(Mg)alloys are considered to be a new generation of revolutionary medical metals.Laser-beam powder bed fusion(PBF-LB)is suitable for fabricating metal implants withpersonalized and complicated structures.However,the as-built part usually exhibits undesirable microstructure and unsatisfactory performance.In this work,WE43 parts were firstly fabricated by PBF-LB and then subjected to heat treatment.Although a high densification rate of 99.91%was achieved using suitable processes,the as-built parts exhibited anisotropic and layeredmicrostructure with heterogeneously precipitated Nd-rich intermetallic.After heat treatment,fine and nano-scaled Mg24Y5particles were precipitated.Meanwhile,theα-Mg grainsunderwent recrystallization and turned coarsened slightly,which effectively weakened thetexture intensity and reduced the anisotropy.As a consequence,the yield strength and ultimate tensile strength were significantly improved to(250.2±3.5)MPa and(312±3.7)MPa,respectively,while the elongation was still maintained at a high level of 15.2%.Furthermore,the homogenized microstructure reduced the tendency of localized corrosion and favoredthe development of uniform passivation film.Thus,the degradation rate of WE43 parts was decreased by an order of magnitude.Besides,in-vitro cell experiments proved their favorable biocompatibility.

BCCLR:A Skeleton-Based Action Recognition with Graph Convolutional Network Combining Behavior Dependence and Context Clues

In recent years,skeleton-based action recognition has made great achievements in Computer Vision.A graph convolutional network(GCN)is effective for action recognition,modelling the human skeleton as a spatio-temporal graph.Most GCNs define the graph topology by physical relations of the human joints.However,this predefined graph ignores the spatial relationship between non-adjacent joint pairs in special actions and the behavior dependence between joint pairs,resulting in a low recognition rate for specific actions with implicit correlation between joint pairs.In addition,existing methods ignore the trend correlation between adjacent frames within an action and context clues,leading to erroneous action recognition with similar poses.Therefore,this study proposes a learnable GCN based on behavior dependence,which considers implicit joint correlation by constructing a dynamic learnable graph with extraction of specific behavior dependence of joint pairs.By using the weight relationship between the joint pairs,an adaptive model is constructed.It also designs a self-attention module to obtain their inter-frame topological relationship for exploring the context of actions.Combining the shared topology and the multi-head self-attention map,the module obtains the context-based clue topology to update the dynamic graph convolution,achieving accurate recognition of different actions with similar poses.Detailed experiments on public datasets demonstrate that the proposed method achieves better results and realizes higher quality representation of actions under various evaluation protocols compared to state-of-the-art methods.

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

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.