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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017
AFRICA
173
At the end of the training, the trainees completed a post-
training written test, which was identical to the pre-training test.
In addition they underwent a practical examination to assess
their use of the risk tool to calculate CVD risk and to obtain
anthropometric measures. For the former, the CHWs were given
a scenario with all parameters needed to calculate a risk score
(age, gender, smoking status, weight, height and average systolic
blood pressure) and they had to calculate the CVD risk scores.
The practical evaluations were completed individually by the
study coordinator and trainers. Only CHWs who obtained 100%
on both the use of the risk tool and obtaining anthropometric
measurements and at least 60% on the content knowledge test
were permitted to conduct screenings in the community.
A run-in period of two weeks prior to the start of the field-
work allowed the study coordinator to assess the ability of
CHWs who had qualified to perform screening. The coordinator
randomly observed the CHWs during their screening activities
and provided feedback at the end of the observations. During
this two-week period, CHWs who were not able to perform
adequately were withdrawn from further screening activities.
CHWs were given a third, post-field-work test six months
after the training to assess longer-term knowledge retention.
This test did not include evaluating the CHWs’ ability to obtain
anthropometric measurements as they were required to hand in
their equipment at the end of the field-work. All test scripts were
graded, percentages of scores were calculated for each individual,
and each participant was ranked. To maintain confidentiality,
only numbers known to each individual were used for feedback.
Results
A total of 15 CHWs (14 females) were recruited for the training,
ranging between 23 and 36 years. All 15 trainees reported
completing grade 12 but only three had passed the final
examination for grade 12. All were receiving a stipend from
the NGO (between R1 330 and R1 710 per month). The only
previous training they had received was a two-day workshop
related to providing support to clients in the management of
their diagnosed chronic diseases but none related to screening
for CVD.
The results of all written tests administered are shown in
Fig. 2. Prior to the commencement of training, none of the 15
CHWs scored at least 60% (the passing grade) on the content
knowledge test. Since the training was designed to be delivered
over five working days, the first post-test was administered at
the completion of the training programme (8 June 2012) in
order to assess the effectiveness of the training in imparting
knowledge. Only seven of the 15 trainees (47%) reached the
passing threshold.
Based on these scores, it became clear that a second, additional
test would be required in order for at least half of the trainees
to be fit to conduct the field-work. A second week of training
was added, focusing on areas identified by the training team as
being poorly understood, through discussions with the trainees.
A second post-training test was administered at the end of the
second week (15 June 2012). This was identical to the first post-
training examination.
At the completion of the second week of training, 13 of the
15 trainees (87%) reached the passing threshold. During the
two-week run-in period, two additional CHWs were removed
from screening activities due to a failure to perform adequately
in the community. Ten of the eleven CHWs continued field-
work for the post-field-work testing. Out of these 10, 70% had
maintained their knowledge levels above the passing threshold.
During field-work activities, the CHWs used a standard
protocol
14
to screen individuals aged 35 to 74 years for CVD risk
and referred them to the health facility for further evaluation and
treatment. Individuals with a measured systolic blood pressure
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
100
90
80
70
60
50
40
30
20
10
0
Score (% correct)
Pre-training score (%)
Post-training score 2 (%)
* Note: CHWs 10, 12, 13, 15 did not participate in field work
Post-training score 1 (%)
Post-field-work score 1 (%)
Community health worker number
Passing
Threshold
Fig. 2.
Pre- and post-test scores of community health workers.