Challenges to Implementation of Community Health Worker-Led Chronic Obstructive Pulmonary Disease (COPD) Screening...

Area of Science:

• Public Health
• Global Health
• Respiratory Medicine

Background:

• Chronic obstructive pulmonary disease (COPD) poses a significant global health burden, disproportionately affecting low- and middle-income countries (LMICs).
• Limited access to screening and diagnostic tools in rural LMIC settings necessitates innovative healthcare delivery models.
• Community Health Worker (CHW) interventions are crucial for addressing these access barriers.

Purpose of the Study:

• To investigate the facilitators and barriers of implementing a CHW-led COPD screening and referral program in rural Uganda.
• To understand the perceptions of community members, CHWs, and healthcare providers regarding CHW-delivered COPD programming.

Main Methods:

• A qualitative study conducted in rural Uganda from September to October 2022.
• In-depth interviews with 8 CHWs and 10 healthcare providers (HCPs).
• Six focus group discussions with 34 community members, guided by the implementation outcomes framework.

Main Results:

• Implementation acceptability was limited by low COPD awareness, perceived lack of utility, and stigma.
• Spirometry adoption was hindered by accessibility and willingness to participate in the referral process.
• High patient volume and complex referral processes impeded implementation; increased CHW support and decentralized care were suggested for sustainability.

Conclusions:

• CHW-led interventions are vital for overcoming treatment and self-management barriers in resource-limited settings.
• Formative assessments are essential to identify and mitigate potential barriers before intervention implementation.
• Sustainable, evidence-based, and localized approaches with consistent funding are imperative for successful community-based health initiatives.