Training Improves Community Health Workers' Knowledge and Perception of Palliative Care: A Quasi-experimental Study

Community health workers (CHWs) are the frontline workers providing primary care. This study aimed to assess the impact of training on CHWs' knowledge and perceptions of palliative care (PC).

A mixed-method research design was adopted. The participants included CHWs posted in a block of North India. Using a pre-post quasi-experimental design, the PC knowledge questionnaire-basic (PCKQ-B) was used to assess the PC knowledge of CHWs before and after a 3-day PC training programme. Paired t-tests, one-way analysis of variance, and Tukey post hoc tests were used to determine the pre- and post-training differences in knowledge within and between groups. Responses to the open-ended questions and participants' narratives during the training were coded, thematically analysed and triangulated with quantitative results.

Of 49 CHWs who attended the training, 45 completed both pre- and post-tests. The training was associated with a statistically significant increase in mean PCKQ-B score (18.4 ± 2.942 post-training vs. 12 ± 3.422 pre-training; P < 0.001). Six out of seven domains showed improvement in the perception of CHWs regarding PC, with the highest impact on bereavement care (1 ± 0.00 post-training vs. 0.54 ± 0.501 pre-training; P < 0.001). Baseline PC knowledge and improvement in knowledge post-training were significantly associated with participants' designation and gender. Training improved participants' perception of PC from being just basic nursing care (pre-training) to a holistic care which extends beyond death to include bereavement care (post-training) and the importance of communication skills in fostering trust and reducing anger and frustration. Fear and anxiety about cancer, poverty, lack of resources, poor trust in public facilities, myths, lack of health awareness, social stigma and non-supportive families were identified as challenges to providing PC in the community.

Short-term PC training contextualised to the local needs improved CHWs' knowledge and perceptions of PC. Future trainings should emphasise addressing the psycho-social and spiritual domains of care.