Assessment of Community Health Worker Training Program in the Peruvian Amazon Demonstrates Effective Learning Retention: Implications for Health Care Education in a Resource-Limited Setting *

BACKGROUND: UNICEF data suggests under 5 mortality rates (U5MR) in rural Peru are nearly double those of urban areas. To reduce U5MR, the World Health Organization developed the Integrated Management of Childhood Illness (IMCI) framework, which utilizes vital signs to classify illness severity in children under five. Using IMCI as a model, Comunidades Unidas Peru (CU Peru) designed and implemented trainings for community health workers (CHWs) in the Peruvian Amazon. This study evaluated the effectiveness of the training to increase CHWs’ ability to collect and interpret patient vital signs in the rural areas of the Loreto Region in Peru.   

METHODS: A vital sign pre- and post-test was administered to CHWs at each training to evaluate improvement over the year and the retention of the vital signs curriculum from year to year. CHWs were given the Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) to assess the appropriateness of the curriculum for learners with varying health literacy.

RESULTS: After adjusting for gender, age, and years as a CHW, CHWs that have previously attended CU Peru trainings scored higher on the pre-test than first-time attendees (p=0.07); although marginally significant, this implies a trend of curriculum retention. No significant difference was observed in post-test scores between first-time CHW training attendees and those CHWs who had previously attended (p=0.49). For those CHWs who had attended training sessions in 2012 and 2013, there was not a significant difference in the post-test scores from 2012 and pre-test scores in 2013 (p= 0.13) again indicating a trend in curriculum retention. The main effect of SAHLSA-50 scores and possible interaction with CHWs that had attended a previous training were considered in the model but were not statistically a better fit than the model excluding SAHLSA-50 scores (F = 0.41, p = 0.53). Therefore, the SAHLSA-50 scores is not a good predictor of CHWs’ pre-test scores.

CONCLUSIONS: CHWs who complete the training retain the curriculum from year to year, and performed better at the pre-test than those CHWs who have not previously attended a training. First time attendees and repeat attendees did not differ significantly in their post-test scores, indicating that single training provides substantial improvements. CHW SAHLSA-50 scores were not strong predictors of CHWs’ pre-test scores, suggesting that this curriculum is well suited for a CHW population with varying levels of health literacy. Future work will evaluate the effect of training on community health outcomes.