Article type
Year
Abstract
Background: Although lay health workers (LHWs) are widely used to provide health care, little is known about their effectiveness.
Objective: To assess the effects of LHW interventions in primary care and community health.
Methods: We searched multiple databases for randomised controlled trials (RCTs) of interventions delivered by LHWs. A LHW was defined as any health worker delivering health care; trained in the context of the intervention; and having no formal professional certificated or degreed tertiary education. Two reviewers independently extracted data for each study. Studies comparing similar interventions were grouped for analysis.
Results: 43 RCTs met the inclusion criteria. These show considerable heterogeneity in the targeted health issue and the aims, content and outcomes of interventions. Most were conducted in high income countries (n=35). The intervention was delivered to consumers in their homes in thirty studies and in a primary care facility in four studies. Nine studies combined home, primary care and community based interventions.
Study heterogeneity limited meta analysis to outcomes for five subgroups (n=15 studies). LHWs increased immunisation uptake in children and adults (RR=1.30 [95% CI 1.14, 1.48] p=0.0001) and reduced mortality and morbidity for selected infectious diseases through improved diagnosis and treatment (RR=0.74 [95% CI 0.58, 0.93) p=0.01) show promising benefits, when compared to no intervention. There is weak evidence for the effectiveness of LHWs in promoting breast cancer screening uptake (RR=1.05 [95% CI 0.99, 1.12] p=0.10) and some evidence to support their effectiveness in promoting breastfeeding uptake, when compared to no intervention. For the remaining subgroups (n=18 studies), the outcomes were too heterogenous to allow statistical pooling and no conclusions on effectiveness can be drawn. Ten studies could not be assigned to subgroups.
Conclusions: LHWs show promising benefits in promoting immunisation uptake and improving the management of certain infectious diseases, when compared to no intervention. For other health issues, there is currently insufficient evidence to make recommendations for policy and practice. There is also insufficient evidence to assess which LHW training or intervention strategies are likely to be most effective. Further research is needed in these areas.
Objective: To assess the effects of LHW interventions in primary care and community health.
Methods: We searched multiple databases for randomised controlled trials (RCTs) of interventions delivered by LHWs. A LHW was defined as any health worker delivering health care; trained in the context of the intervention; and having no formal professional certificated or degreed tertiary education. Two reviewers independently extracted data for each study. Studies comparing similar interventions were grouped for analysis.
Results: 43 RCTs met the inclusion criteria. These show considerable heterogeneity in the targeted health issue and the aims, content and outcomes of interventions. Most were conducted in high income countries (n=35). The intervention was delivered to consumers in their homes in thirty studies and in a primary care facility in four studies. Nine studies combined home, primary care and community based interventions.
Study heterogeneity limited meta analysis to outcomes for five subgroups (n=15 studies). LHWs increased immunisation uptake in children and adults (RR=1.30 [95% CI 1.14, 1.48] p=0.0001) and reduced mortality and morbidity for selected infectious diseases through improved diagnosis and treatment (RR=0.74 [95% CI 0.58, 0.93) p=0.01) show promising benefits, when compared to no intervention. There is weak evidence for the effectiveness of LHWs in promoting breast cancer screening uptake (RR=1.05 [95% CI 0.99, 1.12] p=0.10) and some evidence to support their effectiveness in promoting breastfeeding uptake, when compared to no intervention. For the remaining subgroups (n=18 studies), the outcomes were too heterogenous to allow statistical pooling and no conclusions on effectiveness can be drawn. Ten studies could not be assigned to subgroups.
Conclusions: LHWs show promising benefits in promoting immunisation uptake and improving the management of certain infectious diseases, when compared to no intervention. For other health issues, there is currently insufficient evidence to make recommendations for policy and practice. There is also insufficient evidence to assess which LHW training or intervention strategies are likely to be most effective. Further research is needed in these areas.