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Table 2 Description of Health Intervention Program Involving Community Health Workers (CHWs) in Chinese literature (n = 23)

From: Delivery of public health services by community health workers (CHWs) in primary health care settings in China: a systematic review (1996–2016)

Author Year Location Names of CHWs Program Duration The Role of CHWs Types of Training Challenges (−) Facilitating factors (+)
Health Education
Baoan Li [47] 2007
Henan, Anyang
VD 5 years Provided health educations on healthy lifestyle using black broad, banners, and brochures. The health education included salt reduction, healthy diet, weight control, less alcohol, and smoking cessation. Government, county CDC provided regular training for VDs on NCDs prevention and control. VDs lack of knowledges on NCDs prevention, risk factors for NCDs, and principles of NCD treatments. 1. Health education is a cost-effective strategy for preventing NCDs.
2. The intervention program can improve the disease prevention capability of VDs thus emphasize the role of VDs in NCD prevention in rural communities.
Reproductive Health
Cuilan Guo, et al. [78] 2011
Not reported
CHW 2 years 1. Establishing women’s health care promoting medical team and counseling clinic;
2. Carrying out free medical examination for women;
3. Giving out regular lectures about women’s health;
4. Distributing health education materials;
5. Collecting women’s health issues, health need, and health status through door to door visits;
6. Providing tailored health care and education.
Training to familiar with their responsibility and understanding the purpose and significance of health education and nursing promotion. All team members have to pass the specific exam before implementing the intervention. 1. Most women in the community had a low educational level and lack knowledge on women’s health 1. Policy support on involving all stakeholders in promoting women’s health;
2. Providing special services to elderly women, which could be a high-risk population for hypertension, diabetes, CVD, and cancer.
Su Qian, et al. [81] 2010
Jiangsu Province
Grass-roots women health education, promotion female VDs, and family planning staff 11 months 1. Launching the intervention campaign;
2. Establishing and improving the community women’s health management files
3. Building a platform for exchanging information among medical staffs and women in the community;
4. Providing special services and expanding their health care services for women
All team members were trained before the campaign start. The training content includes the purpose and significance of establishing health education team; specify their roles, tasks, etc. 1. Most women lack basic knowledge on health in the community, including sexual infectious disease, HIV, and intimate partner violence.
2. Other stakeholders need to be involved, including health department, family planning department, civil administration, All-China women’s federation, and administration of justice.
3. Reproductive health education for women needs to be evaluated in the pay-for-performance system for relevant government departments.
Not reported
Yang Haixia, et al. [85] 2008
Yunnan Province
VD 1 year 1. Implementing health education activities: handing out health education manuals, training, etc.;
2. Selecting, educating, and assessing pregnant women’s companion
Not reported 1. The educational level of rural pregnant women were low;
2. The responsibility of VD needs to be strengthen.
1. Adopting peer education (companion for pregnant women) approach which is suitable for rural population;
2. Choosing relatives as companions, usually husband or mother-in-law;
Infectious Disease Control and Prevention
Lin Wang et al. [78] 2011
Henan Province
VD 6 months 1. Distributing medication of ART to people living with HIV/AIDS (PLWHA) and managing PLWHA.
2. Collecting sputum sample from potential TB patient who is living with HIV/AIDS.
3. Conveying questionnaire screening positive patients to county level health center to get chest X-ray.
Not reported 1. The financial incentive was not given to VD on time;
2. The workload of county level health professionals were increased by having more referred patients.
1. The financial incentives for VD in finding a TB positive patient.
Li Ye, et al. [79] 2011
Shanghai Ctiy
Community TB team, including CHWs 6 months 1. Implementing publicity of tuberculosis prevention and medication safety;
2. Providing monthly door and telephone supervision;
3. Launching quarterly discussion, urging patients to use drugs, explaining the national drug relief policy, and monitoring adverse drug reactions
Not reported 1. The DOTS strategy needs to be tailored. 1. Health professional was the key to introduce TB prevention and explain other health information to patients;
2. Organizing face-to-face counselling between doctors and patients;
3. Explaining the reimbursement in detail to patients to reduce the withdrawing treatment due to low income;
4. Illustrating and explaining TB using materials that easy to understand;
5. Protecting privacy of patient
Wu Bo, et al. [80] Not reportedChongqin City VDs 6 months One-to-one direct educate the residence in the community on TB Not reported 1. The educational level of residents in rural areas was low. Traditional approaches of health education, using public board, newspaper, magazines, was not effective.
2. Elderly people had less engagement in TB health educational activities;
1. Tailored health education approach is suitable for local economic and educational level;
2. Designing and implementing appropriate approaches for different groups of residents
Chen Xi, et al. [83] 2009
Hunan Province
VDs 5 months 1. Door-to-door visit for AIDS prevention knowledge education and education materials and condoms distribution before the migrant workers leave the village;
2. Follow-up education and behavior intervention by telephone and text message after migrant workers left.
Two trainings during 2007–2008 for 317 VDs in 5 counties/villages. Training includes the basic knowledge of AIDS, methods of AIDS prevention, identification of common clinical manifestations of AIDS, consultation and referral services for suspected infected persons, etc. 1. It was difficult to manage migrant workers who often change their jobs;
2. The quality of VDs are difference;
3. There are serious discrimination against HIV infected persons in rural areas;
4. The time of returning home for migrant workers was short;
5. Residency in rural areas are scattered;
6. VDs was lack of communication skills and worried about the discrimination;
7. There were some traditional beliefs in rural areas impede the HIV education;
8.There is no specific regulation on VDs responsibility in participating the HIV prevention and control;
10. The subsidy for VDs was not in time
1. Training changed the VDs’ perspectives towards HIV/AIDS;
2. Providing appropriate subsidies to VDs since the VD services were incorporate into current public health services system;
3. Having support from policy and administrative.
Duan Song, et al. [84] NA
Yunnan Province
VDs and Peer Educator (volunteer) Not reported 1. Implementing one to one education on HIV prevention with brochures;
2. Training home nursing staffs;
3. Distributing free condoms and demonstrating the use of condom;
4. Providing voluntary counseling and testing for HIV;
5. Training peer educators (volunteers);
6. Follow-up HIV patients and prescribe basic medication;
7. Offering various support to family members of HIV patients.
AIDS related training (did not find detail information in the article) Not reported 1. Family based and community based care model;
2. Providing comprehensive services.
Xu Xuejiang, et al. [48] 2016
Chengdu City, Sichuan Province
Community Health Services Team, including CHWs 4 years Community health services based HIV/AIDS preventions for female sex workers Not reported 1. Intervention needed to be strengthened;
2. Only few health workers in community which were part-time and quick turnaround.
3. Lack of incentive mechanism.
1. Community health services centers are familiar with the environment and close to the target population;
2. The interventions conducted by community health services centers are more timely and are initiated more frequent.
Tobacco Control
Li Jianping, et al. [67] 2009
Tianjin City
CHWs 2 months 1. Setting up smoking cessation clinic;
2. Promoting tobacco control in target community using brochures, posters, and board.;
3. Launching health education activities and collecting signatures for smoking cessation.
Training were instructed by expertise from the city level CDC and a tertiary hospital. The content includes smoking hazards, smoking cessation methods, smoking cessation skills, and management skills, to improve tobacco control ability of CHWs. 1. The intervention time was too short;
2. Education without other compulsory measures may be not strong enough to combat with nicotine addictive.
Suggestions from the author:
1. Developing long-term planning, extending the intervention time, and increasing the intensity of intervention;
2. Strengthening legislation on tobacco control;
3. Increasing scientific research in the field of smoking cessation.
Wu Xiaoli, et al. [75] 2014
Shanghai City
CHWs 12 months 1. Distributing smoke-free endorsement card to pregnant women;
2. Face-to-face health education;
3. Distributing intervention booklets
4. Playing tobacco control video courses for pregnant women;
5. Home visits;
6. Telephone follow-up.
Not reported 1. The effect of knowledge dissemination had reached a bottleneck due to the popular use of many social media platforms;
2.The intervention only affected the family level
1. Pregnant women were more sensitive to health;
2. Incorporating the intervention with the existing pregnancy insurance service system
3. Videos can largely reduce the cost of face-to-face demonstrating skills on refusing SHS.
Child Health and Vaccination
Jianbin Zhang, et al. [72] 2005
Hunan Province
VDs 9 months 1. Storing HBV vaccine
2. Vaccinating newborns with HBV vaccination
3. Using auto-disable syringes to vaccinate newborns.
4. Using HB-Uniject™ to store vaccines and vaccinate for those newborns cannot covered by cold chain in remote area.
Not reported 1. Cost were increased by using HB-Uniject™ as injector 1. HBV vaccine can be stored in room temperature;
2. HB-Uniject™ is easy to use with accurate dose and time saving.
NCD related - Diabetes and/or Hypertension
Wei Qiao et al. [57] 2014
Shanghai City
VDs 1 year 1. Provide health education regularly; instruct diabetes patients to test their daily blood glucose and blood pressure; monitor the blood glucose level remotely; give advice on diet, exercise, and lifestyle for patients. Not reported The clinical skills of VDs need to be improved. 1. This intervention program is in accordance with the government policy in health. 2. The remote surveillance platform solved the transportation issue for rural areas.
Junfeng Ji [58] 2015
Shandong Province
VDs 1 year Patient follow-up at least four times every year (weight, heart rate, BMI, and asking for diabetes condition and lifestyles); complete the health profile for diabetes patients Training for the process of follow-up a diabetes patient, lifestyle and treatment adjustment for patients who did not maintain their blood glucose well. 1. VDs are lack of knowledge for diabetes. 2. The average age of VDs is old. Multiple task and over workload for VDs.
3. Patients did not realize the serious impact of diabetes complications.
4. Economic issue for some patients.
Not reported
Cengceng Chen & Hui Li [59]. 2016
Shandong Province
VDs 1 year Patient follow-up four times a year. Five trainings provided by the program including treatment for hypertension, essential drugs or medicine, case study, and health education skills. 1. Diagnostic and disease prevention skills need to be improved among VDs. 1. Strong bond between VDs and the local patients
Ren Hui, et al. [44] 2016
Shanghai City
Community Health Service Team, including general practitioner, community nurse, public health physician, and lay health worker(or non-medical workers?) 6 months 1. Intensive group intervention: nurses introduce self-management; general practitioners make rehabilitation plan with individual patients;
2. Follow-up: public health physicians monitor patients; non-medical workers organize group intervention and coordinate with patients.
Not reported Not reported 1. Redesigned health delivery system based on chronic disease care model. Involving nurses, public health physicians, and lay health workers;
2. Patients felt more respects on their opinions and their decisions of the disease management;
NCD related - Cancer
Chen Liang, et al. [45] Shanghai City General practitioner-led health management team, including community nurses 3 months 1. Establishing personal health record of patient;
2. Exercise guidance;
3. Nutrition intervention;
4. Sleep regulation;
5. Remission of pain;
6. Correct anemia;
7. Psychological intervention.
Training content includes basic knowledge of breast cancer and cancer fatigue, systematic assessment of cancer fatigue, mitigation methods, dietary guidance and medication knowledge, etc 1. The intervention time was too short;
2. Overload work for these CHWs;
3. Lack of human resource and funding;
4. The intervention only target at patients but not their social support system.
Not reported
Du Ling, et al. [46] 2013
Nanjing City, Jiangsu Province
Community workers and community nurses 3 months 1. Telephone calls and home visits, group health education activities organization, motivational interviews in peer support group. 2. Communicating with patients, and building the bridge between patients and physicians. Not reported 1. Patients were very easy to be infected by negative mood of peer educator; 1. costs of voluntary peer support was low;
2. Peer educator has sympathy with patients;
3. Community workers can offer social and psychological support for patients as the extension and complement of the clinical services.
NCD related - Mental Health
Jiang Yaqin, et al. [54] NA
Shanghai City
Neighborhood committee staff, community psychiatric doctors and volunteers 6 months Programmed training:
1. Training of drug self-management skills;
2. Training of symptom self-monitoring skills
Not reported Not reported 1. Programmed skill training is effective in relieving mental symptoms, improving self-knowledge and social function;
Shu Dalin, et al. [65] 2010
Hunan Province
Community Health Service Team, including CHWs 2 years Community comprehensive intervention:
1. Health education;
2. Drug intervention;
3. Psychological intervention;
4. Life intervention;
5. Rehabilitation training;
6. Follow up and health evaluation.
Not reported 1. Lack of funding and mental health workers;
2. Huge economic burden for families with financial difficulties during the long-term intervention;
3. Patient disturbance during the intervention was difficult to solve without civil administration and public security department.
1. Community health intervention can be flexible and practical.
2. Community health intervention can largely reduce the burden of their family and the society.
NCD related - Cardiovascular diseases & Hypertension
Guan Fei, et al. [69] 2005
Henan Province
Community General Practitioners 1 year Hierarchical Risk factors management intervention:
1. Dissemination of health knowledge using lectures, training course, free counselling, contest, and distribute education materials;
2. Psychological assessment and counseling including phone and face-to-face counselling;
3. Full-course demonstration intervention of family health
Not reported 1. Obesity and overweight rates of body mass needed long-term intervention;
2. the intervention stage is short, and the effect of some intervention project was not obvious;
3. cardiovascular endpoints were not observed;
1. Management of the whole population, including healthy population, high risk population, and patients;
2. Educating the family members of the patients, especially those who had the right to decide the health education of patients with cardiovascular diseases was effective