Prospective feasibility study of a telehealth platform for community-based NCD risk assessment by community health leaders in rural northern Thailand.
Limited access to preventive healthcare in rural and remote areas poses a persistent challenge for early identification of non-communicable disease (NCD) risk. We evaluated the feasibility and acceptability of HealthD, a telehealth-supported platform that enables Community Health Leaders (CHLs) to conduct community-based NCD risk assessment and facilitate follow-up in rural northern Thailand.
We conducted a prospective, single-arm feasibility and acceptability study from June to November 2023 in Chiang Mai Province, Thailand. A total of 120 adults aged 30-70 years without a prior recorded diagnosis of the target NCDs were enrolled. Trained CHLs used HealthD to perform community-based assessment for diabetes mellitus (DM), cardiovascular disease (CVD), and respiratory symptom/functional limitation screening using guideline-informed algorithms and field-based measures, followed by risk-tailored counseling or teleconsultation at two- and four-month follow-up. Feasibility was assessed through recruitment, retention, CHL competency, workflow delivery, and acceptability among CHLs and participants.
Of 126 individuals approached, 120 were enrolled (recruitment rate 95.2%), and 119 completed follow-up (retention rate 99.2%). CHL competency improved after training, with mean assessment scores increasing from 8.4 to 9.3 (p= 0.010). Acceptability was high among CHLs (92%) and participants (97%). The HealthD workflow, including in-person assessment, point-of-care testing, digital data entry, algorithm-based risk-output generation, and teleconsultation follow-up, was implemented in the study setting. NCD-related risk outputs are presented as descriptive, exploratory findings. At baseline, 73% of participants were classified for DM-related risk, 3% for CVD-related risk, and 9% for respiratory symptom/functional limitation category. Across follow-up visits, DM-related risk categories changed, whereas CVD- and respiratory symptom/functional limitation categories remained relatively stable.
This prospective study suggests that HealthD is feasible and acceptable for CHL-led, telehealth-supported community-based NCD risk assessment and follow-up in a rural Thai setting. These findings are preliminary and are intended to inform workflow refinement and the design of larger studies evaluating effectiveness, implementation outcomes, and sustainability.
We conducted a prospective, single-arm feasibility and acceptability study from June to November 2023 in Chiang Mai Province, Thailand. A total of 120 adults aged 30-70 years without a prior recorded diagnosis of the target NCDs were enrolled. Trained CHLs used HealthD to perform community-based assessment for diabetes mellitus (DM), cardiovascular disease (CVD), and respiratory symptom/functional limitation screening using guideline-informed algorithms and field-based measures, followed by risk-tailored counseling or teleconsultation at two- and four-month follow-up. Feasibility was assessed through recruitment, retention, CHL competency, workflow delivery, and acceptability among CHLs and participants.
Of 126 individuals approached, 120 were enrolled (recruitment rate 95.2%), and 119 completed follow-up (retention rate 99.2%). CHL competency improved after training, with mean assessment scores increasing from 8.4 to 9.3 (p= 0.010). Acceptability was high among CHLs (92%) and participants (97%). The HealthD workflow, including in-person assessment, point-of-care testing, digital data entry, algorithm-based risk-output generation, and teleconsultation follow-up, was implemented in the study setting. NCD-related risk outputs are presented as descriptive, exploratory findings. At baseline, 73% of participants were classified for DM-related risk, 3% for CVD-related risk, and 9% for respiratory symptom/functional limitation category. Across follow-up visits, DM-related risk categories changed, whereas CVD- and respiratory symptom/functional limitation categories remained relatively stable.
This prospective study suggests that HealthD is feasible and acceptable for CHL-led, telehealth-supported community-based NCD risk assessment and follow-up in a rural Thai setting. These findings are preliminary and are intended to inform workflow refinement and the design of larger studies evaluating effectiveness, implementation outcomes, and sustainability.
Authors
Kaewkart Kaewkart, Suebtam Suebtam, Thatong Thatong, Kaewkart Kaewkart, Pinasu Pinasu, Inmonthian Inmonthian, Kohklang Kohklang, Wantanajittikul Wantanajittikul, Pornprasert Pornprasert, Shah Shah, Samleerat Carraway Samleerat Carraway, Khamduang Khamduang
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