Prospective feasibility study of a telehealth platform for community-based NCD risk assessment by community health leaders in rural northern Thailand
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Introduction 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, 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. Methods 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 usedto 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. Results 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 (= 0.010). Acceptability was high among CHLs (92%) and participants (97%). Theworkflow, including in-person assessment, point-of-care testing, digital data
Abstract
Introduction 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, 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. Methods 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 usedto 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. Results 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 (= 0.010). Acceptability was high among CHLs (92%) and participants (97%). Theworkflow, 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. Conclusion This prospective study suggests thatis 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.