3.Panel4 Evvie Rotua
THE ROLE OF COMMUNITY
BASED PROGRAM
AGAINTS NONCOMMUNICABLE
DISEASES
A SYSTEMATIC REVIEW
Evvi Rotua,
Faculty of Public Health
University of Indonesia
BACKGROUND
• NON-COMMUNICABLE (NCDs) ALSO KNOWN AS THE
“SILENT KILLER” IS A MAJOR HEALTH BURDEN FOR
ALMOST ALL COUNTRIES IN THE WORLD.
• WORLD HEALTH ORGANIZATION (WHO) STATE THAT
EACH YEAR 38 MILLION PEOPLE DIED BECAUSE OF
NCDs.
• 16 MILLION DIED AT THE AGE LESS THAN 70 YEARS
OLD AND 82% OF THIS “PREMATURES” DEATH
OCCURED IN LOW AND MIDDLE INCOME COUNTRIES.
BACKGROUND
• THE MAIN RISK FACTORS OF NCDs ARE TOBACCO
USE, PHYSICAL INACTIVITY, THE HARMFUL USE OF
ALCOHOL AND UNHEALTHY DIETS.
• THE BIGGEST NCDs THAT CAUSED OF DEATH ARE
HEART DISEASES, CANCER, DIABETES AND LUNG
DISEASES.
PURPOSE
• TO SYSTEMATICLLY REVIEW EVIDENCE ON THE
EFFECTIVENESS OF INTERVENTION ON COMMUNITY
BASED PROGRAM TO REDUCE THE NUMBER OF
NCDs AND WHAT FACTORS THAT INFLUENCE THE
SUCCESS.
METHODES
• THE METHODES OF THID SYSTEMATIC REVIEWS ARE REPORTED
IN ACCORDANCE WITH THE PREFERRED REPORTING ITEMS FOR
SYSTEMATIC REVIEWS AND META-ANALYSIS PROTOCOLS
(PRISMA-P) 2009 GUIDLINES.
• THIS SYSTEMATIC REVIEW CONDUCTED SEARCH OF ELCTRONIC
MEDICAL DATABASE SUCH AS PROQUEST, PubMed AND EBSCO
USING ENDNOTES APPLICATION AND UNIVERSITY OF INDONESIA
REMOTE LIBRARY FACILITY.
MOTHEDS
INCLUSION
• PUBLISHED STUDIES IN
COMMUNITY BASED
PROGRAM IN ADDITIONS
MANAGING NCDs
• 2010 - 2016
• INTERVENTION STUDIES
• FULL TEXT
CRITERIA
EXCLUSION
• PAPERS WRITTEN NOT
IN ENGLISH
• INDUSTRY REPORT
• MARKET RESEARCH
• GREY LITERATURES
• DATABASE
METHODES
• CITATION FROM THE SEARCH RESULT WERE
IMPORTED FROM DATABASE INTO ENDNOTE FOR
SCREENING THE ELIGIBILITY BASED ON THE
CRITERIA.
• DUPLICATED RESEARCH WERE REMOVED AND THE
REMAINING CITATION ASSESSED BY TITTLE AND
ABSTRACT.
• THE DATA SCREENING AND EXTRACTION WERE
CONDUCTED INDEPENDENTLY.
THE PROCESS OF STUDY SELECTION
27.975 data based
searching
14.348 articles were
assesed for eligibility
7.273 articles
36 articles
7 articles
13.627 articles excluded
by published date from
2010 - 2016
7.075 articles excluded
by peer reviewed
7.237 were excluded by
document type,
abstract/tittle, subject,
language, database, ect
28 articles excluded
independently
RESULT
Table 1. Studies included in the review
No Author
1
Albert Lee, et all
2
Farshad Farzadfar,
et all
Design
Study
RCT
Intervention
Result
Limitation
Ten sessions of 75
minutes after school
and one session of
3-hour weekend of
practical interactive
anf fun activities on
healthy eating and
exercise, and meal
plan together with
parents and printed
tailor-made
management
advices.
Improvement on
dietary habits and
attitudes toward
exercise among
the intervention
group.
Unable to determine the
environment component,
and the sample size might
not have adequat power to
detect difference behaviour
from both control grup and
intervention group. The
studies not comparing
student group receiving
education.
An
Observational
Study
Questioner and
physical and
laboratory
measurment and
CHW were given
trained.
The density of
The use of data from only
health care
one health examination
workers associated survei
with improved
management in
NCDs prevention
and management.
No Author
3
Lungiswa P.
Tsolekile, et all
Design
Intervention
Study
A
qualitative Observation and
study
unstructure
interviews.
4
RCT
Naila Edries, et all
Health promotion,
exercisse,
phamphlets
Result
CHW has a role
in managing
NCDs, despite so
many things
that must be
prepared so the
CHW can work
properlly.
There is No.
significant
difference
between the two
group. But there is
imoprovement on
the experimental
group after
intervention.
Contrary there is
no significant
improvement in
the control group.
Limitation
Methodology utilised.
Study object had alter
behaviour when
observed by an
outsider.
Failed to record medical
history of the participants.
The subject of studies is
the group that has been
aware of their health.
No Author
5
Thomas A
Gaziano, et all
Design
Study
An
observation
al study
6
A quantitative Training, interviews
and
and focus group
qualitative
discussion.
study
Thsipfuralo Ndou,
et all
Intervention
Training, pre-test
and post test,
and
measurement of
weight, BMI, SBP
and DBP by CHW
and health
professionals.
Result
CHW who have
recieved
training can be
effective in
detecting CVD
and define who
at risk with the
help of health
professionals.
Improvement in
controlling
hypertension in
the group that
visited by CHW
Limitation
Low level of numeracy
and literacy. Potensial
generaisability of
intervention.
Few doctor visit,
insufficient monitoring of
patients outcomes by clinic
staff and a poor
procurement process for
supplies required by the
CHWs hampered the
programs activities.
No Author
7
Fatwa Sari
Tetra Dewi, et
all
Design
Study
A quasi-
Intervention
Pre-test and post
experimenta test, meeting,
l srudy
exercise,
interviews
Result
Limitation
Knowledge
increas
significant from
56%-70% in the
intervention
group.
Improvement of
CVD awareness.
Single blind methode
phsicologically effect
on researchers so the
intervention group had
better result. Quasiexperimental design
cause un equal
distribution both in the
intervention group and
control group.
DISCUSSION
• FROM ALL OF THIS STUDIES, 5 STUDIES USING
COMMUNITY HEALTH WORKER AS A MEANS OF
CONDUCTING REASEARCH, ONE CONDUCTED
DIRECTLY ON COMMUNITIES AND ONE ON PRIMARY
SCHOOL.
• STUDIES USING INTERVENTION SUCH AS TRAINING,
PHAMPLETS DISTRIBUTION, EXERCISE AND
LIFESTYLE INTERVENTION.
DISCUSSION
• BASED ON AN OBSERVATIONAL STUDY, INTERVIEWS AND
FOCUS GROUP DISCUSSION SHOW AN ENCREASING
KNOWLEDGE ABOUT NCDs.
• LONG OF INTERVENTION DOES NOT EFFECT THE FINAL
RESULT OF THE STUDY.
• THE PROVISSION OF TRAINING CONTRIBUTE IN THE
SUCCSESS OF A COMMUNITY BASED PROGRAM.
DISCUSSION
• INTERVENTION IN DISEASE MANAGEMENT
PROTOCOL AND/OR MONITORING SHOWED A
STRONG EVIDENCE OF EFECTIVENESS.
• NEED A REGULAR REPLENISHMENT OF SUPPLIES,
MEDICINE AND EQUIPMENT.
CONCLUSSION
•THE PRESENCE OF COMMUNITY BASED PROGRAM CAN HELP
PEOPLE ESPECIALLY ELDER ONE TO GET TRAETMENT,
MEASUREMENT AND MEDICINE WITHOUT LEAVING THE
HOUSE.
•HUMAN RESOURCE NEED TO BE PREPARED WELL, BY
PROVIDING TRAINING RELEVANT INFORMATION REGARDING
RISK FACTORS, MEASUREMENT AND RECORDING THE RESULT
OF EXAMINATION, AND REPORTING THE RECORD IN ORDER
TO CONTROL AND EVALUATED THE PATIENT.
CONCLUSSION
• COMMUNITY BASED PROGRAM CAN BE SUCCSESS
BY MAKING A GOOD POLICY TO SUPPORT THE
PROGRAM.
• NEED A GOOD COMMITMENT BETWEEN POLICY
MAKERS AND ALL RELEVANT PARTIES IN A
COMMUNITY BASED PROGRAM TO RUN THE
PROGRAM PROPERLY.
LIMITATION
• MOST OF THE RESEARCH STUDY IS USING
QUALITATIVE DESIGN STUDIES TO SEE THE
EFFECTIVENESS OF THE INTERVENTION.
• THERE WERE NEED MORE ACCURATE STUDIES
WITH ANOTHER DESIGN STUDY, SO WE CAN SEE
FROM ANOTHER ASPECT OF STUDIES.
BASED PROGRAM
AGAINTS NONCOMMUNICABLE
DISEASES
A SYSTEMATIC REVIEW
Evvi Rotua,
Faculty of Public Health
University of Indonesia
BACKGROUND
• NON-COMMUNICABLE (NCDs) ALSO KNOWN AS THE
“SILENT KILLER” IS A MAJOR HEALTH BURDEN FOR
ALMOST ALL COUNTRIES IN THE WORLD.
• WORLD HEALTH ORGANIZATION (WHO) STATE THAT
EACH YEAR 38 MILLION PEOPLE DIED BECAUSE OF
NCDs.
• 16 MILLION DIED AT THE AGE LESS THAN 70 YEARS
OLD AND 82% OF THIS “PREMATURES” DEATH
OCCURED IN LOW AND MIDDLE INCOME COUNTRIES.
BACKGROUND
• THE MAIN RISK FACTORS OF NCDs ARE TOBACCO
USE, PHYSICAL INACTIVITY, THE HARMFUL USE OF
ALCOHOL AND UNHEALTHY DIETS.
• THE BIGGEST NCDs THAT CAUSED OF DEATH ARE
HEART DISEASES, CANCER, DIABETES AND LUNG
DISEASES.
PURPOSE
• TO SYSTEMATICLLY REVIEW EVIDENCE ON THE
EFFECTIVENESS OF INTERVENTION ON COMMUNITY
BASED PROGRAM TO REDUCE THE NUMBER OF
NCDs AND WHAT FACTORS THAT INFLUENCE THE
SUCCESS.
METHODES
• THE METHODES OF THID SYSTEMATIC REVIEWS ARE REPORTED
IN ACCORDANCE WITH THE PREFERRED REPORTING ITEMS FOR
SYSTEMATIC REVIEWS AND META-ANALYSIS PROTOCOLS
(PRISMA-P) 2009 GUIDLINES.
• THIS SYSTEMATIC REVIEW CONDUCTED SEARCH OF ELCTRONIC
MEDICAL DATABASE SUCH AS PROQUEST, PubMed AND EBSCO
USING ENDNOTES APPLICATION AND UNIVERSITY OF INDONESIA
REMOTE LIBRARY FACILITY.
MOTHEDS
INCLUSION
• PUBLISHED STUDIES IN
COMMUNITY BASED
PROGRAM IN ADDITIONS
MANAGING NCDs
• 2010 - 2016
• INTERVENTION STUDIES
• FULL TEXT
CRITERIA
EXCLUSION
• PAPERS WRITTEN NOT
IN ENGLISH
• INDUSTRY REPORT
• MARKET RESEARCH
• GREY LITERATURES
• DATABASE
METHODES
• CITATION FROM THE SEARCH RESULT WERE
IMPORTED FROM DATABASE INTO ENDNOTE FOR
SCREENING THE ELIGIBILITY BASED ON THE
CRITERIA.
• DUPLICATED RESEARCH WERE REMOVED AND THE
REMAINING CITATION ASSESSED BY TITTLE AND
ABSTRACT.
• THE DATA SCREENING AND EXTRACTION WERE
CONDUCTED INDEPENDENTLY.
THE PROCESS OF STUDY SELECTION
27.975 data based
searching
14.348 articles were
assesed for eligibility
7.273 articles
36 articles
7 articles
13.627 articles excluded
by published date from
2010 - 2016
7.075 articles excluded
by peer reviewed
7.237 were excluded by
document type,
abstract/tittle, subject,
language, database, ect
28 articles excluded
independently
RESULT
Table 1. Studies included in the review
No Author
1
Albert Lee, et all
2
Farshad Farzadfar,
et all
Design
Study
RCT
Intervention
Result
Limitation
Ten sessions of 75
minutes after school
and one session of
3-hour weekend of
practical interactive
anf fun activities on
healthy eating and
exercise, and meal
plan together with
parents and printed
tailor-made
management
advices.
Improvement on
dietary habits and
attitudes toward
exercise among
the intervention
group.
Unable to determine the
environment component,
and the sample size might
not have adequat power to
detect difference behaviour
from both control grup and
intervention group. The
studies not comparing
student group receiving
education.
An
Observational
Study
Questioner and
physical and
laboratory
measurment and
CHW were given
trained.
The density of
The use of data from only
health care
one health examination
workers associated survei
with improved
management in
NCDs prevention
and management.
No Author
3
Lungiswa P.
Tsolekile, et all
Design
Intervention
Study
A
qualitative Observation and
study
unstructure
interviews.
4
RCT
Naila Edries, et all
Health promotion,
exercisse,
phamphlets
Result
CHW has a role
in managing
NCDs, despite so
many things
that must be
prepared so the
CHW can work
properlly.
There is No.
significant
difference
between the two
group. But there is
imoprovement on
the experimental
group after
intervention.
Contrary there is
no significant
improvement in
the control group.
Limitation
Methodology utilised.
Study object had alter
behaviour when
observed by an
outsider.
Failed to record medical
history of the participants.
The subject of studies is
the group that has been
aware of their health.
No Author
5
Thomas A
Gaziano, et all
Design
Study
An
observation
al study
6
A quantitative Training, interviews
and
and focus group
qualitative
discussion.
study
Thsipfuralo Ndou,
et all
Intervention
Training, pre-test
and post test,
and
measurement of
weight, BMI, SBP
and DBP by CHW
and health
professionals.
Result
CHW who have
recieved
training can be
effective in
detecting CVD
and define who
at risk with the
help of health
professionals.
Improvement in
controlling
hypertension in
the group that
visited by CHW
Limitation
Low level of numeracy
and literacy. Potensial
generaisability of
intervention.
Few doctor visit,
insufficient monitoring of
patients outcomes by clinic
staff and a poor
procurement process for
supplies required by the
CHWs hampered the
programs activities.
No Author
7
Fatwa Sari
Tetra Dewi, et
all
Design
Study
A quasi-
Intervention
Pre-test and post
experimenta test, meeting,
l srudy
exercise,
interviews
Result
Limitation
Knowledge
increas
significant from
56%-70% in the
intervention
group.
Improvement of
CVD awareness.
Single blind methode
phsicologically effect
on researchers so the
intervention group had
better result. Quasiexperimental design
cause un equal
distribution both in the
intervention group and
control group.
DISCUSSION
• FROM ALL OF THIS STUDIES, 5 STUDIES USING
COMMUNITY HEALTH WORKER AS A MEANS OF
CONDUCTING REASEARCH, ONE CONDUCTED
DIRECTLY ON COMMUNITIES AND ONE ON PRIMARY
SCHOOL.
• STUDIES USING INTERVENTION SUCH AS TRAINING,
PHAMPLETS DISTRIBUTION, EXERCISE AND
LIFESTYLE INTERVENTION.
DISCUSSION
• BASED ON AN OBSERVATIONAL STUDY, INTERVIEWS AND
FOCUS GROUP DISCUSSION SHOW AN ENCREASING
KNOWLEDGE ABOUT NCDs.
• LONG OF INTERVENTION DOES NOT EFFECT THE FINAL
RESULT OF THE STUDY.
• THE PROVISSION OF TRAINING CONTRIBUTE IN THE
SUCCSESS OF A COMMUNITY BASED PROGRAM.
DISCUSSION
• INTERVENTION IN DISEASE MANAGEMENT
PROTOCOL AND/OR MONITORING SHOWED A
STRONG EVIDENCE OF EFECTIVENESS.
• NEED A REGULAR REPLENISHMENT OF SUPPLIES,
MEDICINE AND EQUIPMENT.
CONCLUSSION
•THE PRESENCE OF COMMUNITY BASED PROGRAM CAN HELP
PEOPLE ESPECIALLY ELDER ONE TO GET TRAETMENT,
MEASUREMENT AND MEDICINE WITHOUT LEAVING THE
HOUSE.
•HUMAN RESOURCE NEED TO BE PREPARED WELL, BY
PROVIDING TRAINING RELEVANT INFORMATION REGARDING
RISK FACTORS, MEASUREMENT AND RECORDING THE RESULT
OF EXAMINATION, AND REPORTING THE RECORD IN ORDER
TO CONTROL AND EVALUATED THE PATIENT.
CONCLUSSION
• COMMUNITY BASED PROGRAM CAN BE SUCCSESS
BY MAKING A GOOD POLICY TO SUPPORT THE
PROGRAM.
• NEED A GOOD COMMITMENT BETWEEN POLICY
MAKERS AND ALL RELEVANT PARTIES IN A
COMMUNITY BASED PROGRAM TO RUN THE
PROGRAM PROPERLY.
LIMITATION
• MOST OF THE RESEARCH STUDY IS USING
QUALITATIVE DESIGN STUDIES TO SEE THE
EFFECTIVENESS OF THE INTERVENTION.
• THERE WERE NEED MORE ACCURATE STUDIES
WITH ANOTHER DESIGN STUDY, SO WE CAN SEE
FROM ANOTHER ASPECT OF STUDIES.