Enhancing Chronic Respiratory disease care through upskilling health care providers of the government health system in a rural district in India: a pre-post educational intervention trial.

Chronic respiratory diseases (CRDs) are a global health problem with low- and middle-income countries contributing about 90% of global DALYs and deaths - and India alone contributing approximately one-third of cases, suggesting a high CRD burden and unmet health need. CRDs in low resource settings are neglected, and often poorly diagnosed, leading to missed opportunities for early initiation of treatment, and poor patient pathways. While CRDs are not curable, they can be treated effectively using evidence-based protocols for diagnosis and treatment to control symptoms and improve quality of life. The government health system, with its three-tier healthcare and state/country wide network is in a unique position to provide a solution to this problem, provided orientation and training are made available to health care providers and evidence-based guidelines are followed. The aim of this research project is capacity building, targeting government primary health centres in Tirupathur district (Madhanur  and Alangayam blocks) through alignment to evidence based CRD management achieved by education, training and skill development to change CRD health care through improvement of knowledge, attitudes and practice. The study will be conducted using a one-group pre-test/post-test, quasi-experimental study design. A needs assessment will be conducted using a tool developed by the investigators (WHO Harmonised Health Facility Assessment, interviews, and review of reports and registers) to assess the gaps in facility and resources and the KAP of the providers; further, there will be exit interviews among patients. Tailored training sessions for doctors, community health workers and therapists on management of CRDs will be provided to orient them to evidence-based diagnosis and management of CRDs including health education, follow-up and referral.  Weekly review meetings will be held as a part of monitoring and evaluation to assess the progress of patient education, screening, clinical review and follow-up. The outputs that will be measured are numbers of training sessions, awareness programmes, screenings done, protocol-based clinical reviews done, spirometry investigations, chest x-rays done and patients diagnosed and treated. Improvement in CRD care in the government health system will be identified using the WHO Harmonized Health Facility Assessment combined core questionnaire tool for CRD. Perceived experience of CRD care by patients will be assessed with the adapted British Lung Foundation COPD Patient Passport responses. Improvement in KAP related to CRD care among providers will be assessed by pre- and post- KAP surveys. Increased compliance to treatment will be assessed using TAI by providers at 3, 6, 9 and 12 months; improvement in KAP of providers will also be assessed at the end of the intervention period. This educational intervention will help in improving the quality of CRD care at primary healthcare level in Government health system using existing manpower through capacity building and skills training.