地域医療と健康教育

抽象的な

Diabetes Prevention through Village Health Support Guides in Cambodia: A Qualitative Investigation of Opportunities and Challenges

Julie Wagner*, Lim Keuky, Lorraine Fraser-King, Theanvy Kuoch and Mary Scully

Objectives: Lifestyle modification can prevent type II diabetes. Rates of diabetes are high in Cambodia. The Cambodian genocide and its aftermath resulted in destruction of the healthcare system and a critical shortage in the Cambodian healthcare workforce. Cambodia has a well-established system of community health workers, or village health support guides (Guides). This study explored opportunities for and challenges to training Guides to deliver diabetes prevention interventions.

Design: In depth interviews were conducted with 12 Guides in Khmer. Guides also completed a 22-item validated Khmer language quiz regarding their knowledge of diabetes.

Results: Participants were 75% female, on average 52 years old, with 8 years of education and 9 years Guides experience. Guides were aware that diabetes is a problem for their communities and were eager to address it. However, they had very low diabetes knowledge (quiz mean=57% correct). Three themes emerged: dedication to being a Guide, current responsibilities and need for additional and high quality training, and striving to do a good job in the face of barriers and insufficient resources. Participants easily identified factors that would support their own training in diabetes, and factors that would promote their teaching diabetes prevention in their villages.

Conclusions: Diabetes prevention is overdue in Cambodia. Guides are poised to be trained to deliver these programs. Such training should be responsive to their perceived needs. Political will must be cultivated to support appropriate resources.