Challenges to Implementation of a CHW-led COPD Screening and Referral in rural Uganda

Chronic obstructive pulmonary disease (COPD) ranks as the third leading cause of global mortality. In rural areas of low- and middle-income countries (LMICs), COPD screening and diagnostic services remain often inaccessible. This study seeks to comprehend the implementation challenges of a Community Health Worker (CHW)-led program for COPD in Nakaseke, rural Uganda. During September and October 2022, this qualitative study explored the perceptions of Community Members, CHWs, and Healthcare Providers (HCPs) on challenges associated with CHW-delivered COPD screening and referral. In-depth interviews were conducted with eight CHWs and ten HCPs, along with six focus group discussions including 34 Community Members. Research assistants recorded and transcripted interviews verbatim. The thematic analysis was guided by the conceptual framework for implementation outcomes research. The acceptability of the implementation was hindered a lack of awareness about COPD, skepticism regarding the usefulness of COPD screening, and the presence of stigma surrounding the diagnostic process. Additionally, limited adoption was attributed to difficulties in accessibility and the willingness of Community Members to participate in the COPD referral process. The high patient volume, coupled with the complexity and time-consuming nature of the diagnostic and referral procedures, posed significant barriers to successful implementation. To ensure program sustainability, participants recommended increased support for CHWs, the decentralization of COPD care, and the expansion of follow-up services provided by CHWs. CHW-led interventions have great potential to deliver health care services that overcome barriers to treatment and self-management, particularly in settings with limited access to healthcare. However, prior to implementation, baseline assessments are needed to identify potential implementation obstacles and strategies that consider evidence-based approaches tailored to local contexts. KEY MESSAGES: • CHW-led interventions are a useful tool to alleviate barriers to COPD treatment and self-management in rural areas of LMICs where access to care is limited. • Formative assessments of the potential challenges prior to an intervention are required to address and minimize barriers to implementation and sustainability.