Impact of a training program for community health officers on neurological disorders: insights from the Karnataka brain health initiative | BMC Health Services Research

This study highlights the significant impact of a structured training program in enhancing the knowledge and skills of CHOs regarding the diagnosis and management of neurological disorders at the grassroots level. Post-training assessments demonstrated substantial improvements in knowledge, with statistically significant increases in scores across all four neurological disorders examined: headache, epilepsy, stroke, and dementia. These findings highlight the importance of targeted capacity-building initiatives in addressing the escalating burden of neurological disorders in India, particularly in underserved and rural areas where access to specialist care is limited.

In India, neurological disorders represent a significant and growing public health challenge, exacerbated by factors such as an aging population, increased prevalence of non-communicable diseases, and changing lifestyles have further intensified this burden. Despite the high prevalence, neurological disorders remain underdiagnosed and undertreated, particularly in rural and underserved areas, due to limited access to specialist care. This highlights the critical need for grassroots-level training programs to equip mid-level healthcare providers with the knowledge and skills to address these challenges effectively.

The structured training program evaluated in this study resulted in a mean knowledge improvement of 18.3 points, with statistically significant gains across all disorders (p < 0.001). These findings align with the outcomes of other training programs for healthcare providers, such as mental health training programs in low-resource settings, which reported similar improvements in knowledge and skills [22]. For instance, mental health training programs for community health workers in India have demonstrated significant improvements in participants’ ability to recognize and manage mental health conditions. A study conducted in Bangalore Rural District reported enhanced mental health literacy among community health workers following a four-day training intervention, with assessments conducted at baseline, post-training, and three months follow-up [23].

Similarly, the National Health Mission (NHM) of India has implemented training programs aimed at improving maternal and child health outcomes. These programs include a 10-day training in Basic Emergency Obstetric Care (BEmOC) for newly recruited medical officers, focusing on skill development to manage obstetric emergencies [24, 25]. Such structured initiatives have played a crucial role in strengthening healthcare providers’ competencies, contributing to improved maternal and child health outcomes.

Beyond mental and maternal health, training programs targeting non-communicable diseases (NCDs) have also shown promising results. In rural India, a five-day training program was developed and evaluated for Accredited Social Health Activists (ASHAs), focusing on NCD prevention and management. The program significantly improved ASHAs’ knowledge and skills in managing NCDs, enabling them to effectively contribute to community health improvement [26]. Similarly, in Ethiopia, the Ministry of Health, in collaboration with Last Mile Health, launched the country’s first integrated in-service training on NCDs for community health workers. This initiative aimed to enhance CHWs’ capacity to provide essential NCD services at the community level, thereby improving early detection and management of chronic conditions [27].

Training programs focused on infectious diseases have also demonstrated significant benefits. For instance, the Infectious Diseases Institute (IDI) at Makerere University in Uganda has played a crucial role in strengthening health systems by providing comprehensive training for healthcare workers. These programs have enhanced the capacity of health professionals to manage infectious diseases, including tuberculosis, effectively, contributing to improved patient outcomes and a stronger public health response [28, 29].

The success of these programs highlights the vital role of targeted training interventions across various healthcare domains. Our findings contribute to this body of evidence by demonstrating that structured training programs can significantly enhance the knowledge and skills of CHOs in managing neurological disorders, an area that remains largely underserved in community healthcare. While previous studies have assessed CHO training initiatives for communicable diseases, mental health, and maternal and child health, limited research has explored their role in neurological care. This study addresses that gap by providing evidence on the effectiveness and scalability of structured neurological training programs, making it one of the first to systematically evaluate their impact within primary healthcare settings.

Nearly all the participants expressed satisfaction with the training program with regards to time allotment, the preparedness, and knowledge of trainers, and the materials and content of the training program. The positive feedback from CHO in this study aligns with findings from other training programs, such as epilepsy training program, where interactive and practical components, including case vignettes and group discussions, were particularly appreciated [30]. This suggests that incorporating practical, scenario-based learning methods enhances knowledge retention and application.

The implications of this study extend beyond immediate knowledge gains. By equipping CHOs with the skills to identify, manage, and refer cases of neurological disorders, the program can contribute to earlier diagnoses, timely interventions, and improved patient outcomes in resource-limited settings. The integration of such training programs into existing public health initiatives, such as the Ayushman Bharat Mission and HWCs, can strengthen the healthcare system’s capacity to address the rising burden of neurological disorders. Overall, the findings from this study and the application of this knowledge in the community will lead to early diagnosis and better management of common neurological disorders, ultimately improving patient care and outcomes in the community.

Identifying persistent knowledge gaps and areas for improvement

While the training program resulted in an overall 18.3-point improvement in mean knowledge scores, a closer analysis of individual disorder domains reveals that certain knowledge areas remained challenging for CHOs despite the intervention. For example, the smallest improvement was observed in epilepsy-related questions, where post-training scores increased only by 2.8 points (Table 1). This suggests that while the training effectively introduced fundamental epilepsy concepts, CHOs may require more in-depth exposure to specific aspects, such as seizure classification and long-term management.

Similarly, while significant score increases were seen in stroke and dementia, feedback from CHOs indicated that identifying early warning signs of cognitive decline and differentiating stroke subtypes remained areas of uncertainty. These persistent gaps suggest that single-session, lecture-based training may not be sufficient for more complex topics.

Addressing suboptimal performance despite training

One explanation for these remaining knowledge gaps could be the short duration of training (two hours in total). CHOs with limited prior exposure to neurology may require reinforcement through additional case-based learning, follow-up sessions, or digital learning modules. Studies in other training domains, such as mental health and maternal care, have shown that multi-session reinforcement strategies lead to greater retention and application of knowledge in clinical settings.

Another challenge could be the clinical experience levels of CHOs. While participants with less than two years of experience showed substantial improvements, those with greater than five years of experience had more modest gains (mean improvement: 19.2 points vs. 17.1 points). This suggests that prior clinical biases or established habits may affect knowledge acquisition among more experienced providers. Tailoring training to account for experience levels—for instance, using advanced case discussions for senior CHOs and foundational skill-building for newer CHOs—could improve training impact across all participants.

Strengths and limitations

A major strength of this study is its large sample size and focus on a relatively unexplored area of CHO training on neurological disorders. The use of standardized assessments and feedback tools further enhances the reliability of the findings. However, the study has certain limitations. The absence of a control group limits the ability to attribute improvements solely to the training program. Additionally, the study did not evaluate long-term knowledge retention or the practical application of skills in real-world settings, which are critical for understanding the sustained impact of the training. Although our current analysis did not explicitly stratify learning outcomes by professional background, exploring this aspect in future studies could support the design of more targeted and effective capacity-building initiatives. These limitations are acknowledged, and as KaBHI is an ongoing initiative, future phases are designed to address these gaps. Planned improvements include the incorporation of control groups, assessments of long-term knowledge retention, and evaluations of the practical application of training in clinical settings, ensuring a comprehensive understanding of the program’s overall impact.

Future directions

Future research should focus on assessing the long-term effectiveness of training programs by evaluating knowledge retention and the application of learned skills in clinical practice. Studies examining patient outcomes following CHO-led interventions for neurological disorders could provide further insights into the real-world impact of such programs. Expanding the scope of training to include other neurological diseases and scaling up the program across different regions would further enhance its relevance and utility. Additionally, qualitative research exploring CHOs’ perspectives on training and identifying barriers to implementation could help inform the design of more effective training interventions.

To address persistent knowledge gaps, future programs should consider incorporating follow-up refresher courses or expanding session durations to reinforce complex topics such as epilepsy management and stroke recognition. Incorporating interactive elements, such as virtual patient case simulations, could further enhance knowledge retention and application in clinical settings. A blended learning approach, combining live training with digital self-learning modules, would allow CHOs to reinforce concepts at their own pace. Additionally, tailoring training intensity based on prior clinical experience can optimize learning outcomes, ensuring that junior CHOs receive structured foundational content while more experienced CHOs engage in advanced problem-solving exercises.

Future training initiatives should incorporate standardized referral pathways to enhance CHOs’ ability to ensure timely referral of care for patients with neurological disorders, improving the overall continuity of care.

Given the differences in training, skill sets, and experience of BAMS doctors and BSc/GNM/ANM nurses, separately assessing the learning outcomes for each group could provide additional insights into specific domains that require further training. This approach would enable more targeted interventions and maximize the effectiveness of training programs, ultimately improving patient care outcomes. Additionally, future studies should aim to identify the optimal frequency of training sessions through longitudinal research, ensuring that knowledge retention and practical application of skills are sustained over time.

Policy recommendations

The findings of this study emphasize the need for integrating structured training programs into national health policies. Policymakers should prioritize continuous professional development for CHOs and allocate resources for regular training and evaluation. Additionally, incorporating telemedicine and digital tools into CHO training can further enhance their capacity to manage complex conditions and improve access to specialist care in remote areas.