Feasibility assessment of telehealth for non-communicable diseases screening by village health volunteers in Doi Lo District, Chiang Mai Province, Thailand

Abstract

Non-communicable diseases (NCDs) represent a significant global health burden, especially in low- and middle-income countries, where they are the leading causes of illness and premature death. However, certain populations living in rural or suburban areas in Thailand often face limited access to centralized healthcare services due to economic and geographical constraints. Therefore, telemedicine or telehealth services offer a crucial alternative solution to improve healthcare access for these populations, particularly for the screening and monitoring of NCDs through telemedicine technology and remote consultations. In Addition, NCDs screening for is typically conducted by healthcare professionals or specialists at healthcare facilities, leading to patient congestion and overcrowding at these facilities. Therefore, decentralizing the screening and monitoring services for NCDs to Village Health Volunteers (VHVs), who reside in these remote areas, is likely to enhance healthcare access for these populations. This study thus aims to evaluate the feasibility of the Health D system, a telehealth service operated by VHVs, for the screening and monitoring of NCDs in Doi Lo District, Chiang Mai Province, Thailand. VHVs were trained to operate the Health D system, which includes portable diagnostic tools and the T-logic algorithm for risk categorization. A total of 120 healthy participants were enrolled and underwent three visits for the collection of socio-demographic data, vital signs, physical examination, and classification of NCD risk groups, including diabetes, cardiovascular diseases (CVD), and chronic obstructive pulmonary disease (COPD). Data were analyzed using descriptive statistics and categorized into risk groups. Teleconsultations were provided based on the risk stratification. The results showed that the Health D system is feasible for the screening and monitoring of NCDs in remote areas. The assessment of the VHVs competency to use the Health D system showed a significant improvement after training (p=0.0098). In the three visits (0, 2, 4 months), the prevalences of hypertension among participants were 32%, 29%, and 34%, respectively. The prevalences of overweight were 66%, 61%, and 60%, and the prevalences of abdominal obesity were 55%, 58%, and 56%, respectively. In the initial diabetes screening visit, the distributions of participants across normal to high-risk categories were 27%, 28%, 24%, and 21%, respectively. In the second visit, the proportion of participants in the normal group increased to 37%. However, the proportions in the normal and low-risk groups decreased in the third visit, while the proportions in other groups increased. For CVD screening, most participants were in the normal group, with 97%, 96%, and 94% in the three visits, respectively. Similarly, for COPD screening, 91%, 94%, and 92% were in the normal group. Additionally, a very weak negative correlation was found between the COPD Assessment Test (CAT) score and the distance covered in the 6-minute walk test (6MWT) for COPD screening (r=-0.1111, p=0.037). When analyzing the combined risk of all three diseases, the proportions of participants in the normal, low-, moderate-, and high-risk groups in the first visit were 21%, 31%, 27%, and 21%, respectively. In the second visit, the proportion in the normal group increased to 35%. In the last visit, the proportions of participants in the normal and low-risk groups were 20%, while the proportions in the moderate- and high-risk groups increased to 36% and 24%, respectively. Moreover, a survey of the VHVs and participants' satisfaction with the Health D system showed that all VHVs were satisfied with the training, and 92% were satisfied with using the Health D system. Additionally, at least 97% of participants expressed satisfaction with all aspects of the Health D system. In conclusion, the Health D system can be effectively operated by VHVs for screening and monitoring, which helps to raise awareness and promote the prevention of NCDs. Furthermore, it can be adapted for other screenings as needed to reduce disparities in healthcare access.