Designing and evaluating training for female community health volunteers to promote physical activity in semi-urban Nepal: a co-designed approach

Physical inactivity is a growing concern in Nepal, contributing to the emerging burden of non-communicable diseases (NCDs). Community-based interventions led by Female Community Health Volunteers (FCHVs) hold the potential to promote physical activity (PA) effectively. This study reports on the development of educational materials, training procedures, and the outcome of the training on FCHVs’ knowledge and awareness about PA and its relationship with NCDs, as well as their feedback on training and intervention implementation. This study is part of a community-based trial promoting PA. This paper reports on the development process, training, and evaluation of the intervention. A co-design approach was employed for active participation of end-users in developing educational materials and training programs for FCHVs in Pokhara, Nepal. Fourteen FCHVs participated in a three-day, five-hour interactive training program, which offered workshops, role-play, followed by supervised practice sessions, using a co-designed pictorial flip chart, brochure, manual, and session register. Pre-and post-training tests measured changes in PA-related knowledge, and qualitative data from interviews and focus group discussions captured feedback on training and implementation. We developed pictorial flip charts as the main educational material, followed by a brochure and program implementation guideline for FCHVs. The training significantly improved FCHVs’ knowledge of PA, its health benefits, and their confidence to do home visits. Knowledge of PA benefits rose from 14.3% (95% CI 1.85% − 42.8%) to 64.3% (95% CI 35.1% − 87.2%) (p = 0.039). Knowledge of health effects associated with physical inactivity increased from 21.4% (95% CI 4.7% − 50.8%) to 85.7% (95% CI 57.2% − 98.2%) (p = 0.004). In terms of program implementation, FCHVs reported that pictorial flip charts were an effective tool for educating community people. However, meeting people and their expectations for medical services was a challenge. The study demonstrates that well-structured training and locally relevant educational materials can be co-designed, engaging end-users to enhance the capacity of FCHVs to promote PA in the community. These findings may guide future community-based PA promotion initiatives in similar low- and middle-income settings.