A knowledge, attitude and practice-based integrative literature review of community health worker training on stroke and cardiovascular diseases in low-and middle-income countries

Cardiovascular disease (CVD) and stroke remain the leading causes of preventable morbidity and mortality, especially in low-and middle-income countries (LMICs). Community Health Workers (CHWs) are well-positioned to support prevention but are often inadequately trained for CVD and stroke-specific challenges. This review aimed to examine the design, content and delivery of CHW training programmes for CVD and stroke prevention using the Knowledge, Attitude and Practice (KAP) framework to identify gaps and advise future curriculum development. An Integrative Literature Review was conducted. First-level analysis used deductive coding guided by the KAP framework to organise the data on training approaches, barriers, facilitators, etc. Second-level analysis applied the Framework Analysis method by Ritchie and Spencer to identify deeper themes across the studies. Twenty-two articles were included in the final analysis representing diverse settings across Africa (n = 11), Asia (n = 6), Latin America [1] and LMICs (n = 4) from different continents. First-level analysis revealed common themes among the studies, highlighting areas such as CHW understanding of CVD/stroke risk factors, screening activities, community education duties, and challenges like lack of supervision and ambiguity in roles. Notably missing were training on attitudes and stroke-specific materials. The second-level analysis was structured according to the five curriculum pillars and their cross-cutting themes, which revealed critical training gaps in areas such as culturally appropriate communication, initiating behaviour change, data literacy, system navigation, and support structures. While CHW confidence and motivation improved post-training, these outcomes were not explicitly addressed in the curriculum. Community health worker training programmes for non-communicable diseases often lack the specificity and depth required for effective stroke and CVD prevention. This review identified critical gaps across five curriculum pillars namely: Communication and Education, Community Engagement, Health System Navigation, Clinical Competencies and Support and Accountability. A unique finding in this review was the limited evidence focused on training CHWs’ attitudes – an essential component of their role, and particularly with regard to stroke and CVD prevention. While positive shifts in CHW confidence and motivation are observed post-training, these are rarely intentional learning outcomes. Future curricula must explicitly integrate these domains to better equip CHWs for context-specific, culturally aligned, and sustainable CVD and stroke prevention in LMICs.