CHW PROTECT: using the ADDIE instructional model to develop and evaluate a stroke prevention training programme for community health workers in low-middle-income countries

Stroke is a leading cause of death and morbidity globally, with increasing prevalence in low- and middle-income countries, which includes South Africa (SA). Community Health Workers (CHWs) play a pivotal role in Primary Health Care (PHC) and are well-positioned to contribute effectively to cardiovascular disease (CVD) and stroke prevention. However, gaps in CHW support, training and resources limit their effectiveness in this role. A multi-phased, descriptive developmental design was followed to develop and evaluate the stroke prevention programme for CHWs. The study comprised of four phases; however, this article only focusses on Phase 3 and 4. A brief overview of all phases is provided for context. Phase 1 included an integrative literature review to synthesise CHWs’ knowledge, attitudes, practices and training strategies for CVD and stroke prevention. Phase 2 (participatory engagement) utilised qualitative data collection methods, including World Café sessions with CHWs and focus group discussions with healthcare professionals, to explore training needs and perceptions of current and needed knowledge about stroke prevention. Phase 3 integrated the findings of the preceding phases to design the stroke prevention programme using the Analysis, Design, Develop, Implement and Evaluate (ADDIE) instructional design framework, underpinned by Menon’s Psychological Health Empowerment Model. Phase 4 included expert evaluation of the draft stroke prevention programme using Chin and Kramer’s critical reflection model, after which it was refined accordingly. The C ommunity H ealth W orker: P revention and R eduction O f stroke T hrough health E ducation, C are and T raining (CHW PROTECT) programme was developed and provides a structured, contextually relevant and evidence-based curriculum which responds to the knowledge, attitudes and practice gaps in CVD and stroke prevention. The programme content consisted of three study units, namely: Navigating the public healthcare system (Study Unit 1), Empowering CHWs for comprehensive stroke prevention (Study Unit 2) and Community dialogue and cultural relevance in stroke prevention (Study Unit 3). Expert reviews confirmed the programme’s clarity, practicality, importance and applicability, with recommendations incorporated to refine the CHW PROTECT programme. The newly developed CHW PROTECT stroke prevention programme offers a theoretically grounded and empirically informed approach to training CHWs. Although the programme has not yet been implemented, it provides a valuable guide for CHW training in similar contexts, potentially improving community health outcomes and supporting CVD and stroke prevention efforts.