Integrating places of worship (PoWs) into the primary care pathway to prevent and control non-communicable diseases (NCDs) in the Caribbean

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The Caribbean has the highest proportion of people suffering from chronic diseases such as diabetes, cancers, stroke and heart disease in the Americas. As in other parts of the world, this is a consequence of ageing populations, urbanisation, lifestyle changes resulting from globalisation such as unhealthy diets, lack of exercise, use of alcohol and cigarettes, and other social influences. The effects of these factors on health are worse in poor communities. Health systems in poorer countries in the Caribbean face challenges in preventing chronic diseases and meeting the needs of those affected. Our approach considers how to enhance health services taking into account the wider social and cultural context in which people live. It will use the strengths and assets of communities to promote health and reach the poorest in a cost effective and sustainable way.Religion plays an important role in the Caribbean with almost everyone attending a place of worship such as a church, mandir or mosque, at least once a month. Many studies have shown that places of worship can be used successfully to promote healthy lifestyles. However these programmes are often discontinued after the research is completed. In collaboration with national and international agencies including Ministries of Health, Inter-Religious Organizations, the Healthy Caribbean Coalition, the Caribbean Public Health Agency, and the Pan American Health Organization, we will plan and implement an intervention which uses health advocates recruited from places of worship to promote health and lifestyle changes and support the management of chronic diseases. The health advocates will be linked into local primary health care centres and supervised by nurses to ensure that when needed, early referrals are made and patients are followed up in the community. By evaluating the intervention as it is implemented in real time, we will examine whether and how this approach will improve the prevention and early detection of chronic diseases as well as support the care and treatment of those already affected. The study will take place in three of the less wealthy Caribbean Commonwealth countries which face challenges in providing quality health care: Guyana, Jamaica and Dominica. Each of these have different social and cultural features so we will be able to compare the results and develop solutions that have relevance to the entire region. We will focus on poor rural and urban areas where the need is greatest. We will work with the Ministries of Health, nurses and doctors in regional and local health care centres and hospitals, religious leaders and congregations. The Ministry of Health will train members of the congregations to be health advocates. They will be taught to conduct simple tests such as measuring blood pressure and weight, encourage people to take medications as prescribed and attend clinic appointments, inform people about welfare benefits and help with applications, and support a healthier, more active lifestyle, such as providing exercise or healthy cooking sessions. Health advocates will be supervised and monitored by nurses at local health centres who will be trained in this new role. We will conduct continual evaluation to look at if and how the intervention is working to address the needs of the community, especially the most vulnerable. If the research is successful, we will develop a tool kit for the Caribbean providing guidelines on how health systems and communities can work together to combat chronic diseases through the engagement of places of worship and other community-based organisations. Changing the health system in this way will reach more people than through traditional health care by providing easily accessible and regular health advice and support in the heart of local communities. It will result in significant social and economic benefits by reducing health care costs for chronic diseases and preventing disability and premature death.