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

加勒比地区患有糖尿病、癌症、中风和心脏病等慢性病的人口比例在美洲最高。与世界其他地区一样，这是人口老龄化、城市化、全球化导致的生活方式变化（如不健康的饮食、缺乏锻炼、饮酒和吸烟）以及其他社会影响的结果。这些因素对健康的影响在贫困社区更为严重。加勒比较贫穷国家的卫生系统在预防慢性病和满足受影响者的需要方面面临挑战。我们的方法考虑到人们生活的更广泛的社会和文化背景，考虑如何加强卫生服务。它将利用社区的优势和资产，以具有成本效益和可持续的方式促进健康，并惠及最贫穷的人。宗教在加勒比地区发挥着重要作用，几乎每个人都参加礼拜场所，如教堂，mandir或清真寺，每月至少一次。许多研究表明，礼拜场所可以成功地用来促进健康的生活方式。然而，这些方案往往在研究完成后就停止了。我们将与国家和国际机构，包括卫生部、宗教间组织、健康加勒比联盟、加勒比公共卫生机构和泛美卫生组织合作，规划和实施一项干预措施，利用从礼拜场所招募的健康倡导者促进健康和生活方式的改变，并支持慢性病的管理。健康倡导者将与当地初级保健中心建立联系，并由护士监督，以确保在需要时及早转诊，并在社区对病人进行跟踪。通过评估干预措施在真实的时间内的实施情况，我们将研究这种方法是否以及如何改善慢性病的预防和早期发现，并支持对已受影响者的护理和治疗。这项研究将在三个较不富裕的加勒比英联邦国家进行，这些国家在提供优质保健方面面临挑战：圭亚那、牙买加和多米尼克。每一个都有不同的社会和文化特征，因此我们将能够比较结果，并制定与整个地区相关的解决方案。我们将把重点放在需求最大的贫困农村和城市地区。我们将与卫生部、区域和地方保健中心和医院的护士和医生、宗教领袖和教会合作。卫生部将培训教会成员成为健康倡导者。他们将被教导进行简单的测试，如测量血压和体重，鼓励人们服用处方药并参加诊所预约，告知人们福利福利并帮助申请，并支持更健康，更积极的生活方式，如提供锻炼或健康烹饪课程。健康倡导者将由当地保健中心的护士监督和监测，护士将接受这一新角色的培训。我们将不断进行评估，以了解干预措施是否以及如何满足社区，特别是最弱势群体的需求。如果研究成功，我们将为加勒比地区开发一个工具包，为卫生系统和社区如何通过礼拜场所和其他社区组织的参与共同努力防治慢性病提供指导方针。以这种方式改变卫生系统将比通过传统的卫生保健覆盖更多的人，在当地社区的中心提供方便和定期的卫生咨询和支持。它将通过减少慢性病的保健费用和预防残疾和过早死亡产生重大的社会和经济效益。

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.