The Community Health Aide Program in rural Alaska: Responding to change

The Community Health Aide Program was established in 1968 to provide health care for Alaska's rural communities. The program trains residents of underserved areas to provide emergency, acute, and preventive health care for their communities. The resident health care provider, called Community Health Aides or Practitioners, receive ten weeks of training in three sessions. They are supervised by physicians at distant clinics and hospitals by telephone or radio. Curriculum for the federally-sponsored program is periodically reviewed to maintain current with existing medical care and to improve instructional quality. Between 1990 and 1992, a second revision of the curriculum for basic training in the Alaskan Community Health Aide Program was completed. To support the revision process with empirical data, a needs survey was conducted to determine changing medical needs of Alaskan rural communities and to examine commonalities in the needs of different training centers. Among the issues identified by the survey was the perception by survey participants that there is a difference between the abilities of health aides and other health professionals to perform the female pelvic examination.;A non-experimental correlational study was designed to test the perception. The study compared abilities of health aides and other health care providers to perform the female pelvic examination as measured by the ability to obtain an adequate specimen for Pap (Papanicolaou-stained) smear. An examination of Pap smear results showed that, for all samples, a significantly higher proportion of smears obtained by health aides were termed inadequate compared to those that were obtained by other health professionals when analyzed by Chi square analysis at 95% confidence level. The difference in results was significant for comparison of health aides and physicians and for comparison of health aides and other health care providers. As a result of the study, training for pelvic examination skills was decreased in the basic training curriculum. The authors of the curriculum suggest that competency for the skill be gained through advanced training courses offered by regional health care facilities.