Training-of-trainers program for community health workers involved in an innovative and community-based intervention among goldminers in the Guiana Shield: a quality and effectiveness evaluation

Introduction: An innovative and community-based intervention is implemented in the Guiana Shield to eliminate malaria among people involved in artisanal and small-scale gold mining. The intervention is possible in the field thanks to community health workers (CHWs) who are previously trained to master all intervention’s procedures, including training gold miners to treat themselves for malaria. This article describes thus a training-of-trainers (ToT) program for CHWs, as well as the method and results of its evaluation in terms of quality and effectiveness. Methods : A mixed-method case study was implemented in two steps and based on knowledge survey, satisfaction test, observations and semi- structured interviews. Quantitative and qualitative data were triangulated. Results : The project team’s previous experience and the Guiana Shield countries’ commitment to the WHO E-2025 initiative were identified as levers for the quality of the ToT training, while the complexity of the project context was a challenge. Group dynamics and adaptations were found to be central elements of a high-quality training program. CHWs’ satisfaction was elevated especially regarding training format and learning results. Improvements on knowledge level demonstrated good effectiveness of the training. Nevertheless, some difficulties persisted regarding certain tasks to be carried out by CHWs during the intervention procedure. Further on-the-job training permitted to address them, improving CHWs’ practices in the field. Discussion : High-quality, effective, and appropriate training programs are required for effective and sustainable intervention involving CHWs profiles. Training design is a crucial point to attend quality and effectiveness. ToT model has been shown to allow a high level of satisfaction, good learning results and satisfactory implementation in the field. Initial and continuing training is an indispensable continuum to sustain good practices in the field and CHWs’ motivation. Training evaluation permits to standardize methods and facilitate transferability of successful efforts. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Curema project is funded by European Funds FEDER-PCIA and Synergy no 8754, and by Regional Health Agency of French Guiana. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Curema protocol was approved by the ethics committees of the countries involved in the project (Brazil: CONEP:5,507,241 and Suriname: CMWO05/22). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors