Dr Swetha is a Dental Surgeon by training and has a Master of Public Health (MPH). She is currently working as a Research Associate at the Department of Research in SingHealth Polyclinics. Her research interests include digital health, infectious and chronic diseases, operational and health service research. Dr Swetha is currently supporting the EmPaTHy Programme in conducting evaluation studies and was instrumental in evaluating the My Care Team model in SingHealth Polyclinics.
Preventive care is often neglected in primary care due to high patient volume and limited consultation time. A proven model to overcome these challenges is to train non-clinical staff (‘health pal’) to deliver preventive care. Since July 2022, a Singapore public primary care institution pilot tested the ‘health pal’ model by training existing patient service associates to provide preventive care for patients with chronic diseases. As part of process evaluation, this study aimed to explore challenges faced by health pals when performing this new role.
A qualitative study was conducted in two polyclinics from January to April 2023. A total of 6 health pals, 12 management team members and 7 patients participated in 25 in-depth interviews. Two researchers conducted interviews using semi-structured guides, which were audio-recorded, transcribed verbatim and checked. The data was managed using NVivo software and analysed thematically. Additionally, detailed field notes were taken during direct observation of four consultations between health pals and patients.
While health pals welcomed their new clinical role, they faced some challenges in task execution. Despite their initial training, the health pals expressed the need for initial on-site “hand-holding”, and refresher courses as new patient queries emerged during implementation. Care delivery was hampered by their limited access to electronic medical records, resulting in an inability to obtain the patient’s full medical history. Direct observation revealed that although health pals were confident in assessing patients’ needs and offering screening and immunization, they were less confident in explaining the procedures when asked by patients.
This study highlights the importance of continuous training and support when transitioning non-clinical staff to undertake a clinical role. Determining the level of access to the electronic medical record is essential to empower the health pal to deliver appropriate preventive care while ensuring patient confidentiality.