A Pilot Study of the Village Health Volunteer Peripheral Arterial Disease Screening (V-PAD) Program

Abstract

Peripheral arterial disease (PAD) affects over 230 million people worldwide and remains a leading contributor to cardiovascular morbidity and mortality. Despite this burden, PAD is frequently underdiagnosed, particularly in rural communities. Training Village Health Volunteers (VHVs) as trusted community members, to facilitate PAD screening using automated ankle-brachial index (ABI) devices may provide a feasible and sustainable approach to improving early detection in underserved settings where access to specialized vascular care is limited. The overarching purpose of this dissertation was to (1) evaluate the feasibility and implementation of the Village Health Volunteer Peripheral Arterial Disease Screening (V-PAD) Program in Thailand, and (2) examine PAD screening outcomes among patients at increased risk for PAD attending a non-communicable disease clinic within a rural primary care unit in Thailand, as facilitated by trained VHVs. A non-randomized, single-arm pilot study design was employed. Recruitment, retention, and performance among VHVs were high. All 16 participating VHVs completed V-PAD training and demonstrated competence on the post-training ABI assessment: 11 (68.8%) achieved adequate performance by completing the 8 key steps required to pass, and 5 (31.2%) completed all 16 steps of the procedure, with none failing or requiring further training. Trained VHVs subsequently screened 192 patients at increased risk for PAD, of whom 189 completed ABI testing. The prevalence of PAD was 10.6%, and 55.0% were asymptomatic. Overall, the findings suggest that the V-PAD program is feasible and offers a practical approach to expanding screening coverage and strengthening community engagement. The high proportion of asymptomatic cases highlights the importance of proactive screening and early PAD identification strategies in rural communities.