<![CDATA[Highlights: Rheumatic heart disease remains a significant health concern in low-and middle-income countries, as it is often challenging to detect in its early stages due to subtle or absent symptoms, particularly during the subclinical phase. Task-shifting echocardiographic screening of RHD to general practitioners offers a scalable solution in low-resource settings. Abstract Introduction: Rheumatic heart disease (RHD) remains a significant health burden in low- and middle-income countries. Early detection of RHD by trained general practitioners (GPs) allows for faster intervention to prevent disease progression. This study aimed to evaluate the feasibility and effectiveness of training non-expert health workers in Indonesia to perform echocardiographic screening for RHD, addressing the country’s unique challenges and bridging the gap in healthcare resources. Methods: A quasi-experimental pre-post intervention study was conducted involving 18 GPs with no prior echocardiography experience. The training consisted of one day of lecture-based instruction and six days of supervised hands-on practice. Knowledge was assessed using a newly developed RHD-echocardiography test that underwent face and content validation by two cardiologists and demonstrated good internal consistency (Cronbach’s alpha = 0.82). Pre- and post-training knowledge was compared using paired t-tests. Diagnostic sensitivity and specificity were calculated using cardiologist-confirmed findings from a subsequent one-month school-based screening of 440 students. Results: The mean pre-test score was 64 ± 11, significantly increasing to 95 ± 7.5 after training (p<0.001). Image quality was diagnostically adequate in 97.7% of examinations. Sensitivity and specificity of GP-acquired screening echocardiograms were 41.4% (95% Confidence Interval/CI: 29.9%-53.0%) and 73.7% (95% CI: 69.1%-78.3%), respectively. No significant differences in scores were observed by gender or age group. Conclusion: Although participants initially had limited exposure to echocardiography, the structured short-term curriculum substantially improved knowledge, image acquisition skills, and screening capability. Task-shifting echocardiographic screening to mid-level providers appears feasible in Indonesia and warrants further refinement and scale-up.]]>
