{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T12:59:57Z","timestamp":1785243597749,"version":"3.55.0"},"reference-count":38,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"unspecified","delay-in-days":90,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005201","name":"Elsevier Foundation","doi-asserted-by":"publisher","award":["202501"],"award-info":[{"award-number":["202501"]}],"id":[{"id":"10.13039\/100005201","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004331","name":"Johnson & Johnson","doi-asserted-by":"crossref","award":["JJ GCCHE 2024-2026"],"award-info":[{"award-number":["JJ GCCHE 2024-2026"]}],"id":[{"id":"10.13039\/100004331","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,6,2]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Extreme heat is a growing public health emergency in India, with rural and low-income communities most at risk. Early symptoms are often overlooked, delaying care and increasing mortality risk. Frontline health workers (FHWs) are critical for prevention and early intervention yet major knowledge and preparedness gaps persist. This study aimed to evaluate a district-wide training programme designed to improve FHWs\u2019 knowledge and confidence in identifying, managing and preventing heat-related illnesses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Climate Care Champions Programme (CCCP) was designed to strengthen the capacity of FHWs to detect, manage and prevent heat-related illnesses. In February 2025, a 2-day Training of Trainers workshop prepared 90 trainers from Ananthapuramu District, Andhra Pradesh, India, who went on to train 2266 FHWs across 76 primary health centres, reaching an estimated 4.5 million residents. A baseline household survey (n=1007, including 241 FHWs) explored knowledge and perception before the training. Longitudinal surveys evaluated confidence and knowledge among trainers and trainees in four heat-vulnerable blocks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Although 70% of FHWs reported prior climate-health training and most expressed confidence in providing preventive advice, knowledge deficits were identified. During CCCP, a longitudinal evaluation revealed improvements in knowledge: recognition of early symptoms increased from 19% to 70%, severe symptoms from 42% to 95% and infant-specific signs from 32% to 89%. Misconceptions around first-aid priorities were corrected, and confidence rose across all domains. Data from 1453 FHWs confirmed effective knowledge transfer across the cascade training model, particularly in protective actions (+29.5%) and understanding heat-illness aetiologies (+18.6%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These results demonstrate that localised, evidence-based training can strengthen frontline health worker capacity and close critical knowledge gaps. Scaling such programmes\u2014supported by policy, infrastructure and sustained government commitment\u2014is essential to protect health, reduce inequalities and strengthen community resilience in the face of escalating extreme heat.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004475","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:11:32Z","timestamp":1782846692000},"page":"e004475","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Building heat resilience through district-wide training of frontline health workers in India: a pre-post evaluation of the climate care champions programme in Ananthapuramu district"],"prefix":"10.1136","volume":"4","author":[{"given":"Cecilia","family":"Sorensen","sequence":"first","affiliation":[{"name":"Global Consortium on Climate and Health Education, Columbia University, New York, New York, USA"},{"name":"Department of Emergency Medicine, New York-Presbyterian\/Columbia University Irving Medical Center, New York, New York, USA"},{"name":"Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielly de P","family":"Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"Global Consortium on Climate and Health Education, Columbia University, New York, New York, USA"},{"name":"Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"DePhillips","sequence":"additional","affiliation":[{"name":"Global Consortium on Climate and Health Education, Columbia University, New York, New York, USA"},{"name":"University of Delaware School of Nursing, Newark, Delaware, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nymisha","family":"Herrera Nimmagadda","sequence":"additional","affiliation":[{"name":"Climate x Health, Swasti, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Global Consortium on Climate and Health Education, Columbia University, New York, New York, USA"},{"name":"Department of Internal Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedika","family":"Tikmani","sequence":"additional","affiliation":[{"name":"Climate x Health, Swasti, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristie","family":"Hadley","sequence":"additional","affiliation":[{"name":"Global Consortium on Climate and Health Education, Columbia University, New York, New York, USA"},{"name":"Department of Emergency Medicine, New York-Presbyterian\/Columbia University Irving Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8409-4654","authenticated-orcid":false,"given":"Hannah N W","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Global Consortium on Climate and Health Education, Columbia University, New York, New York, USA"},{"name":"Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nithya","family":"Shree","sequence":"additional","affiliation":[{"name":"Climate x Health, Swasti, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umashankar","family":"K","sequence":"additional","affiliation":[{"name":"Climate x Health, Swasti, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syama B","family":"Syam","sequence":"additional","affiliation":[{"name":"Evidence to Impact, Swasti, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"O\u2019Donnell","sequence":"additional","affiliation":[{"name":"Global Consortium on Climate and Health Education, Columbia University, New York, New York, USA"},{"name":"Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Chaudhuri","sequence":"additional","affiliation":[{"name":"Climate x Health, Swasti, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"2026072805050560000_4.2.e004475.1","unstructured":"The cooling dilemma amid climate change. 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