A Community Health Worker–Led Community–Clinical Linkage Model to Address Emotional Well-Being Outcomes Among Latino/a People on the US–Mexico Border

Abstract

Introduction Compared with their non-Hispanic White counterparts, Latino/a people have limited access to health resources that might improve their emotional well-being. Interventions that prioritize the Latino/a population, address social determinants of health, and decrease health disparities are needed. The objective of this study was to describe a community–clinical linkage intervention led by community health workers (CHWs) in 3 Latino/a populations along the US–Mexico border. Methods Researchers at the Arizona Prevention Research Center conducted the Linking Individual Needs to Community and Clinical Services (LINKS) study during 2017–2018. Clinic-based CHWs referred participants to community-based CHWs who met with participants monthly for 6 months to assess participant needs, provide support for emotional well-being, and link them to resources. Two community-based CHWs collaborated to maximize participant care; they also administered an emotional well-being questionnaire at baseline and at 3-month and 6-month follow-up. We estimated changes in emotional well-being outcomes. Results Scores for social support, perceived hopefulness, and quality-of-life measures among 189 LINKS participants increased significantly during the study period, especially among men and participants with low baseline scores. For each of the 3 outcomes, the standardized change was approximately 0.28 per 3 months of intervention, a decrease of more than half an SD (0.56) during 6 months of follow-up. Conclusion A CHW-led community–clinical linkage intervention can result in positive emotional well-being outcomes. We encourage policy makers, funders, and public health practitioners to further investigate such interventions as a solution to reduce disparities in emotional well-being.

Longer Times to Delivery of Otolaryngology Care for Patients With Limited English Proficiency

“…A systematic review found that patient navigators increased breast, colorectal, and cervical cancer screening rates with up to 60% improvement for LEP patients 20 . Moreover, bilingual community health workers have been shown to improve access to contraception, increase rates of emotional wellbeing, and even achieve reductions in HbA1c levels for patients with diabetes 21‐23 . Studies have found that many health centers do not have their websites available in a language other than English and a survey of mental health apps showed that the vast majority (>85%) were not translated to Spanish, 24‐26 which represents a straightforward intervention that clinics can implement to make sure their information is readily accessible to LEP patients.…”

“…20 Moreover, bilingual community health workers have been shown to improve access to contraception, increase rates of emotional wellbeing, and even achieve reductions in HbA1c levels for patients with diabetes. [21][22][23] Studies have found that many health centers do not have their websites available in a language other than English and a survey of mental health apps showed that the vast majority (>85%) were not translated to Spanish, [24][25][26] which represents a straightforward intervention that clinics can implement to make sure their information is readily accessible to LEP patients. Not surprisingly, recent work has demonstrated that language-concordant care leads to superior communication outcomes and higher number of patient-asked questions during the clinical encounter, suggesting that language discordant care, even in the presence of an interpreter, represents a source of disparities in access to information.…”

Development and Feasibility Testing of the Clinical-Community Linkage Self-Assessment Survey for Community Organizations

“…The literature provides case examples of CCLs that describe the various strategies and diverse settings, primarily focusing on a variety of patient outcomes. Examples include interventions focused on community health workers ( 14 – 16 ) system or clinical level interventions ( 17 – 21 ), pediatricians ( 22 , 23 ), nursing students ( 24 ), and reviews describing screening and connection strategies ( 25 ). Some examples also provide descriptions of specific CCL protocols ( 26 – 28 ).…”

Behind Closed Doors

“…[3][4][5][6] CHWs play an especially important role in immigrant communities generally, and there is specific evidence of their impact on Latinx communities. [7][8][9][10][11] Established guidelines describe core CHW roles, skills, and qualities that are thought to be the essential components of CHWs' success. 12 Roles are functions that CHWs serve in communities and the health system such as health educator or cultural mediator.…”

“…This expansion of CHW services has been supported by a growing body of research that has evaluated CHW interventions and found many of them to improve health outcomes 3–6. CHWs play an especially important role in immigrant communities generally, and there is specific evidence of their impact on Latinx communities 7–11. Established guidelines describe core CHW roles, skills, and qualities that are thought to be the essential components of CHWs' success 12.…”