Community Health Worker Integration with and Effectiveness in Health Care and Public Health in the United States

Knowles, Molly; Crowley, Aidan; Vasan, Aditi; Kangovi, Shreya

doi:10.1146/annurev-publhealth-071521-031648

Cited by 29 publications

(8 citation statements)

References 97 publications

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“…While there is no quick fix for structural and systemic barriers within the outer setting, including the financial barriers identified, the salience of this barrier within our study and the broader literature underscores the need for continued advocacy and policy work to make CHW programs financially sustainable, such as through Medicaid and Medicare reimbursement. 51 A recent Centers for Medicare & Medicaid Services rule allowing for Medicare reimbursement for services provided by CHWs, effective January 1, 2024, may help to mitigate this barrier. 52 Future work should examine perspectives of individuals across the implementation and delivery spectrum regarding the extent to which this ruling may ameliorate financial barriers.…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model

Schriger,

Knowles,

Daglieri

et al. 2024

JAMA Health Forum

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ImportanceCommunity health worker (CHW) programs may improve health outcomes, increase quality of life, and reduce hospitalizations and cost of care. However, knowledge is limited on the barriers and facilitators associated with scaling evidence-based CHW programs to maximize their public health outcomes.ObjectiveTo identify barriers and facilitators to implementing an evidence-based CHW model.Design, Setting, and ParticipantsThis qualitative study examined perspectives of Individualized Management of Person-Centered Targets (IMPaCT) program staff (health system leaders, program managers, and community health workers) and patients receiving the intervention between March 9, 2020, and July 22, 2021, at 5 institutionally and geographically diverse health systems across the US. The collected data were analyzed between December 1, 2021, and April 27, 2022. Program staff were recruited via purposive sampling, and patients were recruited via convenience sampling.InterventionThe disease-agnostic IMPaCT CHW model includes a standardized implementation approach and a structured set of theory-informed intervention components to create and achieve individualized action plans.Main Outcomes and MeasuresInterview guides were informed by the Consolidated Framework for Implementation Research. A rapid qualitative analytic technique was used to identify key themes, which were categorized into barriers and facilitators associated with framework ecological domains.ResultsOf a total 41 individuals invited, 39 agreed to participate (95% response rate; mean [SD] age, 45.0 [12.6] years; 30 women). General barriers included economic and policy constraints, including insufficient funding for CHW programs, clinical integration challenges, and CHW difficulty with maintaining boundaries. Program-specific barriers included insufficiently tailored materials for certain populations and upfront and ongoing program costs. General facilitators included CHWs’ interpersonal skills and life experiences. Program-specific facilitators included the model’s strong evidence base, supportive implementation team, and program design that enabled relationship building and engagement. Additional themes were cited as both barriers and facilitators, including the COVID-19 pandemic, organizational leadership, IMPaCT training, and program fidelity.Conclusions and RelevanceThese findings suggest growing recognition of the importance of CHWs to improving health equity and population health. Barriers identified point to important policy and practice implications for CHW programs more broadly, including the need for continued attention to improving clinical integration and the need for sustainable program financing to preserve the longevity of this workforce.

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Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model

Schriger,

Knowles,

Daglieri

et al. 2024

JAMA Health Forum

Self Cite

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“…To move toward sustainable health systems that support workers' holistic wellbeing, we must bolster institutional support for and provide commensurate remuneration to CHWs through sustainable financing (Knowles et al, 2023;Smithwick et al, 2023). To achieve this imperative, we need metrics to account for the vital roles that CHWs perform as frontline healthcare workers, as they address the myriad drivers of health inequities as part of ongoing care and during crises such as the COVID-19 pandemic (Johnson-Agbakwu et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

“If You Don’t Have the Heart to Help, You Cannot Do This Job”: The Multidimensional Wellbeing of Community Health Workers Serving Refugees During the COVID-19 Pandemic

Schuster,

Wachter,

McRae

et al. 2023

Qual Health Res

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Community health workers are members of two groups whose short- and long-term health has been uniquely shaped by the COVID-19 pandemic: health workers and the oft-marginalized populations that they serve. Yet, their wellbeing, particularly of those serving resettled refugees, before and during the pandemic has been largely overlooked. Drawing from a holistic conceptualization of wellness, this study examined the effects of the COVID-19 pandemic on a group of cultural health navigators (CHNs), who serve resettled refugees. We conducted semi-structured individual interviews with CHNs at a southwestern U.S. hospital system between July and August 2020, a critical time in the pandemic. Our analysis produced four themes that encapsulate the effects of the pandemic on CHN wellbeing: (1) “You fear for your life”: Chronic risk of COVID-19 exposure takes a toll on physical, emotional, and environmental wellbeing; (2) “It is stressful because it is completely new”: Uncertainty diminishes occupational, financial, and emotional wellbeing; (3) “If you don’t have the heart to help, you cannot do this job”: CHNs remain committed while facing challenges to their occupational wellbeing on multiple fronts; and (4) “Now, you cannot release your stress”: Loss of and shifts in outlets integral to social and spiritual wellbeing. The findings deepen empirical understanding of how the pandemic affected the holistic wellbeing of CHNs, as they continued to serve their communities in a time of crisis. We discuss the implications for addressing the multidimensionality of community health worker wellbeing in research, policy, and practice.

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“…The critical role CHWs play in improving community health outcomes and reducing the cost of healthcare is being increasingly recognized [18][19][20][21][22]. However, little is published on the process or outcomes of CHWs' work.…”

Section: Discussionmentioning

confidence: 99%

Development of a Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers

Acharya,

Sykes,

Neira

et al. 2023

Preprint

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Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency. We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs. The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection systems for CHWs. Pilot tests with CHWs occurred over several months to ensure the functionality supported their daily use and to identify areas for improvement. At launch, the database had 60 active users in 20 counties. To our knowledge, this is one of the first single-platform systems allowing for the collection of information about partner organizations, community outreach events, client encounters, and progress toward client's goals. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE) and continue with longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE Database provides real-world data on CHW accomplishments, improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings.

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Community Health Worker Integration with and Effectiveness in Health Care and Public Health in the United States

Cited by 29 publications

References 97 publications

Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model

Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model

“If You Don’t Have the Heart to Help, You Cannot Do This Job”: The Multidimensional Wellbeing of Community Health Workers Serving Refugees During the COVID-19 Pandemic

Development of a Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers

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