Community health workers recruitment from within: an inner-city neighborhood-driven framework

Abstract

BackgroundCommunity health workers (CHWs) are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served (APHA 2009). Among other roles, they are effective in closing critical communication gap between healthcare providers and patients as they possess key abilities to overcome cultural barriers, minimize disparities, and maximize adherence to clinical directions. In previous descriptions of the selection of CHWs, the role of community is clearly emphasized, but residence in the community is not indicated.ObjectiveWe present an effective model of CHW selection by the community of members that reside in the community to be served.MethodsWe outlined and implemented necessary steps for recruiting CHWs from within their target neighborhood between years 2011 and 2013. The identified community was an “isolated” part of Newark, New Jersey comprised of approximately 3000 people residing in three publicly-funded housing developments. We utilized a community empowerment model and established a structure of self-governance in the community of interest. In all phases of identification and selection of CHWs, the Community Advisory Board (CAB) played a leading role.ResultsThe process for the successful development of a CHW initiative in an urban setting begins with community/resident engagement and ends with employment of trained CHWs. The steps needed are: (1) community site identification; (2) resident engagement; (3) health needs assessment; (4) CHW identification and recruitment; and (5) training and employment of CHWs. Using an empowered community model, we successfully initiated CHW selection, training, and recruitment. Thirteen CHW candidates were selected and approved by the community. They entered a 10-week training program and ten CHWs completed the training. We employed these ten CHWs.ConclusionsThese five steps emerged from a retrospective review of our CHW initiative. Residing in the community served has significant advantages and disadvantages. Community empowerment is critical in changing the health indices of marginalized communities.

Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature

“…The search did not produce any articles using the term boundary spanners for community-based people (in contrast with health management literature, as noted above). People fulfilling boundary-spanning roles in the community were described as “engaged insider” [ 43 ], “bridging role within the clinic” [ 54 ], “cultural bridge” [ 38 , 41 , 52 , 59 ], “nexus” [ 46 ], “intermediary” [ 27 ], “connector” [ 48 , 63 , 65 ] “psychosocial bridge” [ 48 ] and “trusted liaison” [ 50 ].…”

“…Where health services use community-based boundary spanners as a solution to a workforce shortage problem [ 46 , 62 , 65 , 67 ], the boundary spanners are valued due to physical location in the marginalised community setting where it is difficult to recruit health workers. In the articles related to a connection or trust discrepancy between the health service and the community, their similarity to the community members being served is the reason for the health service using them [ 38 , 43 , 50 , 54 , 56 , 57 , 64 ].…”

“…Where the main use is to extend the workforce, increase compliance with treatment/screening or improve the efficiency of the system, the tasks of boundary-spanning roles are practical and structured. When the health service is using the boundary spanners for community-based research, community strengthening or to provide support for behaviour change, boundary spanners have a broader range of tasks and functions that constitute community development, health promotion and advocacy [ 43 , 55 , 65 ].…”

“…Trust, respect and supportiveness were dominant character traits for the community health workers. There were two examples with a community led approach to determining the important characteristics for community health workers, by the community being served [ 43 ] or the cohort of community health workers [ 67 ]. The community health worker examples did not rely on prior health knowledge or experience, with the exception of one article where the worker was integrated into a health practitioner team [ 27 ].…”

“…Only seven articles described outcomes for the wider community where the boundary-spanning activity was occurring. These were more tentative and were predominately concerned with improved health knowledge and behaviour [ 55 , 59 , 61 , 63 , 65 ], social benefits of increased community competency [ 61 , 65 ], reduced social isolation [ 65 ]; identification of community needs [ 43 , 44 , 65 ] and improved social cohesiveness [ 59 ].…”