The role of community health workers in primary healthcare in the WHO-EU region: a scoping review

Abstract

Background Existing evidence on the role of community health workers (CHWs) in primary healthcare originates primarily from the United States, Canada and Australia, and from low- and middle-income countries. Little is known about the role of CHWs in primary healthcare in European countries. This scoping review aimed to contribute to filling this gap by providing an overview of literature reporting on the involvement of CHWs in primary healthcare in WHO-EU countries since 2001 with a focus on the role, training, recruitment and remuneration. Methods This systematic scoping review followed the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, extension for Scoping Reviews. All published peer-reviewed literature indexed in PubMed, Web of Science, and Embase databases from Jan 2001 to Feb 2023 were reviewed for inclusion. Included studies were screened on title, abstract and full text according to predetermined eligibility criteria. Studies were included if they were conducted in the WHO-EU region and provided information regarding the role, training, recruitment or remuneration of CHWs. Results Forty studies were included in this review, originating from eight countries. The involvement of CHWs in the WHO-EU regions was usually project-based, except in the United Kingdom. A substantial amount of literature with variability in the terminology used to describe CHWs, the areas of involvement, recruitment, training, and remuneration strategies was found. The included studies reported a trend towards recruitment from within the communities with some form of training and payment of CHWs. A salient finding was the social embeddedness of CHWs in the communities they served. Their roles can be classified into one or a combination of the following: educational; navigational and supportive. Conclusion Future research projects involving CHWs should detail their involvement and elaborate on CHWs’ role, training and recruitment procedures. In addition, further research on CHW programmes in the WHO-EU region is necessary to prepare for their integration into the broader national health systems.

Engaging with peers to integrate community care: Knowledge synthesis and conceptual map

“…Another way peers connect is through their membership and engagement in a local or geographic community. Some programmes recruit local members to educate and provide advice on health and illness; for instance, in Roma communities in Europe or Latino neighbourhoods in the United States 15,63 . While these peers also share certain identities (e.g., ethnicity or language) with those they support, what distinguishes them is that they are embedded in the local community served 19,20 .…”

“…While these peers also share certain identities (e.g., ethnicity or language) with those they support, what distinguishes them is that they are embedded in the local community served 19,20 . As such, they closely understand the challenges the community faces when accessing local services and their actual needs or concerns 15,64 . As community members, they can translate services and information to be culturally appropriate, and advocate for their community's needs to local healthcare representatives or providers 19,20 .…”

“…In healthcare ecosystems, peers hold a unique position. They mobilize lived experiences of hardships, life challenges or ‘insider’ knowledge of communities to support others 2,15 . Growing evidence suggests that through their ability to build trust and relationships, peers can serve as a bridge between communities and formal healthcare, particularly for those marginalized and disadvantaged 2,11,16 .…”

“…Third, we conclude by discussing the potential and limitations of the map to offer a common language and facilitate knowledge exchange between practitioners, policymakers and researchers, regardless of the terms or labels used. Throughout the paper, we choose to use the term ‘peer’, and define it broadly to include different practices where individuals offer support based on lived experiences or ‘insider’ knowledge of communities 2,15 …”

“…Research suggests that peers can complement professional healthcare and address some of its shortcomings, notably inequities in care and fragmentation of services 10,11 . Peer support programmes have been launched in numerous settings, for instance, clinics, hospitals, schools, community and peer‐run organizations, to reach a variety of communities, such as people experiencing homelessness, chronic illnesses, migrants and refugees, or Indigenous people 12–15 . Engaging with peers is thus seen as an innovative way to integrate health and community care, cutting across contexts, settings and populations.…”