Abstract
BackgroundDespite the positive effects of community health workers (CHWs) on addressing social determinants of health, improving patient health outcomes, and decreasing overall healthcare costs, there is a lack of standardization in training and certifying this workforce, resulting in different approaches to integrating this role into medical home models. The purpose of the current study is to evaluate the application of Project ECHO (Extension for Community Healthcare Outcomes) in enhancing CHWs’ capacity to address health and social issues of vulnerable populations.MethodsAn explanatory sequential mixed methods design was applied in which all participants (N = 49) completed pre (January 2019) and post (July 2019) quantitative online surveys measuring changes in self-efficacy, behavior change intent, and knowledge. Virtual focus groups were conducted with a subset of participants (n = 20) in July 2019 to assess the feasibility, acceptability, and impact of Project ECHO.ResultsThere was a statistically significant difference of + 0.453 in the composite self-efficacy mean score pre- to post-series. For every 1 additional Project ECHO CHW session attended, there was a .05 improvement in participants’ self-efficacy to perform CHW-related job duties and address social determinants of health (SDOH). Four major themes emerged from the qualitative focus group data: value in learning from other participants’ caseloads, CHW-care team integration, availability of training and resources, and shared decision-making with patients.ConclusionsThis evaluation suggests that ECHO is a viable means of increasing access to training resources for CHWs. Future studies on the ECHO model as a means of educating and broadening implementation of CHWs are warranted. Programs such as Project ECHO can support CHWs by providing continuing education opportunities, as well as standardizing training content across large geographic areas.
Highlights
Introduction and backgroundHealth initiatives that target social determinants of health (SDOH) underscore the notion that a patient’s environment influences their overall health and wellbeing
This evaluation suggests that Project Extension for Community Healthcare Outcomes (ECHO) can be a feasible and acceptable tool to provide continuing education and training for community health workers (CHWs)
Participants shared how certain skills and knowledge obtained from ECHO CHW could be deployed in their respective communities and healthcare settings
Summary
Introduction and backgroundHealth initiatives that target social determinants of health (SDOH) underscore the notion that a patient’s environment influences their overall health and wellbeing. Quality improvement efforts in healthcare have traditionally focused on ameliorating poor health indicators within clinical practice [1] This approach may lead to improvements in some health outcomes, it often fails to account for the significant influence of health-related social factors such as housing, access to food, transportation, and employment. Collaboration among healthcare providers, patients, and patients’ natural supports (e.g., family, friends, community members) is necessary to improve health and promote wellness Federal initiatives, such as Healthy People 2020, have established national objectives to create environments that promote good health for all [2]. Initiatives like these identify the most pressing preventable threats to health and establish indicators to diminish these threats These initiatives target local communities and emphasize whole-person-centered healthcare systems supported by programs such as Community-Clinical Integration Programs and Patient-Centered Medical Homes [3, 4].
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