Community Health Workers as a Strategy to Tackle Psychosocial Suffering Due to Physical Distancing: A Randomized Controlled Trial.

Dorien Vanden Bossche,Susan Lagaert,Sara Willems,Peter Decat

doi:10.3390/ijerph18063097

Dorien Vanden Bossche, Susan Lagaert + Show 2 more

Open Access

https://doi.org/10.3390/ijerph18063097

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Abstract

Background: During the COVID-19 pandemic, many primary care professionals were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psychosocial support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks. Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined. Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health. Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW interventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises.

Highlights

We found no significant between-group difference in mean change from baseline in emotional support, social isolation, ability to participate in social roles and activities, anxiety and fear of COVID-19. (Tables 3 and 4)
We failed to find a significant effect of the intervention on experiences of emotional support, social isolation, ability to participate in social roles and activities, anxiety and fear of COVID-19
The determination of the target population in this study, i.e., patients with limited social network, was done by the researchers of the research team. To reach this target population, we relied on family physicians and other primary care professionals to identify patients for whom they saw a role for the community health worker (CHW)

Summary

Introduction

Besides the rising number of cases and fatalities as a consequence of this pandemic, there has been significant socioeconomic, political, and psychosocial impact [1]. Billions of people are quarantined in their own homes as nations have locked down to implement physical distancing as a measure to contain the spread of infection [1]. Physical distancing and lockdown measures, work disruptions, and school closures, have suddenly changed social life and daily routines. Multiple lines of evidence confirm these profound psychosocial effects of the COVID-19 pandemic and physical distancing measures [7,8,9,10]. Some groups may be more vulnerable than others to the psychosocial effects of pandemics. COVID-19 will disproportionately affect vulnerable populations, worsening prevailing inequalities [3,7,11]

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