Impact Of Community Health Workers Research Articles

OA55 Impact of community health workers for continuum care of palliative care at community level integrated in rwanda public health system.

Multi-disciplinary palliative care for patients with any disease is rarely integrated into the public healthcare system at all levels in Africa. In Kigali, Rwanda, we have developed palliative care services in a district general hospital and linked these services to home care using community health workers. In addition, the Ministry of Health recently approved a palliative care training curriculum for community health workers employed by the government who will expand and make sustainable palliative home care. The impact of Community health workers helped the district hospital to map patients with chronic diseases, palliative care and identify symptoms for better orientation. At Kibagabaga Hospital, the public hospital for Gasabo District that includes 60% of the population of Kigali, we initiated a training of 481 community health workers (CHW), 1 CHW/per village for continuing care and retro-information to the District Palliative Care team through Health centre. As of June 2014, community health workers had identified 432 patients and report has been sent to the district palliative care team for mapping. Anecdotal data indicates a high level of satisfaction by patients and family members with palliative care assisted at community level and a reduced stress of continuum care. It is feasible to integrate palliative care for patients at community level into public healthcare systems in Africa using Community health workers.

Development of a composite outcome score for a complex intervention - measuring the impact of Community Health Workers.

BackgroundIn health services research, composite scores to measure changes in health-seeking behaviour and uptake of services do not exist. We describe the rationale and analytical considerations for a composite primary outcome for primary care research. We simulate its use in a large hypothetical population and use it to calculate sample sizes. We apply it within the context of a proposed cluster randomised controlled trial (RCT) of a Community Health Worker (CHW) intervention.MethodsWe define the outcome as the proportion of the services (immunizations, screening tests, stop-smoking clinics) received by household members, of those that they were eligible to receive. First, we simulated a population household structure (by age and sex), based on household composition data from the 2011 England and Wales census. The ratio of eligible to received services was calculated for each simulated household based on published eligibility criteria and service uptake rates, and was used to calculate sample size scenarios for a cluster RCT of a CHW intervention. We assume varying intervention percentage effects and varying levels of clustering.ResultsAssuming no disease risk factor clustering at the household level, 11.7% of households in the hypothetical population of 20,000 households were eligible for no services, 26.4% for 1, 20.7% for 2, 15.3% for 3 and 25.8% for 4 or more. To demonstrate a small CHW intervention percentage effect (10% improvement in uptake of services out of those who would not otherwise have taken them up, and additionally assuming intra-class correlation of 0.01 between households served by different CHWs), around 4,000 households would be needed in each of the intervention and control arms. This equates to 40 CHWs (each servicing 100 households) needed in the intervention arm. If the CHWs were more effective (20%), then only 170 households would be needed in each of the intervention and control arms.ConclusionsThis is a useful first step towards a process-centred composite score of practical value in complex community-based interventions. Firstly, it is likely to result in increased statistical power compared with multiple outcomes. Second, it avoids over-emphasis of any single outcome from a complex intervention.

The impact of integrating community health workers into the patient-centered medical home.

Establishing patient-centered medical homes (PCMHs) that deliver comprehensive care can be challenging for practices serving diverse populations. Integrating community health workers (CHWs) as members of the care team is one approach to deliver such care; however, little is known about this process. We study an approach of integrating CHWs into PCMHs with predominantly Latino, pediatric asthma patients and examine the impact on care delivery. A case study was conducted to examine the integration of 8 CHWs into 5 PCMHs in an academic medical center located in a large, urban setting. Data associated with referrals to CHW practice-based education and support and to a care coordination program, as well as survey results from providers on the impact of CHWs in PCMHs were collected and analyzed over the study period. More than 750 families of children with asthma received education and support from CHWs from February 2011 through December 2013. The number of referrals to the care coordination program increased 7-fold during this time (P < .001). Of providers surveyed (n = 55), those who reported not referring to care coordination decreased from 22% to 6% and those who reported referring patients to care coordination increased from 67% to 79%. Additionally, 39% of providers reported giving a care plan to patients when prompted by the CHW. CHWs can be successfully integrated into the PCMH care team. They may also impact the identification of high-risk populations for care coordination and delivery of comprehensive care.

Rationale and design of the Miami Healthy Heart Initiative: a randomized controlled study of a community health worker intervention among Latino patients with poorly controlled diabetes.

BackgroundType 2 diabetes mellitus disproportionately affects the Latino community. Latinos with diabetes are also less likely to have adequate control of cardiovascular risk factors such as cholesterol and blood pressure. Community health workers (CHWs) are increasingly being used to address various health disparity conditions, including diabetes. However, evidence of their effectiveness from randomized controlled trials is limited.MethodsThe Miami Health Heart Initiative is a randomized controlled trial of 300 Latino patients with diabetes. Patients with hemoglobin A1c (HbA1c) ≥8.0% were recruited from Miami-Dade’s public hospital system. At baseline, all patients underwent phlebotomy, physical examination, and a structured 90-minute research interview. They were then randomized to either usual care or a CHW intervention called Cariño. For participants in the Cariño arm of the study, CHW services included assistance with nonmedical social services, health education, and patient navigation in which the CHWs serve as a bridge between patients and the health care system. These services were delivered through home visits, phone calls, and group visits. At 12 months, all subjects had a follow-up examination. The primary outcomes at 1 year are changes in systolic blood pressure, low-density lipoprotein, and HbA1c. Secondary outcomes include medication adherence, medication intensification, diabetes self-efficacy, physical activity, and self-reported fruit and vegetable intake.DiscussionThe Miami Healthy Heart Initiative is one of the first rigorously conducted randomized controlled trials to provide evidence on the impact of CHWs on diabetes intermediate outcomes among Latinos. If the data support our primary hypotheses, the study would lend added support to ongoing efforts to incorporate CHWs as part of our national efforts to reduce and ultimately eliminate health disparities.

Women's Empowerment in Rural China: The Impact of Community Health Workers

Surmang Foundation's Clinic is located in Qinghai Province, Yushu Prefecture, Xiao Surmang Township, China. It is a remote, 97 percent ethnic Tibetan, mountainous region with little access to organized health care services. Surmang Foundation, a US 501(c)3 charity, has organized a cadre of local women to provide community‐based care and education to women, resulting in a notable reduction in maternal mortality based on the report of community members. A festival organized to celebrate the accomplishments of the community health workers provided an opportunity for the women to demonstrate how their roles benefit themselves and their community. Both health care services and support for community empowerment are provided through the community health worker model.

The impact of community health workers (CHWs) on Buruli ulcer in sub-Saharan Africa: a systematic review.

Buruli ulcer (BU) is a cutaneous neglected tropical disease caused by Mycobacterium ulcerans. Participation of Community Health Workers (CHWs) is an integral part of the management of BU, yet their impact has not been systematically evaluated in sub-Saharan Africa. METHODS: Our objectives were to summarize the evidence on the impact of CHWs on the control of BU in sub-Saharan Africa by looking at their recruitment, training, non-governmental support and performance. We searched the following electronic databases from January 1998 to July 2012: Medline, EMBASE (Excerpta Medica Database), The Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. There were no restrictions to language or publication status. All study designs that could provide the information we sought were eligible, provided the studies were conducted in sub-Saharan Africa. Critical appraisal of all identified citations was done independently by two authors to establish the possible relevance of the articles for inclusion in the review. Of 195 hits, 17 papers met the inclusion criteria. For the management of Buruli Ulcer, CHWs are often recruited from the communities they will serve. Communities play a role in CHW selection. Larger numbers of CHWs are needed in order to improve the detection and management of cases. One of the major obstacles to the control of BU is inadequate and poorly- equipped health facilities in the affected areas. Evidence from this review suggests that CHW programmes can have large impacts on the control of BU in sub-Saharan Africa. Large-scale rigorous studies, including RCTs, are needed to assess whether the CHWs programs promote equity and access.

The potential contribution of community health workers to improving health outcomes in UK primary care.

The potential contribution of community health workers to improving health outcomes in UK primary care.

Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa.

BackgroundOver thirty years have passed since the Alma-Ata Declaration on primary health care in 1978. Many governments in the first decade following the declaration responded by developing national programmes of community health workers (CHWs), but evaluations of these often demonstrated poor outcomes. As many CHW programmes have responded to the HIV/AIDS pandemic, international interest in them has returned and their role in the response to other diseases should be examined carefully so that lessons can be applied to their new roles. Over half of the deaths in African children under five years of age are due to malaria, diarrhoea and pneumonia - a situation which could be addressed through the use of cheap and effective interventions delivered by CHWs. However, to date there is very little evidence from randomised controlled trials of the impacts of CHW programmes on child mortality in Africa. Evidence from non-randomised controlled studies has not previously been reviewed systematically.MethodsWe searched databases of published and unpublished studies for RCTs and non-randomised studies evaluating CHW programmes delivering curative treatments, with or without preventive components, for malaria, diarrhoea or pneumonia, in children in sub-Saharan Africa from 1987 to 2007. The impact of these programmes on morbidity or mortality in children under six years of age was reviewed. A descriptive analysis of interventional and contextual factors associated with these impacts was attempted.ResultsThe review identified seven studies evaluating CHWs, delivering a range of interventions. Limited descriptive data on programmes, contexts or process outcomes for these CHW programmes were available. CHWs in national programmes achieved large mortality reductions of 63% and 36% respectively, when insecticide-treated nets and anti-malarial chemoprophylaxis were delivered, in addition to curative interventions.ConclusionsCHW programmes could potentially achieve large gains in child survival in sub-Saharan Africa if these programmes were implemented at scale. Large-scale rigorous studies, including RCTs, are urgently needed to provide policymakers with more evidence on the effects of CHWs delivering these interventions.

The Impact of Community Health Workers on Behavioral Outcomes and Glycemic Control of Diabetes Patients on the U.S.-Mexico Border

This study attempts to determine the impact of Community Health Workers (promotoras de salud) on the self-management practices of people with diabetes on the U.S.-Mexico Border. The region has higher incidence rates of type 2 diabetes than the nation as a whole due to its Mexican-American population, an ethnic group genetically vulnerable to the disease. Unlike prior research that investigated the overall effectiveness of the CHWs, this study monitored a wide range of biologic (HbA1c, BMI) and behavioral (diabetes knowledge, self-efficacy, self-management activities scores) outcomes among the diabetes patients. The experimental research design tested whether or not the monthly visits by CHWs to the diabetic patients helped them in controlling their disease. The sample (N = 30) was recruited from Mexican-American diabetes patients aged 30 or above. The intervention group received monthly visits from CHWs, while the control group did not. The intervention group showed a significant improvement after 2 years of intervention in all outcomes, except Body Mass Index (BMI).

Community Health Workers and Medicaid Managed Care in New Mexico

We describe the impact of community health workers (CHWs) providing community-based support services to enrollees who are high consumers of health resources in a Medicaid managed care system. We conducted a retrospective study on a sample of 448 enrollees who were assigned to field-based CHWs in 11 of New Mexico’s 33 counties. The CHWs provided patients education, advocacy and social support for a period up to 6 months. Data was collected on services provided, and community resources accessed. Utilization and payments in the emergency department, inpatient service, non-narcotic and narcotic prescriptions as well as outpatient primary care and specialty care were collected on each patient for a 6 month period before, for 6 months during and for 6 months after the intervention. For comparison, data was collected on another group of 448 enrollees who were also high consumers of health resources but who did not receive CHW intervention. For all measures, there was a significant reduction in both numbers of claims and payments after the community health worker intervention. Costs also declined in the non-CHW group on all measures, but to a more modest degree, with a greater reduction than in the CHW group in use of ambulatory services. The incorporation of field-based, community health workers as part of Medicaid managed care to provide supportive services to high resource-consuming enrollees can improve access to preventive and social services and may reduce resource utilization and cost.

The impact of community health workers on the self‐determination, self‐sufficiency, and decision‐making ability of low‐income women and mothers of young children

AbstractPregnant women at high risk for adverse health outcomes can benefit from the services of community health workers. Maternity Care Coalition identifies at risk women and provides links to health care and social services through the MOMobile Program. The purpose of this study was to explore (a) the relationship formed between community health workers and pregnant women, and (b) the change over time in a mother's perceived level of empowerment as measured by self‐sufficiency, self‐determination, and decision‐making skills. A multiphase study was developed to collect data. Focus group interviews with community health workers explored their professional role, their relationship with mothers, and the meaning of decision‐making, self‐sufficiency, and self‐determination as empowerment constructs. A questionnaire was developed to measure each construct at two points in time. A pilot study with 80 women was conducted. Scores for each construct and overall empowerment were calculated and the pre‐ and post‐scores compared to measure change over time. Results of paired t‐tests showed significant differences between the postpartum mean score for decision‐making (P &lt; .01), self‐sufficiency (P &lt; .01), self‐determination (P &lt; .001), and overall empowerment (P &lt; .001) and the mean scores on each construct at registration. Results suggest that empowerment can be operationalized in community settings and that increasing an at risk pregnant woman's sense of empowerment may positively impact the overall health of the mother and child. Further research is needed to assess the full impact of this variable as a health status indicator. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 343–356, 2004.

La promotora. Linking disenfranchised residents along the border to the U.S. health care system.

Narrative Matters Health AffairsVol. 20, No. 3: Lessons From Abroad La PromotoraDarryl M. WilliamsPUBLISHED:May/June 2001No Accesshttps://doi.org/10.1377/hlthaff.20.3.212AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSClinicsImmigrantsPatient carePharmaceuticalsMedicaid patientsChildren's Health Insurance ProgramNursingPublic healthDiseasesMedicaid Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 21 History Published online 1 May 2001 InformationCopyright 2001 by Project HOPE - The People-to-People Health Foundation, Inc.PDF downloadCited byBrief Intervention Among Mexican-Origin Young Adults in the Emergency Department at the USA–Mexico Border: Examining the Role of Patient’s Preferred Language of Intervention in Predicting Drinking Outcomes†28 August 2018 | Alcohol and Alcoholism, Vol. 53, No. 6Differences by gender at twelve months in a brief intervention trial among Mexican-origin young adults in the emergency department28 January 2016 | Journal of Ethnicity in Substance Abuse, Vol. 16, No. 1Brief Intervention in the Emergency Department Among Mexican-Origin Young Adults at the US–Mexico Border: Outcomes of a Randomized Controlled Clinical Trial Using Promotores4 August 2015 | Alcohol and Alcoholism, Vol. 51, No. 2Cost-effectiveness of Community Health Workers in controlling diabetes epidemic on the U.S.–Mexico borderPublic Health, Vol. 128, No. 7Promotoras Across the Border: A Pilot Study Addressing Depression in Mexican Women Impacted by Migration26 February 2013 | Journal of Immigrant and Minority Health, Vol. 16, No. 3Predictors and a Framework for Fostering Community Advocacy as a Community Health Worker Core Function to Eliminate Health DisparitiesAmerican Journal of Public Health, Vol. 103, No. 7Capacity Building in the Latino Community: Lessons from the Promotora Project in Eastern North CarolinaPracticing Anthropology, Vol. 34, No. 4Fundamentals: Building Communities of Practice in Comparative Effectiveness Research2 January 2012The Impact of Community Health Workers on Behavioral Outcomes and Glycemic Control of Diabetes Patients on the U.S.-Mexico Border22 December 2011 | International Quarterly of Community Health Education, Vol. 31, No. 4Promotoras as Mental Health Practitioners in Primary Care: A Multi-Method Study of an Intervention to Address Contextual Sources of Depression30 September 2010 | Journal of Community Health, Vol. 36, No. 2The Role of Community Health Workers in Combating Type 2 Diabetes in the Rio Grande Valley3 February 2011 | Journal of Primary Care & Community Health, Vol. 2, No. 1Understanding the Role of the Promotora in a Latino Diabetes Education Program4 February 2010 | Qualitative Health Research, Vol. 20, No. 3Community Health Workers and Community Advocacy: Addressing Health Disparities27 June 2008 | Journal of Community Health, Vol. 33, No. 6Promotor(a)s, the organizations in which they work, and an emerging paradox: How organizational structure and scope impact promotor(a)s’ workHealth Policy, Vol. 82, No. 2Evolving trends in medical care-coordination for patients with HIV and AIDSCurrent HIV/AIDS Reports, Vol. 3, No. 4Promovisión: Designing a Capacity-Building Program to Strengthen and Expand the Role of Promotores in HIV Prevention21 August 2006 | Health Promotion Practice, Vol. 7, No. 4Promotores-Focused Screening and Education to Improve Diabetes Awareness and Self-Care in Low-Income Latino Intergenerational FamiliesInternational Journal of Self Help and Self Care, Vol. 5, No. 3Nontraditional Work Factors in Farmworker Adolescent Populations: Implications for Health Research and Interventions3 August 2016 | Public Health Reports, Vol. 120, No. 6Provider Counseling, Health Education, and Community Health Workers: The Arizona WISEWOMAN ProjectJournal of Women's Health, Vol. 13, No. 5Collaboration to Improve Services for the UninsuredHealth Care Management Review, Vol. 29, No. 3Improvement in Diabetes Care of Underinsured Patients Enrolled in Project DulceDiabetes Care, Vol. 27, No. 1

Impact of community health workers on access, use of services, and patient knowledge and behavior.

Community health workers have been used in health centers for several decades. Known by various names (e.g., community health advisors, outreach workers, promotoras), they are trusted community members providing informal community-based health-related services and establishing vital links between health providers and the community. They perform many functions, including outreach and case finding, health education, translation, patient transportation, and case management (under the supervision of a nurse or social worker). This article, based on a study of community health worker programs at seven sites, is intended to share the lessons learned that could be helpful to other program managers and to examine the outcomes of such programs.