Role Of Community Health Workers Research Articles

The role of community health workers in influencing social connectedness using the household model: a qualitative case study from Malawi

ABSTRACT Background Community health workers (CHWs) play a vital role in facilitating social connectedness, building trust, decrease stigma, and link communities to essential healthcare and social support services. More studies are needed to understand the factors facilitating these interactions among CHWs, clients, and community members. Objective This study examined the CHW role and relationships between CHWs, communities, and health facilities that promote trust, positive relationships, and social connectedness. Methods In 2016, the CHW program in Neno District, Malawi, was transitioned to a household-level assignment of CHWs to provide screening, linkage to care, and psychosocial and chronic disease support from a disease-based program. We employed an exploratory qualitative study with thematic analysis linked to Fredrickson’s broaden-and-build theory of positive emotions through focus group discussions (FGDs) and in-depth interviews (IDIs) to understand the impact of the household assignment. We purposively sampled community stakeholders, CHWs, health service providers, and clients (total N = 180) from October 2018 through March 2020. All interviews were audiotaped, transcribed verbatim, translated, coded, and analyzed. Results Participants reported decreased stigma and discrimination with increased trust and confidence in CHWs with household-level assignment. Positive relationships between CHWs in their households, community members, and health facility staff fostered health knowledge, individual agency, and personal resources for the community members to access health services. Community members’ personal resources of increased health knowledge, trust, gratitude, and social support improved social connectedness and subjective wellbeing. Areas to improve positive relationships include CHWs maintaining confidentiality and caring for pregnant women. Conclusion Our study findings demonstrate that by building solid relationships as a community chosen, well informed, and household-level workforce, CHWs can develop positive relationships with communities and the health-care facility staff through building knowledge, trust, gratitude, and hope. Further work is needed in maintaining CHW confidentiality and new ways to approach culturally sensitive health areas.

The Role of Community Health Workers in Oral Health Promotion and the Impact of their services in Sub-Saharan Africa: A Systematic Review.

Oral ailments are largely preventable but remain a significant public health concern afflicting nearly half the global population. These conditions account for 220 years of life lost per 100,000 people and about US$500 billion in health-related expenditures. SubSaharan Africa bears a significant burden of oral health problems thus exerting additional pressure on the scarce human resources for health. Community healthcare workers (CHWs) could be potentially utilised to bridge the shortage of oral health professionals in sub-Saharan Africa, hence, this systematic review that seeks to explore their current roles in oral health and potential impact on general physical health. This review follows the PRISMA guidelines and databases searched include PubMed, Web of Science, Medline, and CINAHL published between January 2010 and December 2019. Nine studies met the study eligibility criteria. The authors of this review established that CHWs perform variable roles cutting across primary, secondary, and tertiary prevention including providing oral hygiene education, recognising common pathologies, and treating oral lesions, administration of tooth extractions, dental pain management, and referral for advanced care. Although this could potentially improve oral health, our review did not establish the extent of the specific impact on general physical health of patients and the burden of oral condition.

Using Peer Power to Reduce Health Disparities: Implementation of a Diabetes Support Coach Program in Federally Qualified Health Centers.

Community health workers (CHWs) provide vital support to underserved communities in the promotion of health equity by addressing barriers related to the social determinants of health that often prevent people living with diabetes from achieving optimal health outcomes. Peer support programs in diabetes can also offer people living with diabetes invaluable support through a shared understanding of the disease and by offsetting diabetes-related stigma. As part of a Project Extension for Community Healthcare Outcomes (ECHO) Diabetes program, participating federally qualified healthcare centers were provided diabetes support coaches (DSCs) to facilitate patient engagement. DSCs hold invaluable expert knowledge, as they live with diabetes themselves and reside in areas they serve, thus combining the CHW role with peer support models. The use of DSCs and CHWs during the coronavirus disease 2019 pandemic and beyond is highly effective at reaching underserved communities with diabetes and promoting health equity.

The Role of Community Health Workers in Developing Multidimensional Organizational Relationships.

Effective care coordination relies on organizations working collaboratively to meet medically and socially complex participants' needs. This study examines community health workers' (CHWs') roles in developing the organizational relationships on which care coordination efforts depend. Semistructured interviews (n = 13) were conducted with CHWs, CHWs' supervisors, and executive staff at organizations participating in a Washington State care coordination program. Interviewees described how CHWs developed and furthered multidimensional relationships in service of participants between and within participating organizations, as well as external organizations. Relationship-building challenges included COVID-19, geographic context, and staffing. The study concludes with considerations for care coordination efforts to support CHWs.

Using Implementation Science to Promote Integration and Sustainability of Community Health Workers in the HIV Workforce.

Community health worker (CHW) interventions are an evidence-based practice adopted by health care settings to increase retention in care and viral suppression for people living with HIV (PLWH) from racial/ethnic minority communities. However, disparate funding, unclear roles vis a vis other care team members, limited training and promotion opportunities, and a lack of standards for wages and tasks limit the ability to effectively use CHWs as part of the health care team. Guided by the Exploration, Preparation, Implementation, and Sustainment and Reach, Effectiveness, Adoption, Implementation, and Maintenance frameworks, this study describes the key determinants for CHW integration and sustainability at 3 agencies in Shelby County, TN, to improve viral suppression and reduce disparities among rural and urban people living with HIV. Memphis Transitional Grant Area (TGA) which includes 8 rural and urban counties in west Tennessee, Arkansas, and Mississippi. Seventeen key informants were identified using purposeful and snowball sampling techniques, including community and agency leadership staff, frontline staff, and faith leaders. Key determinants of CHW integration include establishing clear and standardized CHW roles within and across organizations, facilitating interorganizational networks, and leveraging funds for livable CHW wages and sustainable positions. Training strategies that strengthen the CHW workforce include content related to trauma-informed care, managing stress, and cultural humility. Several inner and outer settings and innovation and bridging factors affect CHW positions. Data collected will inform the implementation and sustainment of future policies and interventions intended to improve HIV care continuum outcomes and reduce disparities for PLWH.

Establishing a health profession: What oncology patient navigators can learn from the National Association of Community Health Workers.

Persons who identify as community health workers (CHWs) may hold other titles and/or certifications, including the title of patient navigator (PN). PN roles first emerged from Dr. Harold Freeman's initiative at Harlem Hospital as a strategy to reduce disparities in access to health care, whereas CHW roles extend beyond health systems and are predominantly found in community-based organizations and nonprofits. Although CHWs' origins in the United States predate those of PNs, the growth of CHWs' professional identity and national representation trails that of PNs despite evidence of CHWs' effectiveness since the 1960s. Barriers to progress have included a pattern of short-term and inequitable funding for CHW positions, a lack of employer support for participation in association business, and broad diversity in CHW roles and work settings. The National Association of Community Health Workers (NACHW) was launched in 2019 and built on earlier organizing efforts by multisector, multicultural CHWs and allies in the CHW section of the American Public Health Association and on efforts to create the American Association of Community Health Workers (2006-2009). Trends in health care financing, increasing calls for racial equity, and the coronavirus disease 2019 (COVID-19) pandemic have amplified the unique abilities and trust that CHWs apply to underresourced, marginalized, and multiethnic populations to address both the social determinants of health and health system access, cost, and quality. As a result, the NACHW has been at the forefront of efforts to improve federal funding for COVID responses, to sustain funding for CHWs and their organizations beyond the pandemic, and to drive equity in the rebuilding of public health infrastructure and the transformation of payment models and health systems. Lessons learned from this process that have implications for the oncology patient navigation field include the persistent need to reinforce the value of self-determination for the profession in matters of policy; the importance of actively cultivating unity among diverse cultural and practice groups within the profession; the essential roles of active volunteer leadership, early staffing, and substantial financial support over an extended startup period; the ongoing need for leadership development within a workforce with limited exposure to a professional association culture; the vital importance of ongoing efforts to collaborate with and build capacity among state-level CHW networks; and the value of opportunistic national collaborations in a rapidly evolving policy environment.

The Role of Posyandu Community Health Workers in Improving the Health of Mothers and Children

The COVID-19 pandemic has led to a decline in the quantity and quality of maternal and child health services in Indonesia, especially of Posyandu. According to data from the Ministry of Health, at the end of 2019 there were 298,058 Posyandu in Indonesia and only 65.42% were active. To improve the quality of Posyandu, especially when promoting the adaptation of new habits, community health workers (CHWs) play a very important role. CHWs are expected to be drivers for communities to obtain health services. The purpose of this study was to identify the role of and barriers faced by CHWs in improving maternal and child health in Posyandu Cempaka Mekar Cimahi. This was qualitative research, and data were collected through observations, documentation analysis and interviews with CHWs, pregnant women, and mothers who had babies and toddlers in the work area of Posyandu Cempaka Mekar Cimahi. Secondary data were collected from notes, books and brochures. Data were analyzed using interactive analysis models through four stages: data collection, data reduction, data presentation, and verification. It was found that the role of CHWs in improving maternal and child health in Posyandu Cempaka Mekar was by conducting socialization, counseling and mentoring activities. The obstacles faced by CHWs were a lack of human resources, a lack of supporting devices for CHW activities and a lack of implementation processes. The active role of CHWs in the implementation of Posyandu continues to run well so that the target group still benefits from Posyandu services.
 Keywords: community health worker, maternal and child health, adaptation of new habits

Training community health workers to increase advanced care planning in African American women with breast cancer.

e18549 Background: Black women are more likely to be diagnosed with more aggressive subtypes of breast cancer, at more advanced stages, and have worse outcomes than white women. Rates of advanced care planning (ACP) discussions are lower among black patients with advanced cancer, and they are less likely to receive care concordant with their wishes at end of life. Community health workers (CHW) play a versatile role in bridging social barriers to care and offer a unique mechanism to improve ACP discussions in this population. The aim of our study was to use a mixed methods approach to examine current practices and strategies to facilitate integration of CHW in ACP with black women with breast cancer. Methods: Participants completed a 22-item questionnaire to assess prior training in ACP and experience serving cancer patients. Focus groups were conducted with CHW (N = 5) and providers (i.e., oncologists, radiation oncologists, and palliative medicine physicians; N = 6) to discuss knowledge of ACP, barriers to ACP discussions, strategies to integrate CHW into ACP, and components of an effective ACP training curriculum for CHW. Focus groups were transcribed and two independent coders analyzed the data using the Framework method to extract themes and components of an ACP training curriculum for CHW. Results: Approximately 60% of CHW reported having received prior training in ACP. All providers reported primarily serving Black patients, and 66% self-reported low rates of ACP documentation (10-25%) among their patients. In the focus groups, CHW and providers described elements of effective ACP discussions as patient value-focused, multidisciplinary, timely, and empowering. Common barriers to ACP discussions identified by CHW included inexperience with ACP, unclear responsibility to initiate the discussion, and patient factors such as reluctance and complex social dynamics; providers identified issues of mistrust, historic injustice and power dynamics with their patients. Both CHW and providers viewed the role of CHW in ACP as a longitudinal process to empower, educate and reinforce patients’ values via a non-judgmental member of the community. For both groups, an ideal training curriculum teaches about key oncologic concepts, assesses patient readiness, and increases familiarity with ACP documentation. Conclusions: CHW serve a vital role in bridging care gaps for vulnerable patients and provide an opportunity to improve rates of ACP discussions in Black women with breast cancer. A training curriculum designed to help CHW assess a patient’s understanding of ACP and reinforce a longitudinal conversation is feasible, straightforward and can be incorporated into CHW workflow. One such training curriculum could expose CHW to different ACP documents, provide simulated patient encounters, and educate CHW on verbal and non-verbal cues from providers that may signal an ACP discussion is needed.

Maternal and child surveillance in peri-urban communities: Perceptions of women and community health workers from Pakistan.

Community health workers (CHWs) in maternal, newborn, and child health (MNCH) programs play an important role in demographic surveillance activities; however, there is lack of literature regarding the community and CHWs' perceptions about these activities. The purpose of this study was to explore perceptions of married women of reproductive age (MWRA) regarding the role of CHWs involved in maternal and child surveillance and explore facilitators and barriers for CHWs involved in surveillance activities. A qualitative study was conducted in five peri-urban surveillance sites along the coastal belt of Bin Qasim Town, Karachi, Pakistan. In-depth interviews were conducted with 25 randomly selected MWRAs and 15 CHWs. A thematic analysis was performed to explore perceptions, barriers, and facilitators of the study participants about maternal and child surveillance activities. The results showed that MWRAs perceived surveillance CHWs as service providers with regards to standard counselling i.e. importance of antenatal care, nutrition, immunization, and distribution of iron and folic acid tablets to pregnant women, child growth assessment, and referral of sick children to the health facility. Trust in the CHWs was an enabler for MWRAs, whereas lack of incentives was cited as a barrier to share their health data. CHWs perceived themselves as a bridge in liaising community with the primary health care facility. They highlighted an enabling environment such as appreciation, supportive supervision, training, and utilization of digital data collection tools as facilitators for their work. Low health literacy of the communities, lack of provision of incentives by CHWs to the community, and facility-based experiences of the community were reported as barriers. Surveillance CHWs are an integral link between the health facility and MWRAs. Hence an enabling environment may lead to improved health service delivery, translating into meaningful impact for the mother and child.

Public financing for primary health care is the key to universal health coverage and strengthening health security

Public financing for primary health care is the key to universal health coverage and strengthening health security

Community Health Workers’ Role in Preventing and Controlling the COVID-19 Pandemic

Background. The outbreak of COVID-19 in Iran in February 2019 prompted the Iran’s health system to plan for pandemic prevention and control. The national mobilization program (NMP) against COVID-19 was devised to support the sick and vulnerable and promote community awareness and skills regarding the crisis. This study aimed to investigate the role of community health workers (CHWs) in preventing and controlling the COVID-19 pandemic. Methods. The present study is a descriptive cross-sectional study. The census method was used to study 30,034 rural health workers (RHW) and 22,573 urban health workers (UHW) working in medical universities. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education's Primary Health Network Management Center and were analyzed using descriptive and analytical statistical methods. Results. More than 78 million people were screened during the first phase of the NMP , more than 42 million during the second phase, and more than 59 million during the third phase. In addition, by the end of the fourth phase of the NMP, 4,278,899 highly vulnerable individuals were screened. According to the health system's report, CHWs administered 28,073,777 vaccines since the implementation of the fifth step (until 04.09.2021) Conclusion. Considering the facilities and capabilities of primary health care networks in providing prevention, diagnostic, and treatment services, the activity of the primary health network management center and all affiliated units in the implementation of the NMP has been significant since the beginning of this pandemic. Inadequacies in human resources, financial resources, and training planning should all be considered.

Latino Community Health Workers: Meeting their Community's Emotional Needs in Intuitively Culturally Appropriate Ways.

Scarcity of trained mental health professionals who speak the language and understand Latino cultures is a significant challenge in Oregon. Latinos, particularly immigrants, present to health settings with a variety of psychosomatic symptoms associated with emotional distress. Generalized fear in an anti-immigrant environment is an exacerbating problem that alienates Latinos, regardless of citizenship or immigration status, preventing them from accessing mental health services. The value of community health workers (CHWs) in addressing the health disparities of marginalized groups is immeasurable, and has the potential to be expanded to also assist in meeting the mental health needs of Latino communities. The role of CHWs in providing help to Latinos who are not served by traditional mental health services is explored. This qualitative, participatory research study, codesigned and delivered by CHWs, reports on the experiences of CHWs working with Latinos in Oregon. Focus groups and a survey were used to gather data from CHWs about their experiences responding to the psychoemotional needs of Latinos. CHWs significantly contribute to meeting the gap in provision of culturally relevant crisis intervention, in the language of Latinos in need. Latinos in Oregon rarely make use of traditional mental health services and/or the services offered are linguistically and culturally inadequate. Health care providers are encouraged to attend to both the mental health and physical needs of Latinos in culturally informed and sensitive ways. Given the shortage of adequately trained mental health providers, CHWs are key in accomplishing these goals.

Latino Community Health Workers: Meeting their Community's Emotional Needs in Intuitively Culturally Appropriate Ways.

Latino Community Health Workers: Meeting their Community’s Emotional Needs in Intuitively Culturally Appropriate Ways Martha Lucia Garcia, PhD, LCSW, Lorena Sprager, BA, CHW, and Elizur Bello Jiménez, MSW, CHW Purpose of the Study • The study aimed to determine if community health workers (CHWs) were responding to the mental health needs of the Latino community in Oregon. The researchers suspected that CHWs were filling a gap in services due to a lack of trained bilingual/bicultural mental health professionals. • Simultaneously, the stress of anti-immigrant sentiment and the rise of White supremacist groups who target immigrants were having a deleterious effect on the well-being of the entire Latino community, not just those who are undocumented. • Oregon practitioners believed that CHWs were, in some capacity, responding to the increasing mental health needs of the communities they served, and that they were doing so in culturally appropriate and sensitive ways. This was suspected because CHWs are trusted by these communities, and are a link between health practitioners and the resilient, but marginalized, Latino. • To determine if this was the case, the researchers held a series of focus groups with CHWs who are immersed in the Latino communities in Oregon. Problem • Immigrants tend to present with a range of symptoms that are often misinterpreted and misdiagnosed by medical professionals. The Ulysses Syndrome, as coined by Dr Achetagui, relates physical symptoms with the psychosocial challenges of being an immigrant, encouraging medical practitioners to become familiar with the physical manifestations of unarticulated psychological and emotional suffering. • The current sociopolitical environment and anti-immigrant climate increases the fear and stress experienced by immigrants, which may lead to mental health crises. • The generalized fear and stress reactions are felt by Latino as a whole, as many families are mixed status (immigrant and U.S. citizens), and attacks by White supremacist groups are towards anyone who looks Latino. There are not enough mental health providers to meet the increased hardship. • More important, providers who can adequately respond to the mental health need of the Latino community in culturally and linguistically appropriate ways are even more scarce. A lack of trained professionals limits the support this community receives especially during a time of critical demand. Findings • CHWs are doing the best they can to meet their communities’ emotional needs and have developed culturally appropriate ways of doing so. There is much to be learned from CHWs about what is taking place in Latino communities, and about the creative strategies they use to address these needs. Some of the lessons learned are discussed in the article. Recommendations for how to meet some of the mental health needs of a community marginalized from mainstream resources, and ways administrators can support CHWs, are offered. [End Page 3] • CHWs are charged with great responsibility but often times are not provided with the appropriate supports necessary to adequately do their work. They are impacted by the current anti-immigrant environment, as they are targeted by members of the mainstream community for being allies to undocumented immigrants. They feel undervalued by their employers, as well as colleagues, and medical professionals, who do not realize the breadth and scope of the work they do. • Additionally, CHWs feel they do not receive adequate support from supervisors, which can be due to a lack of knowledge regarding the scope of their work, as well as lack of training for adequate supervision of CHWs. Who Should Care Most • Medical administrators, clinicians, social workers, mental health providers, CHWs, CHW supervisors. • People concerned with meeting the healthcare needs of marginalized Latino and immigrant communities. Recommendations for Action • Provide adequate supervision and training to CHWs so they can offer crisis assistance in the communities they serve. • Adequately train supervisors about the role of CHWs so they understand and properly respond to the breadth and scope of CHWs work as well as the secondary trauma they experience in their crisis-driven work. • Train medical and mental health providers on the CHW model to support culturally appropriate approaches to work with Latino immigrants. • Develop systems to link Latino immigrants with available mental health resources. • Develop methods to effectively employ CHWs, integrating them to the medical team. • Create and sustain educational pipelines and...

Integrating community health workers into a community hearing health collaborative to understand the social determinants of health in children with hearing loss.

Children with hearing loss (HL) require coordination of care to navigate medical and social services. Strong evidence supports the role of community health workers (CHWs) to identify and address social barriers. The goal of this study was to evaluate the impact of integrating CHWs into the medical teams of children with HL and identify the social needs associated with their caregivers at a large urban hospital center. A retrospective chart review was conducted for 30 children with HL whose caregivers enrolled in a CHW program between August 1, 2017 and December 31, 2019. Baseline demographic data were collected, including social circumstances such as food and housing insecurity, status of social security supplemental income (SSI), and need for referral to early intervention (EI) or preschool/school services. Caregivers were assessed for confidence in self-management; baseline distress level was measured via a distress thermometer. Of the 30 charts reviewed, 93% demonstrated social needs including food insecurity (24%) and educational service needs (45%). Eighty-seven percent of caregivers reported a sense of control over the child's condition, yet 73% reported a stress level of four or greater on the distress thermometer scale. At 3 months follow-up, 70% of patients completed referrals; a significant number of patients had obtained hearing aids and cochlear implants compared to baseline (p=0.017). Caregivers of children with HL face multiple social obstacles, including difficulties connecting to educational and financial resources. CHWs are instrumental in identifying social needs and connecting caregivers to services.

Agentes Comunitárias de Saúde na pandemia de Covid-19: scoping review

ABSTRACT This paper aimed to systematize and analyze the literature that addresses the role of Community Health Workers (CHWs) in addressing the Covid-19 pandemic. This scoping review was conducted in the Embase, Lilacs, SciELO, Medline, and Cochrane Virtual Libraries databases. It includes publications from January to December 2020, and the selected studies were submitted to analysis, considering the following categories: practices, training, working conditions, and legitimacy. Twenty-nine studies were included in the review whose CHW performance backdrops were African, South American, North American, Asian, and European countries. The results revealed diversified approaches to practice in the countries studied that involve care, surveillance, health communication, education, administrative, intersectoral articula- tion, and social mobilization actions. The training received does not seem to correspond to the list of practices and expected impact of the CHWs. Working conditions remain substandard, with some extra incentives offered in different backdrops. The recognition and legitimacy before the health authorities reveal the dispute over the direction of health care models and the scope of social protection systems in different countries.

Improving access to maternal health services among rural hard-to-reach fishing communities in Uganda, the role of community health workers.

Objectives:To explore whether community health worker household-based maternal health visits improve antenatal care and skilled birth attendance among hard-to-reach fishing villages on Lake Victoria, Uganda.Methods:This quasi-experimental 18-month prospective study involved 486 consenting women aged 15–49 years, who were pregnant or had a pregnancy outcome in the past 6 months, from 6 island fishing communities. The community health worker household-based intervention (community health workers’ household visits to provide counseling, blood pressure measurement, anemia, and HIV testing) involved 243 women from three fishing communities. Random effects logistic regression was used to determine the association between the community health worker intervention and antenatal care and skilled birth attendance among women who had at least 5 months of pregnancy or childbirth at follow-up.Results:Almost all women accepted the community health worker intervention (90.9% (221/243)). Hypertension was at 12.5% (27/216) among those who accepted blood pressure measurements, a third (33.3% (9/27)) were pregnant. HIV prevalence was 23.5% (52/221). Over a third (34.2% (69/202)) of women tested had anemia (hemoglobin levels less than 11 g/dL). The community health worker intervention was associated with attendance of first antenatal care visit within 20 weeks of pregnancy (adjusted odd ratio = 2.1 (95% confidence interval 0.6–7.6)), attendance of at least four antenatal care visits (adjusted odd ratio = 0.9 (95% confidence interval 0.4–2.0)), and skilled birth attendance (adjusted odd ratio = 0.5 (95% confidence interval 0.1–1.5)), though not statistically significant.Conclusion:Community health workers have a crucial role in improving early antenatal care attendance, early community-based diagnosis of anemia, hypertensive disorders, and HIV among women in these hard-to-reach fishing communities.

Community Health Worker Impact on Knowledge, Antenatal Care, And Birth Outcomes: A Systematic Review.

Community health worker (CHW) interventions have been shown to be effective in areas of maternal and child health (MCH), mostly in relation to infant and neonatal mortality. The specific aims of this review were to expand outcomes to include improving knowledge related to pregnancy and infant health and the receipt of antenatal care(ANC), along with birth outcomes. We also summarized the role, characteristics and activities of CHWs in interventions conducted in settings with demonstrated improvements in key MCH outcomes. Articles were retrieved from: PubMed, CINAHL, Global Health, Scopus, Web of Science, and the Cochrane Library from January 2008 through 2018. We included evaluation studies that utilized CHWs as all or part of an intervention to improve outcomes, were printed in English, and published in peer-reviewed journals. Initial electronic database search identified 816 studies and 123 studies met inclusion criteria for full text review. The quality assessment resulted in 0 strong-, 19 moderate-, and 25 weak-rated studies. In most interventions, CHWs were a component of a larger intervention. The majority of the studies (n = 10) found that a CHW intervention can have a positive impact on outcomes. CHW interventions showed improvements in knowledge and ANC. When combined with clinical services, the interventions positively impacted birth outcomes. Most conducted home visits and utilized CHW that were members of the community. CHWs serve an important role as health educators conducting home visits as a member of the community they serve. They should also continue to collaborate with clinical providers to address MCH outcomes.

Effects of community health worker-based interventions on physical activity levels in children: a systematic review.

ABSTRACTObjective: To identify the strategies and effects of interventions carried out by community health workers (CHW) on physical activity (PA) levels in children and adolescents.Data source: In August 2020, a systematic review, designed according to the PRISMA checklist items, was conducted by searches in seven electronic databases and in reference lists. Original studies were searched without restriction with regard to year of publication; they were written in Spanish, English or Portuguese and examined interventions implemented by CHW, involving theoretical and/or practical contents of PA, with a focus on children and/or adolescents between three and 19 years of age.Data synthesis: Of the 2,321 studies initially retrieved, eight were included, targeting samples with more specific characteristics (e.g., clinical, ethnic and/or socioeconomic). In all studies, CHW were trained to lead educational activities. In three non-controlled trials, positive results were observed, involving indicators such as moderate and vigorous PA and physical inactivity reduction. Also, two positive results were found in reducing sedentary behavior.Conclusions: Even though most of the interventions included did not have a significant effect on increasing PA levels, the available findings reinforce the role of CHW as an important strategy for dialogue between health services and the most vulnerable communities, and they suggest a greater articulation of these professionals in the actions developed in the school context.

A Programmatic Evaluation of School Preparedness for Latinx Children and Families: A Partnership Program.

Introduction: Latinx children are the fastest-growing ethnic minority of children under the age of 5 years in a tri-county area in the Southeastern United States (US Census, 2018). There are limited culturally and linguistically appropriate school preparedness initiatives in this geographic region. Methods: A cultural and linguistic appropriate program was developed in coordination with the state's largest Latinx advocacy organization and two patient-centered pediatric medical homes (PCPMHs) after securing extramural grant funding for an evidenced-based home visitation program using skilled community health workers (CHWs) aimed at Latinx children at the age of 0-5 years and their caregivers. The program includes developmental screenings using the Ages & Stages Questionnaires®, Third Edition (ASQ®-3), CHW role modeling of developmentally appropriate play, early literacy, connection to resources, oral health, nutrition, and physical activity. Results: Of the 103 unique children represented in this programmatic evaluation that received an initial and follow-up ASQ®-3 developmental screening, paired t-tests indicate statistically significant improvement in mean scores from the first to second ASQ®-3 in all five major developmental domains with the largest gains represented in the communication and fine motor skill domains. Conclusion: This evaluation suggests that low-frequency home visits from skilled CHWs can have a beneficial effect on development in early childhood. PPCMHs can serve as a hub for these community-based programs.

Evaluating the association of state regulation of community health workers on adoption of standard roles, skills, and qualities by employers in select states: a mixed methods study

BackgroundThe occupation of community health worker (CHW) has evolved to support community member navigation of complex health and social systems. The U.S. Bureau of Labor Statistics formally recognized the occupation of community health worker (CHW) in 2009. Since then, various national and state efforts to professionalize the occupation have been undertaken. The Community Health Workers Core Consensus (C3) project released a set of CHW roles and competency recommendations meant to provide evidence-based standards for CHW roles across work settings. Some states have adopted the recommendations; however, there are a variety of approaches regarding the regulation of the occupation. As of 2020, 19 U.S. states have implemented voluntary statewide CHW certification programs. The purpose of this study was to explore the relationship between state regulation of CHWs and adoption of standard roles, skills, and qualities by employers in select states.MethodsThis mixed methods study used purposive sampling of job ads for CHWs posted by employers from 2017 to 2020 in select states. Natural language processing was used to extract content from job ads and preprocess the data for statistical analysis. ANOVA, chi-square analysis, and MANOVA was used to test hypotheses related to the relationship between state regulation of CHWs and differences in skills, roles, and qualities employers seek based on seniority of state regulatory processes and employer types.ResultsThe mean job ads with nationally identified roles, skills, and qualities varies significantly by state policy type (F(2, 4801) = 26.21) and by employer type (F(4, 4799) = 69.08, p = 0.000).ConclusionsEmployment of CHWs is increasing to provide culturally competent care, address the social determinants of health, and improve access to health and social services for members of traditionally underserved communities. Employers in states with CHW certification programs were associated with greater adoption of occupational standards set by state and professional organizations. Wide adoption of such standards may improve recognition of the CHW workforce as a valuable resource in addressing the needs of high-need and marginalized groups.