Learning from Community Health Worker Programs, Big and Small

2013

• CHW training needs to be carefully adapted to the needs of the trainees, the job, and the tasks they are expected to perform and the context in which they will be working. • Current training approaches and techniques that are effective for training CHWs should be employed. • Examples of training programs and their structures from a variety of CHW programs are provided.

American Journal of Public Health, 2012

Community health workers (CHWs) are increasingly being incorporated into health programs because they are assumed to effectively deliver health messages in a culturally relevant manner to disenfranchised communities.Nevertheless, the role of CHWs—who they are, what they do, and how they do it—is tremendously varied. This variability presents a number of challenges for conducting research to determine the effectiveness of CHW programs, and translating research into practice.We discuss some of these challenges and provide examples from our experience working with CHWs. We call for future research to identify the “core elements” of effective CHW programs that improve the health and well-being of disenfranchised communities.

Human Resources for Health, 2015

Background: There is robust evidence that community health workers (CHWs) in low-and middle-income (LMIC) countries can improve their clients' health and well-being. The evidence on proven strategies to enhance and sustain CHW performance at scale, however, is limited. Nevertheless, CHW stakeholders need guidance and new ideas, which can emerge from the recognition that CHWs function at the intersection of two dynamic, overlapping systemsthe formal health system and the community. Although each typically supports CHWs, their support is not necessarily strategic, collaborative or coordinated.

2016

No words or space can capture my heartfelt appreciation to everyone who has supported me on this journey. In the deepest way possible, I honor my dissertation committee members. Your mentorship and unwavering support throughout this journey have helped prepared me for this moment. I am especially appreciative of my family, fictive kinfolks, friends, colleagues, students, and acquaintances who always found time to listen, encourage and support me in whatever way possible. You each contributed more than you'll ever know and for that, I am eternally grateful.

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Public Health Nursing, 2002

Community health workers (CHWs) are promoted as a mechanism to increase community involvement in health promotion eorts, despite little consensus about the role and its eectiveness. This article reviews the databased literature on CHW eectiveness, which indicates preliminary support for CHWs in increasing access to care, particularly in underserved populations. There are a smaller number of studies documenting outcomes in the areas of increased health knowledge, improved health status outcomes, and behavioral changes, with inconclusive results. Although CHWs show some promise as an intervention, the role can be doomed by overly high expectations, lack of a clear focus, and lack of documentation. Further research is required with an emphasis on stronger study design, documentation of CHW activities, and carefully de®ned target populations.

American Journal of Preventive Medicine, 2009

Background: Research evaluating community health worker (CHW) programs inherently involves these natural community leaders in the research process, and often represents community-based participatory research (CBPR). Interpreting the results of CHW intervention studies and replicating their findings requires knowledge of how CHWs are selected and trained.

2011

Community health workers (CHWs) are promoted as a mechanism to increase community involvement in health promotion eorts, despite little consensus about the role and its eectiveness. This article reviews the databased literature on CHW eectiveness, which indicates preliminary support for CHWs in increasing access to care, particularly in underserved populations. There are a smaller number of studies documenting outcomes in the areas of increased health knowledge, improved health status outcomes, and behavioral changes, with inconclusive results. Although CHWs show some promise as an intervention, the role can be doomed by overly high expectations, lack of a clear focus, and lack of documentation. Further research is required with an emphasis on stronger study design, documentation of CHW activities, and carefully de®ned target populations.

Journal of Ambulatory Care Management, 2019

Community health worker (CHW) programs can act as bridges between patients and health care teams, but the complexity and variability of program components and outcomes make them difficult to evaluate. This evaluation used a realist approach to identify underlying mechanisms and contextual factors associated with successful implementation of a community-placed CHW program affiliated with a primary care practice in the Midwest United States. The analysis identified mechanisms by which stakeholders built trust, self-efficacy, and empowerment to improve patient-centered outcomes and experiences. It also identified conditions that support activation of these mechanisms, including the ability of CHWs to make home visits, effective communication between members of the care team across settings, and clarity about the role of the CHW relative to other support services for patients. This type of context-mechanismoutcome evaluation facilitated development of recommendations responsive to local context.

Health Research Policy and Systems, 2021

Background: This is the ninth paper in our series, "Community Health Workers at the Dawn of a New Era". Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain beneficial relationships with both sets of actors, who may have different expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities. Methods: The authors conducted a selective review of journal articles and the grey literature, including case study findings in the 2020 book Health for the People: National CHW Programs from Afghanistan to Zimbabwe. They also drew upon their experience working with CHW programmes. Results: The space where CHWs form relationships with the health system and the community has various inherent strengths and tensions that can enable or constrain the quality of these relationships. Important elements are role clarity for all actors, working referral systems, and functioning supply chains. CHWs need good interpersonal communication skills, good community engagement skills, and the opportunity to participate in community-based organizations. Communities need to have a realistic understanding of the CHW programme, to be involved in a transparent process for selecting CHWs, and to have the opportunity to participate in the CHW programme. Support and interaction between CHWs and other health workers are essential, as is positive engagement with community members, groups, and leaders. Conclusion: To be successful, large-scale CHW programmes need well-designed, effective support from the health system, productive interactions between CHWs and health system staff, and support and engagement of the community. This requires health sector leadership from national to local levels, support from local government, and partnerships with community organizations. Large-scale CHW programmes should be designed to enable local flexibility in adjusting to the local community context.