Outcomes and Costs of Community Health Worker Interventions

RTI International, Research Triangle Park, NC 27709-2194, USA.
Medical care (Impact Factor: 3.23). 09/2010; 48(9):792-808. DOI: 10.1097/MLR.0b013e3181e35b51
Source: PubMed


We conducted a systematic review on outcomes and costs of community health worker (CHW) interventions. CHWs are increasingly expected to improve health outcomes cost-effectively for the underserved.
We searched Medline, Cochrane Collaboration resources, and the Cumulative Index to Nursing and Allied Health Literature for studies conducted in the United States and published in English from 1980 through November 2008. We dually reviewed abstracts, full-text articles, data abstractions, quality ratings, and strength of evidence grades and resolved disagreements by consensus.
We included 53 studies on outcomes of CHW interventions and 6 on cost or cost-effectiveness. For outcomes, limited evidence (5 studies) suggests that CHW interventions can improve participant knowledge compared with alternative approaches or no intervention. We found mixed evidence for participant behavior change (22 studies) and health outcomes (27 studies). Some studies suggested that CHW interventions can result in greater improvements in participant behavior and health outcomes compared with various alternatives, but other studies suggested that CHW interventions provide no statistically different benefits than alternatives. We found low or moderate strength of evidence suggesting that CHWs can increase appropriate health care utilization for some interventions (30 studies). Six studies with economic information yielded insufficient data to evaluate the cost-effectiveness of CHW interventions relative to other interventions.
CHWs can improve outcomes for underserved populations for some health conditions. The effectiveness of CHWs in many health care areas requires further research that addresses the methodologic limitations of prior studies and that contributes to translating research into practice.

Download full-text


Available from: Jennifer L Kraschnewski,
44 Reads
  • Source
    • "An increased demand for primary care services and projected shortfalls in primary care physician supply under current delivery models necessitate greater involvement of nonphysician clinician and staff in patient care. Previous research indicates that, compared with single physician approaches, interdisciplinary care team approaches to primary care can yield substantial benefit to patient self-management, patients' experiences of care, and the technical quality of care (Carter et al., 2009; Ohman-Strickland et al., 2008; Stellefson, Dipnarine, & Stopka, 2013; Vermeire et al., 2005; Viswanathan et al., 2010). In recognition of the potential benefits of highfunctioning interdisciplinary teams, team-based care is a central feature of the patient-centered medical home (PCMH) and the chronic care models, which aim to improve care coordination and enhance patients' self-management skills. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Early experiences of patient-centered medical home implementation indicate that redesigning primary care is an intensive organizational change that is most effectively undertaken by high-functioning interdisciplinary teams. Team effectiveness research indicates that consistent availability of team members and other aspects of team structure can impact teamwork and organizational outcomes. Methods: We conducted a survey of 766 adult primary care providers and staff in 34 California safety net practices to assess primary care team structure (team size, team member availability, and access to interdisciplinary expertise), teamwork, and readiness for change. We used path models with robust standard errors for clustering of respondents within practices to examine relationships between team member availability and readiness for change. Using path analysis, we examined the extent to which better teamwork mediated relationships between team member availability and readiness for change. Results: We received 628 completed surveys (response rate = 82%). Greater team member availability was associated with greater readiness for change, but the relationship was stronger for staff than for primary care providers. Contrary to our hypothesis, path analyses revealed that the relationship of team member availability and greater readiness for change was only partially mediated (21%) by better teamwork. The direct effect of teamwork on readiness for change is approximately 2.9 times larger than the direct effect of team member availability on greater readiness for change. Conclusions: Ensuring that members perceive that their teammates are routinely available to them may improve readiness for implementing organizational changes like adopting patient-centered medical home models. Given that better teamwork only partially explained the availability-readiness relationship, additional research to identify the mechanisms through which consistent team member availability increases change readiness could lend insight into how to more effectively support clinicians and staff undergoing complex organizational changes.
    Health care management review 01/2016; DOI:10.1097/HMR.0000000000000082 · 1.30 Impact Factor
  • Source
    • "We have been able to show that group-based approaches with underlying behaviour change theory and strong emphasis on peer support will lead to significant improvement in health behaviours and metabolic risk factors [16-19]. More broadly, substantial research from around the world shows the effectiveness of peer support in prevention and disease management [20-24] as well as engaging audiences whom health promotion programs often have difficulty reaching [25,26]. Adapted from these programs, the Kerala Diabetes Prevention Program (K-DPP) is the first implementation trial to evaluate a peer-led, group-based lifestyle intervention program among individuals at ‘high risk’ of developing T2DM in rural India. "
    [Show abstract] [Hide abstract]
    ABSTRACT: India currently has more than 60 million people with Type 2 Diabetes Mellitus (T2DM) and this is predicted to increase by nearly two-thirds by 2030. While management of those with T2DM is important, preventing or delaying the onset of the disease, especially in those individuals at 'high risk' of developing T2DM, is urgently needed, particularly in resource-constrained settings. This paper describes the protocol for a cluster randomised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala, India.Methods/designA total of 60 polling booths are randomised to the intervention arm or control arm in rural Kerala, India. Data collection is conducted in two steps. Step 1 (Home screening): Participants aged 30--60 years are administered a screening questionnaire. Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of >=60 are invited to attend a mobile clinic (Step 2). At the mobile clinic, participants complete questionnaires, undergo physical measurements, and provide blood samples for biochemical analysis. Participants identified with T2DM at Step 2 are excluded from further study participation. Participants in the control arm are provided with a health education booklet containing information on symptoms, complications, and risk factors of T2DM with the recommended levels for primary prevention. Participants in the intervention arm receive: (1) eleven peer led small group sessions to motivate, guide and support in planning, initiation and maintenance of lifestyle changes; (2) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors, prevention and management; (3) a participant handbook containing information primarily on peer support and its role in assisting with lifestyle modification; (4) a participant workbook to guide self-monitoring of lifestyle behaviours, goal setting and goal review; (5) the health education booklet that is given to the control arm. Follow-up assessments are conducted at 12 and 24 months. The primary outcome is incidence of T2DM. Secondary outcomes include behavioural, psychosocial, clinical, and biochemical measures. An economic evaluation is planned. Results from this trial will contribute to improved policy and practice regarding lifestyle intervention programs to prevent diabetes in India and other resource-constrained settings.Trial registrationAustralia and New Zealand Clinical Trials Registry: ACTRN12611000262909.
    BMC Public Health 11/2013; 13(1):1035. DOI:10.1186/1471-2458-13-1035 · 2.26 Impact Factor
  • Source
    • "However, there is very limited information about the utility of CHW approaches to cancer education for Asian American or other minority men. Consequently, several recent reviews of CHW interventions have reported a need for studies that include male participants (Rhodes et al., 2007; Viswanathan et al., 2010). This descriptive report addresses similarities and differences between Cambodian American men and women with respect to the outcomes of our HBV CHW educational intervention. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Cambodian Americans have high rates of chronic hepatitis B virus (HBV) infection and liver cancer. There is very limited information about the utility of community health worker (CHW) approaches to cancer education for Asian American men. We have previously reported our positive findings from a trial of CHW education about HBV for Cambodian Americans who had never been tested for HBV. This report describes similarities and differences between the outcomes of our CHW HBV educational intervention among Cambodian American men and women. Methods: The study group for this analysis included 87 individuals (39 men and 48 women) who were randomized to the experimental (HBV education) arm of our trial, participated in the CHW educational intervention, and provided follow-up data six months post-intervention. We examined HBV testing rates at follow-up, changes in HBV-related knowledge between baseline and follow-up, and barriers to HBV testing (that were reported to CHWs) by gender. Results: At follow-up, 15% of men and 31% of women reported they had received a HBV test (p=0.09). HBV-related knowledge levels increased significantly among both men and women. With respect to HBV testing barriers, women were more likely than men to cite knowledge deficits, and men were more likely than women to cite logistic issues. Discussion: Our study findings indicate that CHW interventions can positively impact knowledge among Cambodian American men, as well as women. They also suggest CHW interventions may be less effective in promoting the use of preventive procedures by Cambodian American men than women. Future CHW research initiatives should consider contextual factors that may differ by gender and, therefore, potentially influence the relative effectiveness of CHW interventions for men versus women.
    Asian Pacific journal of cancer prevention: APJCP 08/2013; 14(8):4705-4709. DOI:10.7314/APJCP.2013.14.8.4705 · 2.51 Impact Factor
Show more