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Building a Framework for Community Health Worker Skills Proficiency Assessment to Support Ongoing Professional Development
... Additionally, integration of CHWs at the table with top-level management lets CHWs advocate for their needs [18]. Several frameworks promote CHW roles and skills including advocacy, specializations of roles and skills, and details surrounding CHW trainings [18][19][20][21][22]. For example, one workforce framework delineates 3 categories of CHWs based on training, workplace setting, and scope of practice while linking these categories to measurable competencies [19]. ...
... Supervisors can advocate for several macrosystem supports including prioritizing CHW mental health and addressing the stigma around requesting help, providing a safe space for CHWs to discuss their needs and stress, reinforcing workload boundaries for CHWs, and regularly meeting with their CHWs to continually strengthen their organization. Oftentimes, individuals are placed into supervisor positions without formal leadership training or the tools needed to successfully supervise a team of CHWs [21]. Development of supportive CHW supervisors will require the integration of specialized training on how to best support and meet the needs of the CHW workforce. ...
Half of the foreign-born population in the United States speaks English "less than very well." The extant literature suggests that low-English-proficient (LEP) patients experience poorer healthcare outcomes than do language-concordant patients. It remains unclear which methods of interpreter services are best for communicating effectively and achieving positive health outcomes for LEP patients. This review examines interpretation methods to compare their effectiveness and frequency of use and identifies the remaining gaps in our knowledge. The evidence suggests that any type of professional language service is superior to untrained interpreting and vastly better than not using an interpreter at all. Even with this knowledge, use of interpreter services is unacceptably low and gaps remain. Further research is needed to isolate and examine different methods of interpretation and measure objective health outcomes. In addition, education is needed for interpreters and healthcare providers to ensure the most effective communicative strategies for LEP patients.
... Additionally, integration of CHWs at the table with top-level management lets CHWs advocate for their needs [18]. Several frameworks promote CHW roles and skills including advocacy, specializations of roles and skills, and details surrounding CHW trainings [18][19][20][21][22]. For example, one workforce framework delineates 3 categories of CHWs based on training, workplace setting, and scope of practice while linking these categories to measurable competencies [19]. ...
... Supervisors can advocate for several macrosystem supports including prioritizing CHW mental health and addressing the stigma around requesting help, providing a safe space for CHWs to discuss their needs and stress, reinforcing workload boundaries for CHWs, and regularly meeting with their CHWs to continually strengthen their organization. Oftentimes, individuals are placed into supervisor positions without formal leadership training or the tools needed to successfully supervise a team of CHWs [21]. Development of supportive CHW supervisors will require the integration of specialized training on how to best support and meet the needs of the CHW workforce. ...
Community health workers (CHWs) serve as the linkage between community and providers and are stakeholders for bridging services to the public. However, integration of CHWs into health care organizations is often lacking. This study explored macrosystem level barriers faced by CHWs and their ability to do their jobs effectively. Using qualitative interviews from CHWs (n = 28) in Nebraska, we used an abductive approach to derive the following themes: (1) CHWs and client macrosystem barriers, (2) CHW workforce supports, and (3) macrosystem solutions for CHW workforce sustainability. Study results also found various macrosystem barriers affecting CHW workforces including immigration policies, insurance policies, funding sources, supervisor support, and obstacles for health seeking of clients. Moreover, through the lens of CHWs, results revealed the need to provide and advocate for solutions that prioritize the needs of CHWs as they continue to fill a crucial gap in community healthcare systems.
... The primary results add to a growing body of literature indicating that peer-to-peer support is feasible to implement and acceptable to VHVs who work in low-resource areas. This program also demonstrated that training sessions based on community needs can increase VHVs' skill competencies and have positive outcomes for older adults with chronic diseases in terms of disease management, continuing care, flexibility, and accessibility services [4, 13,30,36]. Moreover, Choowong et al. [11] reported that care service delivery by VHVs in their communities allowed VHVs to make themselves heard and demonstrate their competency to healthcare professionals, which enhanced healthcare professionals' confidence in working with VHVs [39,40]. ...
Objectives:
This study aimed to investigate the effect of a peer-training program for village health volunteers (VHVs) to improve chronic disease management among older adults in rural Thailand.
Methods:
The study was guided by community-based participatory research (CBPR). The peer-training program was developed by engaging diverse stakeholders, including community organizations, healthcare services, VHVs, older adults with chronic illnesses, and folk scholars in remote communities with high healthcare needs. The peer-training program comprised a three-day training workshop that convened once a week for three weeks with the following six sessions: knowledge sharing, peer support and empowerment, health literacy and health behavior, the general caring procedure for older adults with chronic illnesses, information sharing and communication, and home visit. From January to April 2021, a total of 28 VHVs completed the peer training program in a rural area in Chiang Rai province, Thailand. The Health Literacy and Health Behavior-3E2S (HLHB-3E2S), the Management of Non-Communicable Diseases Questionnaire (MNCDQ), and a self-confidence questionnaire were used to survey pre (week 1) and post-intervention (week 12), respectively. Then VHVs were interviewed to collect attitudes, and opinions about the intervention.
Results:
After the intervention, the HLHB-3E2S scores (49.39 ± 5.54 vs. 52.35 ± 4.26, P = 0.001), the MNCDQ scores (44.10 ± 6.27 vs. 50.60 ± 4.84, P < 0.001), and the self-confidence questionnaire scores (22.28 ± 2.46 vs. 23.21 ± 1.81, P = 0.01) of VHVs significantly increased. VHVS also reported that the peer-training program enhanced their healthcare services, including health education, chronic disease management, leadership skills, and improving their relationship with healthcare providers.
Conclusion:
Peer training programs are a practical strategy to improve VHVs' capacities.Healthcare professionals should provide a continuous training program for VHVs with their peers to increase capacities, confidence, and satisfaction in caring for the older adults with chronic diseases in the community.
... In the United States, extensive studies document that peer support can make important contributions to health, health care, and prevention [5,6]. The development of the community health worker workforce constitutes an important element of this landscape, emphasizing extensive training and professional identity [7]. Similarly, within behavioral health and services addressing substance use problems, mental health peer support specialists also meet extensive background and training requirements and have emerged both within the Veterans Administration as well as in many programs supported by Medicaid and other funders [8]. ...
... Similarly, there is variation across states in what has been implemented and adopted, while still others have proposed newer frameworks for advancing the profession. [17][18][19] Two thirds (67%) of the study population reported the need to hire more CHWs, suggesting that the utility of CHWs is widely recognized among employers in Nebraska. Government funds (76%) and general operating budget (68%) were the major sources of funding for CHWs. ...
The Patient Protection and Affordable Care Act supports the integration of community health workers (CHWs) into the health care workforce, but little is known about integration and current roles of CHWs among employers in community settings. This analysis of 97 employers described the roles of CHWs in Nebraska and found significant differences between CHWs practicing in rural and urban areas in organization types employing CHWs, funding sources, and minority populations served. The findings suggest that the utility of CHWs is widely recognized among employers, but deliberate support will be needed to better define the roles of CHWs to meet the needs of the increasingly diverse demographic.
... This points to a major deficit in the training of health professionals on-the-job in order to make them system-ready for delivering services to the community members. This finding comes at the backdrop of previous studies which have established the important role of on-the-job training [25,26]. ...
Background
In 1999, Ghana introduced the Community-Based Health Planning and Services (CHPS) as the key primary health care strategy. In this study, we explored the challenges, capacity development priorities, and stakeholder perspectives on improving the CHPS concept as it has been fraught with a myriad of challenges since its inception. Our study is the outcome of the national programme for strengthening the implementation of CHPS Initiative in Ghana (CHPS+) introduced in 2017.
Methods
This exploratory research was a qualitative study conducted in two Systems Learning Districts (SLDs) of CHPS+ in the Volta Region of Ghana from March to May, 2018. Four focus group discussions and two general discussions were conducted among 60 CHPS+ stakeholders made up of health workers and community members. Data analyses were conducted using conceptual content analysis. Statements of the participants were presented as quotes to substantiate the views expressed.
Results
Negative attitude, high attrition, inadequacy and unavailability of health professionals at post when needed were challenges associated with the health professionals. Late referrals, lack of proper community entry and engagement, non-availability of essential logistics, distance of CHPS compounds from communities, and inadequate funding were challenges associated with the health system. Lack of community ownership of the CHPS programme, lack of security at CHPS compounds, and late reporting of cases by the community members were also realised as challenges emanating from the community members. Priority areas for capacity development of health workers identified included logistics management, community entry and engagement, emergency delivery, managing referrals at the CHPS level, and resuscitation of newborns.
Conclusion
Health-worker, community, and health systems-based challenges inhibit the implementation of CHPS in Ghana. Capacity development of health professionals and continuous community engagement are avenues that can improve implementation of the programme.
... Workforce development is an important aspect in advancing the work of PNs and CHWs. [45][46][47][48] action plans reflected the many ways programs are working to develop and build capacity within PN and CHW workforces by providing trainings and networking opportunities, working to secure solid sources of financing, working to standardize roles and competencies, and working toward credentialing. Not every NCCCP awardee reported being involved in each of these workforce development activities, but it is clear that many awardees have prioritized taking part in PN and/or CHW workforce development to increase the capacity of PNs and CHWs to serve populations within their jurisdictions. ...
Purpose: Health disparities persist across the cancer care continuum. Patient navigator (PN) and community health worker (CHW) interventions are designed to increase health equity. National Comprehensive Cancer Control Program (NCCCP) awardees develop and implement plans to coordinate cancer prevention and control activities, including supporting PN and CHW interventions. This content analysis examined NCCCP action plans to assess the extent to which jurisdictions report engaging in PN and/or CHW activities.
Methods: We abstracted PN and CHW content from NCCCP action plans and coded content according to specific areas of PN and/or CHW intervention (e.g., screening, survivorship, and cancer type), used descriptive statistics to characterize overall results, and calculated chi-squares to determine whether programs engaged PNs and CHWs differently.
Results: Eighty-two percent (n=53) of 65 NCCCP action plans had content related to PN and/or CHW activities, with more PN language (83%) than CHW (58%). These action plans described engaging PNs and CHWs in activities across the cancer continuum, but particularly for screening (60%) and survivorship (55%). Eighty-one percent of these plans described activities related to workforce development, such as training and standardizing roles and competencies. Programs engaged CHWs more often than PNs for outreach and in community settings.
Conclusion: The majority of NCCCP awardees reported engaging in PN and/or CHW activities. Understanding how NCCCP awardees engage PNs and CHWs, including awardees' needs for workforce development in this area, can help Centers for Disease Control and Prevention provide more focused technical assistance as programs increase engagement of PNs and CHWs to improve health equity.
Cardiovascular disease (CVD) and stroke are major contributors to chronic disease burden in the United States. Despite the high prevalence of stroke, 90% of all stroke events are preventable and can be attributed to seven key modifiable risk factors (MRFs)—high blood pressure (BP), high cholesterol, diabetes mellitus (DM), smoking, obesity, unhealthy diet, and physical inactivity. In the United States, stroke prevention interventions led by community health workers (CHWs) have been proven to be highly effective in preventing the onset of MRFs. We conducted a scoping review of the competency assessment methods used in CVD and stroke-focused CHW training programs. We searched six online databases: PubMed, Cochrane, CINAHL, Embase, Web of Science, and HaPI, from all available years until January 2021. Of the 1,774 initial articles found, we identified 30 eligible articles to be included in the review. Nine of these studies used previously validated instruments, whereas the remaining 21 studies used tools from the training curriculum or independently developed instruments. Only five of these validated tools reported psychometric properties; none of them were designed for the CHW population. Our scoping review of literature revealed that CHW-specific competency assessment methods were limited, with few or no domain-referenced tools on CVD or stroke risk factors that complied with established measurement standards. We conclude that there is an urgent need for the development of a comprehensive and valid assessment instrument in CVD and stroke prevention to evaluate CHW performance and optimize their credibility, representing important first steps toward integrating CHWs into health care systems.
This chapter describes the Community Health Worker Core Consensus (C3) Project carried out from 2014 to 2018. The focus of the C3 Project was to develop an updated contemporary list of CHW core roles and competencies (skills and qualities) common in the United States, using the National Community Health Advisor Study (NCHAS, 1994–1998) as a baseline. This chapter outlines the process of undertaking the Project and the methods incorporated to maximize CHW voice and leadership in the process. The chapter closes with a presentation of the C3 Project’s updated CHW core roles and competencies. Of those roles or areas of CHW scope of work, three were newly identified since the NCHAS. They are implementing individual and community assessments; conducting outreach; and participating in evaluation and research. These and the other seven roles named by the C3 Project serve as the foundation for the organization of the ten roles highlighted in this book. Skills newly identified or refined in the same time frame include individual and community assessment skills; outreach skills; professional skills and conduct; and evaluation and research skills. Finally, qualities embraced by the C3 Project are noted; these are based on previous research in the field. The most prominent is the quality of CHWs’ “connection to the community served.”
Community health workers (CHWs) have gained increased visibility in the United States. We discuss how to strengthen the roles of CHWs to enable them to become collaborative leaders in dramatically changing health care from “sickness care” systems to systems that provide comprehensive care for individuals and families and supports community and tribal wellness.
We recommend drawing on the full spectrum of CHWs’ roles so that they can make optimal contributions to health systems and the building of community capacity for health and wellness.
We also urge that CHWs be integrated into ”community health teams” as part of “medical homes” and that evaluation frameworks be improved to better measure community wellness and systems change.
Today's ambulatory care providers face numerous challenges as they try to practice efficient, patient-centered medicine. This article explains how community health workers (CHWs) can be engaged to address many patient- and system-related barriers currently experienced in ambulatory care practices. Community health workers are frontline public health workers who serve as a trusted bridge between community members and health care providers. Among their varied roles, CHWs can educate and support patients in managing their risk factors and diseases and link these patients to needed resources. As shown in this overview (CHW 101), including CHWs as members of multidisciplinary care teams has the potential to strengthen both current and emerging models of health care delivery.
The recent inclusion of community health workers (CHWs) in the U.S. Department of Labor's 2010 Standard Occupational Classification System provides an opportunity for health educators to reflect on their relationship with CHWs. The authors discuss the ways that health educators and CHWs differ in their orientation toward professionalization and employ the concept of the "experience-based expert" to highlight what they believe to be the unique contributions of CHWs. Finally, considerations important for health educators and CHWs as they work to advance supportive and complementary practices are discussed.
Community health workers are recognized in the Patient Protection and Affordable Care Act as important members of the health care workforce. The evidence shows that they can help improve health care access and outcomes; strengthen health care teams; and enhance quality of life for people in poor, underserved, and diverse communities. We trace how two states, Massachusetts and Minnesota, initiated comprehensive policies to foster far more utilization of community health workers and, in the case of Minnesota, to make their services reimbursable under Medicaid. We recommend that other states follow the lead of these states, further developing the workforce of community health workers, devising appropriate regulations and credentialing, and allowing the services of these workers to be reimbursed.
Science studies has shown us why science and technology cannot always solve technical problems in the public domain. In particular, the speed of political decision-making is faster than the speed of scientific consensus formation. A predominant motif over recent years has been the need to extend the domain of technical decision-making beyond the technically qualified elite so as to enhance political legitimacy. We argue, however, that theProblem of Legitimacy' has been replaced theProblem of Extension.' This is a tendency to dissolve the boundary between experts and the public so that there are no longer any grounds for limiting the indefinite extension of technical decision-making rights. We argue that a Third Wave of science studies -- Studies of Expertise and Experience (SEE) -- is needed to solve the Problem of Extension. SEE will include a normative theory of expertise and will disentangle expertise from political rights in technical decision-making. The theory builds categories of expertise starting with the key distinction between interactive expertise and contributory expertise. A new categorisation of types of science is also needed. We illustrate the potential of the approach by re-examining existing case studies including Wynne's study of Cumbrian sheep farmers. Sometimes the new theory argues for more public involvement, sometimes for less. An Appendix describes existing contributions to the problem of technical decision-making in the public domain.
Members of the community health worker (CHW) workforce have new opportunities to work within the health care system. These opportunities come with questions and challenges about the roles CHWs can play and their specific capacity building and training needs. We use a mixed methods approach including a cross sectional survey of 265 CHWs and qualitative interviews with a subset of survey respondents (n=23) to gather perspectives from CHWs about workforce capacity building needs for CHWs working within transformative health care organizations. Eighty percent of CHWs agreed or strongly agreed that they feel well trained to carry out their duties as CHWs. CHWs ranked communication, advocacy, assurance of services, and culturally competent services as priority roles. In addition, creating a learning environment for CHWs working in health care settings is essential to support capacity building for CHWs. Understanding training needs for CHWs can help improve the relationship and understanding between CHWs and other care team members. Capacity building efforts through appropriate training and supervision of CHWs assists with CHW integration and enhances the fidelity of information CHWs deliver to patients.
Community health workers may become instrumental members of future U.S. health care teams, addressing upstream contributors to health and illness, but CHW programs must address some key implementation barriers to succeed in the post-reform era.
Policymakers, patients and clinicians are increasingly eager to foster patient involvement in health care innovation. Our objective was to use participatory action research with high-risk hospitalized patients to design a post-hospital transition intervention.
We conducted qualitative interviews with sixty-five low-income, recently hospitalized patients exploring their perceptions of barriers to post-hospital recovery and ideas for improvement. We then used a modified grounded theory approach to design an intervention that would address each barrier using patients׳ suggestions.
Five key themes were translated into design elements. First, patients wished to establish a relationship with healthcare personnel to whom they could relate. The intervention was provided by an empathic community health worker (CHW) who established rapport during hospitalization. Second, patients suggested tailoring support to their needs and goals. CHWs and patients designed individualized action plans for achieving their goals for recovery. Third, patient goals were misaligned with those of the inpatient team. CHW facilitated patient-provider discharge communication to align goals. Fourth, patients lacked post-discharge support for predominantly psychosocial or financial issues that undermined recovery. CHWs provided support tailored to patient needs. Finally, patients faced numerous barriers in obtaining post-hospital primary care. CHWs helped patients to obtain timely care with a suitable provider.
Low-income hospitalized patients voiced needs and suggestions that were directly translated into the design of a scalable patient-centered CHW intervention.
The approach of using participatory action research to tightly mapping patient input into intervention design is rapid and systematic strategy for operationalizing patient involvement in innovation.
Copyright © 2014 Elsevier Inc. All rights reserved.
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