Community Health Workers Can Be a Public Health Force for Change in the United States: Three Actions for a New Paradigm

Health Science Center Houston, El Paso Regional Campus, University of Texas School of Public Health, El Paso, 79968, USA.
American Journal of Public Health (Impact Factor: 4.55). 12/2011; 101(12):2199-203. DOI: 10.2105/AJPH.2011.300386
Source: PubMed


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.

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    • "resources in the Hispanic community is the community health worker/Promotora de Salud (CHW/PS, terms used interchangeably) model. CHW/PS are members of a community who serve as a link between community members and health care providers, providing information and social support in a culturally competent manner (Balcázar et al., 2011; Witmer, Seifer, Finocchio, Leslie, & O'Neil, 1995). Although not specifically oriented at promoting the use of existing recreational facilities, studies have shown that PS may be able to promote physical activity and diet in CVD risk reduction programs aimed at Hispanics such as Camina por Salud ( " Walks for Health " ; Keller & Cantue, 2008), "
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    ABSTRACT: Introduction: Limited research has documented interventions aimed at promoting use of existing recreational community resources among underserved populations. This study (HEART [Health Education Awareness Research Team] Phase 2) reports findings of an intervention (Mi Corazón Mi Comunidad) where community health workers facilitated use of diet and exercise programming at local recreational facilities among Mexican American border residents. The aim was to evaluate overall attendance rates and to assess which factors predicted higher attendance. Method: The design was a cohort study. From 2009 to 2013, a total of 753 participants were recruited across 5 consecutive cohorts. The intervention consisted of organized physical activity and nutrition programming at parks and recreational facilities and a free YWCA membership. Attendance at all activities was objectively recorded. Regression analyses were used to evaluate whether demographic factors, health status, and health beliefs were associated with attendance. Results: Participants included mostly females at high risk for cardiovascular disease (72.4% were overweight/obese and 64% were [pre-]hypertensive). A total of 83.6% of participants attended at least one session. On average, total attendance was 21.6 sessions (range: 19.1-25.2 sessions between the different cohorts), including 16.4 physical activity and 5.2 nutrition sessions. Females (p = .003) and older participants (p < .001) attended more sessions. Participants low in acculturation (vs. high) attended on average seven more sessions (p = .003). Greater self-efficacy (p < .001), perceived benefits (p = .038), and healthy intentions (p = .024) were associated with higher attendance. Conclusions: The intervention was successful in promoting use of recreational facilities among border residents at high risk for cardiovascular disease. Findings were similar across five different cohorts.
    No preview · Article · Nov 2015 · Health Promotion Practice
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    • "workforce development and sustainable financing mechanisms, limits the integration of CHWs into new systems of care (Balcazar et al., 2011). Statewide CHW coalitions are addressing these concerns by focusing on expansion of the CHW workforce and influencing health policy (Rosenthal et al., 2010). "
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    ABSTRACT: Community health workers (CHWs) have demonstrated effectiveness in improving health outcomes and addressing health inequities. Statewide CHW coalitions are supporting expansion of the CHW workforce and influencing health policy. Evaluations can play a key role in sustaining coalitions. This article discusses how evaluation has informed the development, processes, and initiatives of the Michigan Community Health Worker Alliance. We highlight the Michigan Community Health Worker Alliance's internal process evaluation, a statewide survey of CHW programs, and other evaluation activities to illustrate how CHW coalitions can use participatory evaluation to develop and reinforce coalition strengths and accomplish mutual goals.
    Full-text · Article · Sep 2015 · The Journal of ambulatory care management
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    • "The size of the workforce is considerable in both of these countries, with Brazil employing 257,265 ( Johnson et al. 2013) and Iran 31,000 ( Javanparast et al. 2011) workers. CHWs in the USA, estimated to number more than 121,000 (HRSA 2007), are recognized as part of the health workforce and have their own CHW Standard Occupational Category – SOC #21 – 1094 Community Health Worker – which recognizes these workers as a distinct occupation (Balcázar et al. 2011; Federal Register 2009). "
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    ABSTRACT: This article reports findings from an applied case study of collaboration between a community-based organization staffed by community health workers/multicultural health brokers (CHWs/MCHBs) serving immigrants and refugees and a local public health unit in Alberta, Canada. In this study, we explored the challenges, successes and unrealized potential of CHWs/MCHBs in facilitating culturally responsive access to healthcare and other social services for new immigrants and refugees. We suggest that health equity for marginalized populations such as new immigrants and refugees could be improved by increasing the role of CHWs in population health programs in Canada. Furthermore, we propose that recognition by health and social care agencies and institutions of CHWs/MCHBs, and the role they play in such programs, has the potential to transform the way we deliver healthcare services and address health equity challenges. Such recognition would also benefit CHWs and the populations they serve. Copyright © 2014 Longwoods Publishing.
    Full-text · Article · Aug 2014 · Healthcare policy = Politiques de sante
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