Community health worker roles and their evolving interprofessional relationships in the United States

Perspectives of Health Care Providers in Rural Côte d'Ivoire on the Influence of Traditional Beliefs on the Management of Rheumatic Heart Disease: A Qualitative Study

INTRODUCTION

This article explores the positions of rural Côte d'Ivoire health care practitioners on the role of traditional beliefs in treating Rheumatic Heart Disease (RHD), a disease in which cardiovascular mortality is still high worldwide. Health care decisions in this region are hugely influenced by traditional African medicine (TAM).

METHODS

A qualitative study was created using semi-structured interviews and focus groups with 24 health care experts. The themes and their significance were found using inductive thematic analysis.

RESULTS

The integration of contemporary and TAM, community engagement and collaboration, improving patient education and awareness, consideration of cultural beliefs and practices in care delivery, and tackling delayed care and diagnosis are highlighted as the five main areas for development.

DISCUSSION

The studies reveal possibilities for improving RHD control in rural Côte d'Ivoire. They emphasize the need for legislative action and cultural competency training to overcome challenges like cultural beliefs and budgetary constraints.

The impact of interprofessional collaboration between pharmacists and community health workers on medication adherence: a systematic review

BACKGROUND

There is increasing evidence to support the effectiveness of interventions involving community health workers (CHWs) in improving patient health outcomes, which reinforces their growing integration in healthcare teams. However, little is known about the interprofessional collaboration between pharmacists and CHWs. This systematic review aimed to explore the impact of interprofessional interventions involving pharmacists and CHWs on patient medication adherence.

METHODS

The English language scientific literature published in Embase, MEDLINE, Web of Science, CINAHL, Scopus, plus the grey literature were searched in October 2024. Using the software Covidence, two authors screened article titles and abstracts and assessed full-text articles for eligibility. Studies were included if (i) the intervention was delivered by pharmacists and CHWs and (ii) reported on medication adherence outcomes. Data were extracted using a customized template using Excel and synthetized narratively. The Effective Public Health Practice Project quality assessment tool was used to assess the studies' methodological quality.

RESULTS

Eight studies met the inclusion criteria, including a total of 1577 participants. Seven studies were conducted in the United States, and six were published since 2020. The interventions consisted of medication therapy management, medication reconciliation, and repeated education sessions. The CHW shared clinical and non-clinical patient information and ensured a culturally safe environment while the pharmacist delivered the clinical intervention. In five studies, medication adherence was evaluated solely through patient self-reported measures. One study used an objective measure (i.e., pharmacy refill records) to evaluate medication adherence. Only two studies assessed medication adherence using both self-reported and objective measures (i.e., pill count and proportion of days covered). A significant improvement in medication adherence was observed in three of the eight studies. Half of the studies were of weak quality and half of moderate quality.

CONCLUSIONS

There was a small number of studies identified which focused on the impact of interprofessional collaboration between pharmacists and CHWs on medication adherence. The impact of the interprofessional interventions on medication adherence was limited. Further studies of higher quality are needed to better evaluate the impact of such collaboration on patient health outcomes.

REGISTRATION

PROSPERO, ID CRD42024526969.

Interprofessional collaboration between pharmacists and community health workers: a scoping review

INTRODUCTION

Community health workers (CHWs) help bridge the cultural gap between health services and the communities they serve. CHWs work with physicians, nurses and social workers, but little is known about their collaboration with pharmacists. This scoping review aims to describe the interprofessional collaboration between CHWs and pharmacists, the types of interventions they deliver and CHWs' and pharmacists' specific roles within these interventions.

METHOD

The scientific literature published in PubMed, Embase, MEDLINE, Scopus, Web of Science, PsycInfo, CINAHL and the grey literature were searched. Inclusion criteria were that the research (i) involved pharmacists and CHWs working collaboratively and (ii) included an intervention, service or program. One researcher screened all articles, and two reviewers screened 6% of articles (20/340) assessed for eligibility, using the software Covidence. After the discrepancies were resolved, data from the included articles were extracted using a customized template for data extraction and synthesized narratively.

RESULTS

Eighteen studies met the inclusion criteria. Most were conducted in the USA (14/18) and were published since 2020 (12/18). Most interventions involved medication reviews, support for medication adherence, disease prevention or addressing the social determinants of health. Pharmacists had primarily clinical roles (i.e., medication reconciliation and patient education), while the CHWs' roles consisted of collecting patient information, supporting patient self-management, bridging the cultural gap by translating information in the patient's language and ensuring patient follow-up. The collaborative practice occurred via interprofessional referral, ranging from the CHW facilitating the link between the patient and the pharmacist, and information sharing between the CHW and the pharmacist, to an interprofessional collaborative practice where CHWs and pharmacists delivered the intervention together.

CONCLUSION

While CHWs and pharmacists had independent roles as part of the interventions, they also collaborated at various levels to deliver services to patients. CHWs have an important role to play in bridging the cultural gap between the patient and the pharmacist, in improving patient referral so that more patients can benefit from pharmaceutical services, and in identifying patients' social determinants of health. CHWs and pharmacists can work synergistically and collaboratively to tailor an intervention to the patient's needs, which can improve and optimize pharmaceutical services, and may ultimately positively impact health outcomes.

Facilitators and Barriers in Collaborations Between Community Health Workers with Primary and Well-Being Providers in Primary Healthcare in Belgium

BACKGROUND

Community health workers (CHWs) play a crucial role in bridging the gap between underserved populations and formal health. Collaborations between CHWs and health and well-being providers in primary healthcare are essential for improving access to and the quality of care for these communities. However, these partnerships require complementary strengths and specific conditions to succeed. This article addresses the limited knowledge on collaborations between CHW and primary health and well-being providers in Belgium's CHW program.

METHODS

This study utilized a descriptive qualitative design. First, team collaboration data were gathered using a spreadsheet. Second, semi-structured interviews were conducted separately with 15 CHWs and 18 of their collaboration partners. The results were thematically analyzed.

RESULTS

CHWs collaborate with healthcare partners, partners with a social or societal focus, and government and educational institutions. The scope of collaborations spans sharing knowledge, connecting with the target group, and offering support to individual clients. Collaborations with healthcare providers tend to focus on individual referrals, with less reciprocity, while collaborations with other partners contribute more to outreach activities and addressing broader social determinants of health. Shared motivations and collaborative work methods facilitate collaboration, while internal organizational processes, lack of role clarity, and discrepancies can hinder successful collaboration.

CONCLUSIONS

Strong local partnerships, well-defined roles, and mutual trust are essential for successful collaboration. The study findings highlight the importance of expanding collaborations to meet the diverse and intersecting needs of target groups. Effective program governance and policy are crucial in providing the flexibility necessary to address specific local requirements.

In their own words: Perspectives of IPV survivors on obtaining support within the healthcare system

BACKGROUND

Almost half of all women in the US experience intimate partner violence (IPV) in their lifetime. The US Preventive Services Task Force recommends IPV screening paired with intervention for women of reproductive age. We aim to understand clinical practices and policies that are beneficial, detrimental, or insufficient to support survivors of IPV in a safety-net healthcare system.

METHODS

We sampled 45 women who were 18-64 years old, had experienced IPV within the prior year and were patients in the San Francisco Health Network. We conducted in-depth, semi-structured interviews to elicit their perspectives on disclosing IPV and obtaining support within the healthcare system. We analyzed our data using thematic analysis and grounded theory practices informed by ecological systems theory.

FINDINGS

We identified four themes regarding factors that impeded or facilitated discussing and addressing IPV across interpersonal and systemic levels relating to relationship-building, respect, autonomy and resources. (1) Interpersonal barriers included insufficient attention to relationship-building, lack of respect or concern for survivor circumstances, and feeling pressured to disclose IPV or to comply with clinicians' recommended interventions. (2) Interpersonal facilitators consisted of patient-centered IPV inquiry, attentive listening, strength-based counseling and transparency regarding confidentiality. (3) Systemic barriers such as visit time limitations, clinician turn-over and feared loss of autonomy from involvement of governmental systems leading to separation from children or harm to partners, negatively affected interpersonal dynamics. (4) Systemic facilitators involved provision of resources through IPV universal education, on-site access to IPV services, and community partnerships.

CONCLUSIONS

Women experiencing IPV in our study reported that relationship-building, respect, autonomy, and IPV-related resources were essential components to providing support, promoting safety, and enabling healing in the healthcare setting. Successful trauma-informed transformation of healthcare systems must optimize interpersonal and systemic factors that improve survivor wellbeing while eliminating barriers.

Older Caregivers: Who They Are and How to Support Them

Caregivers play a crucial role in providing health and social supports to their family and friends. Older adults who take on caregiving roles are themselves uniquely vulnerable to negative health and financial effects due to their age and underlying health risks. Many caregivers do not receive adequate support - either formally or informally - exacerbating the strains of providing care. Racial and ethnic minority caregivers may be less likely to report receiving support in their role and face additional challenges. We describe these caregivers over 65 and the burdens they face. We recommend community health workers, direct compensation, and normalization of respite care to support these essential care workers in their role and as they age.

Advancing social care integration in health systems with community health workers: an implementation evaluation based in Bronx, New York

BACKGROUND

In recent years, health systems have expanded the focus on health equity to include health-related social needs (HRSNs) screening. Community health workers (CHWs) are positioned to address HRSNs by serving as linkages between health systems, social services, and the community. This study describes a health system's 12-month experience integrating CHWs to navigate HRSNs among primary care patients in Bronx County, NY.

METHODS

We organized process and outcome measures using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation framework domains to evaluate a CHW intervention of the Community Health Worker Institute (CHWI). We used descriptive and inferential statistics to assess RE-AIM outcomes and socio-demographic characteristics of patients who self-reported at least 1 HRSN and were referred to and contacted by CHWs between October 2022 and September 2023.

RESULTS

There were 4,420 patients who self-reported HRSNs in the standardized screening tool between October 2022 and September 2023. Of these patients, 1,245 were referred to a CHW who completed the first outreach attempt during the study period. An additional 1,559 patients self-reported HRSNs directly to a clinician or CHW without being screened and were referred to and contacted by a CHW. Of the 2,804 total patients referred, 1,939 (69.2%) were successfully contacted and consented to work with a CHW for HRSN navigation. Overall, 78.1% (n = 1,515) of patients reported receiving social services. Adoption of the CHW clinician champion varied by clinical team (median 22.2%; IQR 13.3-39.0%); however, there was no difference in referral rates between those with and without a clinician champion (p = 0.50). Implementation of CHW referrals via an electronic referral order appeared successful (73.2%) and timely (median 11 days; IQR 2-26 days) compared to standard CHWI practices. Median annual cost per household per CHW for the intervention was determined to be $184.02 (IQR $134.72 - $202.12).

CONCLUSIONS

We observed a significant proportion of patients reporting successful receipt of social services following engagement with an integrated CHW model. There are additional implementation factors that require further inquiry and research to understand barriers and enabling factors to integrate CHWs within clinical teams.

A Review of Community Health Worker Integration in Health Departments

Community health workers (CHWs) are frontline public health workers who bridge the gap between historically marginalized communities, healthcare, and social services. Increasingly, states are developing the CHW workforce by implementing training and certification policies. Health departments (HDs) are primarily responsible for community health through policy implementation and provision of public health services. The two objectives of this study are to explore: (1) state progress in establishing CHW training and certification policies, and (2) integration of CHWs in HD workforces. In this scoping review, we searched PubMed, CINAHL, and Google Scholar for articles published between 2012 and 2022. We looked for articles that discussed state-level certification and training for CHWs and those covering CHWs working with and for city, county, state, and federal HDs. We excluded studies set outside of the US or published in a language other than English. Twenty-nine studies were included for review, documenting CHWs working at all levels of HDs. Within the included studies, HDs often partner with organizations that employ CHWs. With HD-sponsored programs, CHWs increased preventative care, decreased healthcare costs, and decreased disease risk in their communities. Almost all states have begun developing CHW training and certification policies and are at various points in the implementation. HD-sponsored CHW programs improved the health of marginalized communities, whether CHWs were employed directly by HDs or by a partner organization. The success of HD-sponsored CHW programs and state efforts around CHW training and certification should encourage increased investment in CHW workforce development within public health.