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Logan RI, Strater RL. "Entonces, Como Promotores, Pues, No Somos Intérpretes": Reconciling Medical Interpretation & Community Health Work in Indiana and South Carolina. J Ambul Care Manage 2024; 47:84-95. [PMID: 38373054 DOI: 10.1097/jac.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Community health workers (CHWs) and promotores de salud are frontline health workers who typically come from the communities they serve. Despite providing crucial services, they are not institutionalized (or integrated) within much of the U.S. health care system. Many work, either officially or unofficially, as medical interpreters-restricting their full impact as CHWs/ promotores . In this paper, we detail the misemployment and its effects among a subsample of CHWs/ promotores in two geographically distinct, exploratory projects. We encourage that collaborative research with CHWs/ promotores continue and that fidelity to the CHW model be ensured to realize their true potential.
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Affiliation(s)
- Ryan I Logan
- Author Affiliations: Department of Anthropology and Geography & Environmental Resources, California State University, Stanislaus, Turlock, California (Dr Logan); and Center for Community Health Alignment, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (Mr Strater)
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Schuster RC, Wachter K, McRae K, McDaniel A, Davis OI, Nizigiyimana J, Johnson-Agbakwu CE. "If You Don't Have the Heart to Help, You Cannot Do This Job": The Multidimensional Wellbeing of Community Health Workers Serving Refugees During the COVID-19 Pandemic. QUALITATIVE HEALTH RESEARCH 2024; 34:183-194. [PMID: 37950593 DOI: 10.1177/10497323231209836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Community health workers are members of two groups whose short- and long-term health has been uniquely shaped by the COVID-19 pandemic: health workers and the oft-marginalized populations that they serve. Yet, their wellbeing, particularly of those serving resettled refugees, before and during the pandemic has been largely overlooked. Drawing from a holistic conceptualization of wellness, this study examined the effects of the COVID-19 pandemic on a group of cultural health navigators (CHNs), who serve resettled refugees. We conducted semi-structured individual interviews with CHNs at a southwestern U.S. hospital system between July and August 2020, a critical time in the pandemic. Our analysis produced four themes that encapsulate the effects of the pandemic on CHN wellbeing: (1) "You fear for your life": Chronic risk of COVID-19 exposure takes a toll on physical, emotional, and environmental wellbeing; (2) "It is stressful because it is completely new": Uncertainty diminishes occupational, financial, and emotional wellbeing; (3) "If you don't have the heart to help, you cannot do this job": CHNs remain committed while facing challenges to their occupational wellbeing on multiple fronts; and (4) "Now, you cannot release your stress": Loss of and shifts in outlets integral to social and spiritual wellbeing. The findings deepen empirical understanding of how the pandemic affected the holistic wellbeing of CHNs, as they continued to serve their communities in a time of crisis. We discuss the implications for addressing the multidimensionality of community health worker wellbeing in research, policy, and practice.
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Affiliation(s)
- Roseanne C Schuster
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
- Office of Refugee Health, Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
| | - Karin Wachter
- Office of Refugee Health, Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
- School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Kenna McRae
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
- Department of Bioengineering, Schools of Engineering and Medicine, Stanford University, Stanford, CA, USA
| | - Anne McDaniel
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
| | - Olga I Davis
- Office of Refugee Health, Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
- Hugh Downs School of Human Communication, Arizona State University, Tempe, AZ, USA
- Barrett, The Honors College, Arizona State University, Phoenix, AZ, USA
| | - Jeanne Nizigiyimana
- Office of Refugee Health, Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
- Center for Refugee and Global Health, Valleywise Health, Phoenix, AZ, USA
| | - Crista E Johnson-Agbakwu
- Office of Refugee Health, Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
- Department of Obstetrics & Gynecology, UMass Memorial Health, Worcester, MA, USA
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
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Wennerstrom A, Sugarman M, Haywood CG, Jindal D, True G. Roles and Responsibilities of Community Health Workers in Louisiana Medicaid Managed Care Organizations. J Ambul Care Manage 2024; 47:22-32. [PMID: 37994511 DOI: 10.1097/jac.0000000000000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
We explored the roles of community health workers (CHWs) working in Medicaid Managed Care Organizations in Louisiana by conducting 10 interviews with CHWs, supervisors, and administrators. We identified 6 themes: CHWs' backgrounds and training; roles as they related to nationally recognized competencies; team integration; who CHWs serve and how members are identified; metrics for success; and the effects of COVID. CHWs are hired for their community connections. CHWs generally do not receive core competency training, and they focus primarily on improving individual-level health outcomes. Administrators and supervisors may need training and support on CHW competencies, supervision, and using common evaluation indicators.
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Affiliation(s)
- Ashley Wennerstrom
- Department of Behavioral and Community Health Sciences, School of Medicine, Center for Healthcare Value and Equity, School of Public Health, LSU Health-New Orleans, New Orleans, Louisiana (Dr Wennerstrom); Sugarman Research Group, New Orleans, Louisiana (Ms Sugarman); Louisiana Community Health Outreach Network, New Orleans (Ms Haywood); Center for Community Health Alignment, University of South Carolina, Columbia (Ms Jindal); Section of Community and Population Medicine, School of Medicine, LSU Health-New Orleans, New Orleans, Louisiana (Dr True); and Southeast Louisiana Veterans Healthcare System, South Central Mental Illness Research, Education, and Clinical Center, Washington, District of Columbia (Dr True)
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Schwab J, Wachinger J, Munana R, Nabiryo M, Sekitoleko I, Cazier J, Ingenhoff R, Favaretti C, Subramonia Pillai V, Weswa I, Wafula J, Emmrich JV, Bärnighausen T, Knauf F, Knauss S, Nalwadda CK, Sudharsanan N, Kalyesubula R, McMahon SA. Design Research to Embed mHealth into a Community-Led Blood Pressure Management System in Uganda: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46614. [PMID: 38032702 PMCID: PMC10722357 DOI: 10.2196/46614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Uncontrolled hypertension is a leading risk factor for cardiovascular diseases. In Uganda, such diseases account for approximately 10% of all deaths, with 1 in 5 adults having hypertension (>90% of the hypertensive cases are uncontrolled). Although basic health care in the country is available free of cost at government facilities, regularly accessing medication to control hypertension is difficult because supply chain challenges impede availability. Clients therefore frequently suspend treatment or buy medication individually at private facilities or pharmacies (incurring significant costs). In recent years, mobile health (mHealth) interventions have shown increasing potential in addressing health system challenges in sub-Saharan Africa, but the acceptability, feasibility, and uptake conditions of mobile money approaches to chronic disease management remain understudied. OBJECTIVE This study aims to design and pilot-test a mobile money-based intervention to increase the availability of antihypertensive medication and lower clients' out-of-pocket payments. We will build on existing local approaches and assess the acceptability, feasibility, and uptake of the designed intervention. Furthermore, rather than entering the study setting with a ready-made intervention, this research will place emphasis on gathering applied ethnographic insights early, which can then inform the parameters of the intervention prototype and concurrent trial. METHODS We will conduct a mixed methods study following a human-centered design approach. We will begin by conducting extensive qualitative research with a range of stakeholders (clients; health care providers; religious, cultural, and community leaders; academics; and policy makers at district and national levels) on their perceptions of hypertension management, money-saving systems, and mobile money in the context of health care. Our results will inform the design, iterative adaptation, and implementation of an mHealth-facilitated pooled financing intervention prototype. At study conclusion, the finalized prototype will be evaluated quantitatively via a randomized controlled trial. RESULTS As of August 2023, qualitative data collection, which started in November 2022, is ongoing, with data analysis of the first qualitative interviews underway to inform platform and implementation design. Recruitment for the quantitative part of this study began in August 2023. CONCLUSIONS Our results aim to inform the ongoing discourse on novel and sustainable pathways to facilitate access to medication for the management of hypertension in resource-constrained settings. TRIAL REGISTRATION German registry of clinical trials DRKS00030922; https://drks.de/search/en/trial/DRKS00030922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46614.
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Affiliation(s)
- Josephine Schwab
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard Munana
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | - Maxencia Nabiryo
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Sekitoleko
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | | | - Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Caterina Favaretti
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Vasanthi Subramonia Pillai
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | - John Wafula
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | - Julius Valentin Emmrich
- mTOMADY gGmbh, Berlin, Germany
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States
| | - Samuel Knauss
- mTOMADY gGmbh, Berlin, Germany
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christine K Nalwadda
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke District, Uganda
- Department of Physiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
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Vaughan EM, Virani S, Al Rifai M, Cardenas VJ, Johnston CA, Porterfield L, Santiago Delgado Z, Samson SL, Schick V, Naik AD. Determining call-to-entry rate and recruitment barriers in clinical studies for community clinics serving low-income populations: a cohort study. BMJ Open 2023; 13:e077819. [PMID: 37898484 PMCID: PMC10619090 DOI: 10.1136/bmjopen-2023-077819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Recruitment for clinical studies is challenging. To overcome barriers, investigators have previously established call-to-entry rates to assist in planning. However, rates specific to low-income minority populations are needed to account for additional barriers to enrolment these individuals face. OBJECTIVE To obtain a call-to-entry rate in a low-income uninsured Hispanic population with chronic disease. METHODS We used data from four of our randomised clinical studies to determine the call-to-entry rate for individuals (n=1075) with or at risk for type 2 diabetes: participants needed/potential participants contacted=recruitment rate (yield). Research staff contacted potential participants to enrol in a study that evaluated 6 month diabetes programmes at community clinics from 2015 to 2020. We recorded call-to-entry rates, reasons for declining the study, show rates, and attrition. RESULTS The call-to-entry rate was 14.5%. Forty per cent of potential participants could not be contacted, and 30.6%, 19.1%, and 5.4% responded yes, no, and maybe, respectively. No show percentages were 54% for yes and 91.4% for maybe responders. The majority (61.6%) declined due to inability to attend; reasons to decline included work (43%), eligibility (18%), transportation (10%), out of town (9%), did not think they needed the programme (7%) and other/unknown (14%). Being a physician predicted inability to reach participants (adjusted OR 2.91, 95% CI 1.73 to 4.90). Attrition was 6.8%. CONCLUSIONS We described a call-to-entry rate and detailed recruitment data, including reasons to decline the study. This valuable information can assist investigators in study planning and overcoming enrolment barriers in low-income populations. Telehealth-based or strategies that limit transportation needs may increase participant involvement. TRIAL REGISTRATION NUMBER NCT03394456.
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Affiliation(s)
- Elizabeth M Vaughan
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Salim Virani
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Houston Center for Quality of Care and Utilization Studies, Center for Innovations in Quality Effectiveness and Safety, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Michael E DeBakey VA Medical Center, Houston, Texas, USA
- Houston Methodist Debakey Heart & Vascular Center, Houston, Texas, USA
| | - Victor J Cardenas
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Craig A Johnston
- Health and Human Performance, The University of Houston, Houston, Texas, USA
| | - Laura Porterfield
- Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Zuleica Santiago Delgado
- Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Susan L Samson
- Department of Internal Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Vanessa Schick
- Deparrtment of Management, Policy, and Community Health, University of Texas School of Public Health, Houston, Texas, USA
| | - Aanand D Naik
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Deparrtment of Management, Policy, and Community Health, University of Texas School of Public Health, Houston, Texas, USA
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Katzen LS, Skeen S, Dippenaar E, Laurenzi C, Notholi V, le Roux K, le Roux I, WaluWalu N, Mbewu N, Borus MJR, Tomlinson M. Community Health Workers' experiences of a package providing increased support and supervision - a qualitative study of a home visiting model in rural South Africa. RESEARCH SQUARE 2023:rs.3.rs-3333610. [PMID: 37841874 PMCID: PMC10571624 DOI: 10.21203/rs.3.rs-3333610/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Deploying Community Health Workers is a crucial strategy to improve health at a community level in low and middle income countries. While there is substantial evidence for CHW effectiveness, there is a need for more research on the mechanisms through which these programs work. Understanding CHWs experiences of how programmes function is important. This article examines CHW's experiences of three key programmatic domains; training, logistical support and supervision. Data were gathered using a qualitative study embedded within a cluster randomized controlled trial of an enhanced supervision package delivered to government-employed CHWs in the rural Eastern Cape, South Africa. We interviewed CHWs (n = 16) and two supervisors. Three overarching areas and five sub-themes emerged from our interviews. CHW knowledge and confidence increased through additional training, that CHW motivation and community acceptance improved because of added logistical support, and that CHW supervision led to improved sense of accountability, feelings of respect, and sense of being supported. Our findings highlight the importance of a functional support system within which CHWs can operate, in a context where most CHWs operate in isolation and without support. CHWs receiving supportive supervision reported positive impacts on their motivation and ability to carry out their work effectively.
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Sabo S, O'Meara L, Yellowhair J, Hamilton J, Nashio JTN, Bender B, Flores F, Bennett M, Metts R, Denton I, Russell K. Community Health Representative Workforce: Integration across systems and teams to address the social determinants of indigenous health and wellbeing. Front Public Health 2023; 11:1047152. [PMID: 37033042 PMCID: PMC10075253 DOI: 10.3389/fpubh.2023.1047152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/22/2023] [Indexed: 03/17/2023] Open
Abstract
Tribally employed, Community Health Representatives (CHRs) serving Indigenous and American Indian and Alaskan Native (AIAN) peoples are culturally and linguistically embedded community leaders, with the unique ability to serve as the link and intermediary between community members and systems. Unique to the CHR workforce scope of practice is the expectation for high level integration within the medical and social service care team. This explicit role outlined in the scope of work sets an expectation for both CHR and care teams to deliver integrated patient, family, and systems level care coordination and case management. This paper aims to build from our previous manuscript published in Volume 1 of the special issue Community Health Workers Practice from Recruitment to Integration. In that Volume, we explored through a Community Case Study CHR Managers' perspectives on the challenges and opportunities for full CHR integration into health systems and teams serving AIAN. In this paper, we offer new information about the current CHR and CHR Managers' involvements and perceived level of integration within health care teams and the broader public health systems addressing the social and structural determinants of health. We approach this topic considering the COVID-19 pandemic and how CHRs and CHR Programs were included and not included in tribal pandemic response efforts.
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Affiliation(s)
- Samantha Sabo
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Louisa O'Meara
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Janet Yellowhair
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | | | | | - Brook Bender
- Hualapai Tribe, Peach Springs, AZ, United States
| | | | - Marianne Bennett
- Salt River Pima Maricopa Indian Community, Scottsdale, AZ, United States
| | - Rema Metts
- Gila River Health Care, Sacaton, AZ, United States
| | - Isabella Denton
- Arizona Advisory Council on Indian Health Care, Phoenix, AZ, United States
| | - Kim Russell
- Arizona Advisory Council on Indian Health Care, Phoenix, AZ, United States
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Harries MD, Xu N, Bertenthal MS, Luna V, Akel MJ, Volerman A. Community Health Workers in Schools: A Systematic Review. Acad Pediatr 2023; 23:14-23. [PMID: 36223871 PMCID: PMC9951773 DOI: 10.1016/j.acap.2022.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/28/2022] [Accepted: 08/21/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Community health workers (CHWs) are trusted community members who provide health education and care. However, no consensus exists regarding whether community health worker-based interventions are effective within the school setting. OBJECTIVE To determine outcomes and best practices of school-based community health worker interventions. DATA SOURCES PubMed, CINAHL, and SCOPUS databases. STUDY ELIGIBILITY CRITERIA This systematic literature review examined articles that described an intervention led by community health workers, targeted children and/or parents, and took place primarily within a Kindergarten-12th grade school setting. Articles were excluded if they described an intervention outside the United States. PARTICIPANTS Community health workers, children, and/or their parents INTERVENTIONS: School-based community health worker programs RESULTS: Of 1875 articles identified, 13 met inclusion criteria and were included in the final analysis. Of these, 5 described a statistically significant primary outcome. Seven articles provided details regarding community health worker recruitment, training, and roles that would enable reproduction of the intervention. LIMITATIONS This review focused on interventions in the United States. Bias of individual studies had a wide range of scores (9-21). Heterogeneity of studies also precluded a meta-analysis of primary outcomes. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The utilization of Community health workers in school-based interventions for children and/or parents is promising. This review identified a lack of detail and uniformity in program presentation, specifically with Community health worker recruitment, training, and roles. A standardized reporting mechanism for Community health worker interventions in schools would better allow for reproducibility and scalability of existing studies.
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Affiliation(s)
- Michael D Harries
- Department of Pediatrics (MD Harries, M Bertenthal, A Volerman), University of Chicago, Chicago, Ill.
| | - Nuo Xu
- Department of Medicine (N Xu, V Luna, MJ Akel, A Volerman), University of Chicago, Chicago, Ill
| | - Michael S Bertenthal
- Department of Pediatrics (MD Harries, M Bertenthal, A Volerman), University of Chicago, Chicago, Ill
| | - Viridiana Luna
- Department of Medicine (N Xu, V Luna, MJ Akel, A Volerman), University of Chicago, Chicago, Ill
| | - Mary J Akel
- Department of Medicine (N Xu, V Luna, MJ Akel, A Volerman), University of Chicago, Chicago, Ill
| | - Anna Volerman
- Department of Pediatrics (MD Harries, M Bertenthal, A Volerman), University of Chicago, Chicago, Ill; Department of Medicine (N Xu, V Luna, MJ Akel, A Volerman), University of Chicago, Chicago, Ill
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McCarville EE, Martin MA, Pratap PL, Pinsker E, Seweryn SM, Peters KE. Understanding the relationship between care team perceptions about CHWs and CHW integration within a US health system, a qualitative descriptive multiple embedded case study. BMC Health Serv Res 2022; 22:1587. [PMID: 36575412 PMCID: PMC9793519 DOI: 10.1186/s12913-022-08723-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Community health workers (CHW) have grown in prominence within the healthcare sector, yet there is no clear consensus regarding a CHW's role, purpose, and value within health systems. This lack of consensus has the potential to affect how CHWs are perceived, utilized, and ultimately integrated within the healthcare sector. This research examines clinical care teams that currently employ CHWs to (1) understand how members of the care team perceive CHWs' purpose and value, and (2) consider how perceptions of CHWs are related to CHW integration within health care teams. METHODS Researchers conducted a qualitative descriptive multiple embedded case study at the University of Illinois at Chicago's Hospital and Health Science System (UI Health). The embedded subunits of analysis were teams within UI Health that are currently employing CHWs to assist with the provision of clinical care or services to patients. Data were collected via semi-structured interviews and document review. RESULTS In total, 6 sub-units were enrolled to participate, and 17 interviews were conducted with CHWs (n = 9), and administrators or health care providers (n = 8). Reported perceptions of CHWs were inconsistent across respondents. CHWs roles were not always understood, and the CHW's purpose and value was perceived differently by different members of the care team. Moreover, evaluation metrics did not always capture CHWs' value to the health care system. In some cases, care teams were more aligned around a shared understanding of the CHW's roles and purpose within the care team. When perceptions regarding CHWs were both positive and aligned, respondents reported higher levels of integration within the healthcare system. CONCLUSIONS Alignment in a care team's perception of a CHW's role, purpose, and value within the health system could play an important role in the integration of CHWs within healthcare teams.
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Affiliation(s)
- Erin E. McCarville
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, School of Public Health, 1603 W Taylor Street, Chicago, IL 60612 USA
| | - Molly A. Martin
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608 USA
| | - Preethi Lakshmi Pratap
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, School of Public Health, 1603 W Taylor Street, Chicago, IL 60612 USA
| | - Eve Pinsker
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, School of Public Health, 1603 W Taylor Street, Chicago, IL 60612 USA
| | - Steven M. Seweryn
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, School of Public Health, 1603 W Taylor Street, Chicago, IL 60612 USA
| | - Karen E. Peters
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608 USA
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10
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Masquillier C, Cosaert T. Community health workers: A sustainable health system innovation or just an emergency response? Front Public Health 2022; 10:1040539. [PMID: 36561858 PMCID: PMC9763587 DOI: 10.3389/fpubh.2022.1040539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Caroline Masquillier
- Department of Sociology, University of Antwerp, Antwerp, Belgium,Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium,*Correspondence: Caroline Masquillier
| | - Theo Cosaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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11
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Perveen S, Laurence C, Mahmood MA. Indicator-activities to apply primary health care principles in national or large-scale community health worker programs in low-and middle-income countries: a Delphi exercise. BMC Public Health 2022; 22:1599. [PMID: 35996094 PMCID: PMC9396777 DOI: 10.1186/s12889-022-13996-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Primary Health Care (PHC) gained considerable momentum in the past four decades and led to improved health outcomes across a wide variety of settings. In low-and middle-income countries (LMICs), national or large-scale Community Health Worker Programs (CHWPs) are considered as vehicles to incorporate PHC principles into healthcare provision and are an essential aspect of the PHC approach to achieve health for all and sustainable development goals. The success of CHWPs is rooted in the application of PHC principles. However, there is evidence that shows patchy implementation of PHC principles across national CHWPs in LMICs. This may reflect the lack of information on what activities would illustrate the application of these principles in CHWPs. This study aimed to identify a set of core/indicator-activities that reflect the application of PHC principles by CHWPs in LMICs. METHODS A two-round modified Delphi study was undertaken with participants who have extensive experience in planning, implementation and evaluation of CHWPs. Survey design and analysis was guided by the four PHC principles namely Universal Health Coverage, Community Participation, Intersectoral Coordination and Appropriateness. Responses were collected using a secure online survey program (survey monkey). In round one, participants were asked to list 'core activities' that would reflect the application of each PHC principle and its sub-attributes and challenges to apply these principles in CHWPs. In round two, participants were asked to select whether they agree or disagree with each of the activities and challenges. Consensus was set a priori at 70% agreement of participants for each question. RESULTS Seventeen participants from 15 countries participated in the study. Consensus was reached on 59 activities reflecting the application of PHC principles by CHWPs. Based on participants' responses, a set of 29 indicator-activities for the four PHC principles was developed with examples for each indicator-activity. CONCLUSION These indicator-activities may provide guidance on how PHC principles can be implemented in CHWPs. They can be used in the development and evaluation of CHWPs, particularly in their application of PHC principles. Future research may focus on testing the utility of indicator-activities on CHWPs in LMICs.
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Affiliation(s)
- Shagufta Perveen
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Level 5 Rundle Mall Plaza, 50 Rundle Mall, Adelaide, South Australia, 5000, Australia.
| | - Caroline Laurence
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Level 5 Rundle Mall Plaza, 50 Rundle Mall, Adelaide, South Australia, 5000, Australia
| | - Mohammad Afzal Mahmood
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Level 5 Rundle Mall Plaza, 50 Rundle Mall, Adelaide, South Australia, 5000, Australia.,Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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Barbero C, Hafeedh Bin Abdullah A, Wiggins N, Garrettson M, Jones D, S Guinn A, Girod C, Bradford J, Wennerstrom A. Community Health Worker Activities in Public Health Programs to Prevent Violence: Coding Roles and Scope. Am J Public Health 2022; 112:1191-1201. [PMID: 35737917 PMCID: PMC9342815 DOI: 10.2105/ajph.2022.306865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/04/2022]
Abstract
In multiple and related forms, violence is a serious public health issue with lasting impacts on health and wellness in the United States. Community health workers (CHWs) are frontline public health workers and trusted members of communities. We aimed to analyze recent examples of CHW activities in violence prevention public health programs with a goal of informing future programs and research. We collected more than 300 documents published between 2010 and 2020 to identify public health programs to prevent violence including CHW activities. We used an iterative process to develop and apply a coding scheme to the CHW activities. We identified 20 public health programs to prevent violence which included CHW activities. CHWs most often addressed community violence, youth violence, and family violence and played an average of 8 of 10 core roles per program. Fewer than a third (i.e., 6 programs) reported community-focused CHW activities to address upstream and structural determinants of health inequities. This first examination, to our knowledge, of the intersection of the CHW and violence prevention literature shows that CHWs have played many of their core roles in public health programs to address multiple forms of violence. (Am J Public Health. 2022;112(8):1191-1201. https://doi.org/10.2105/AJPH.2022.306865).
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Affiliation(s)
- Colleen Barbero
- Colleen Barbero, Angie S. Guinn, Candace Girod, and Joivita Bradford are with the Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Abdul Hafeedh Bin Abdullah is with CommUnity Healing Through Activism and Strategic Mobilization and Sokoto House, Wilmington, NC. Noelle Wiggins is with the Community Health Worker Common Indicators Project, Portland, OR. Mariana Garrettson is with The Health Alliance for Violence Intervention, Chapel Hill, NC. Dean Jones is with HOOPWAVE Sports Mentoring, Hartford, CT. Ashley Wennerstrom is with the Department of Behavioral and Community Health Sciences, School of Public Health, Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center, New Orleans. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Abdul Hafeedh Bin Abdullah
- Colleen Barbero, Angie S. Guinn, Candace Girod, and Joivita Bradford are with the Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Abdul Hafeedh Bin Abdullah is with CommUnity Healing Through Activism and Strategic Mobilization and Sokoto House, Wilmington, NC. Noelle Wiggins is with the Community Health Worker Common Indicators Project, Portland, OR. Mariana Garrettson is with The Health Alliance for Violence Intervention, Chapel Hill, NC. Dean Jones is with HOOPWAVE Sports Mentoring, Hartford, CT. Ashley Wennerstrom is with the Department of Behavioral and Community Health Sciences, School of Public Health, Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center, New Orleans. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Noelle Wiggins
- Colleen Barbero, Angie S. Guinn, Candace Girod, and Joivita Bradford are with the Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Abdul Hafeedh Bin Abdullah is with CommUnity Healing Through Activism and Strategic Mobilization and Sokoto House, Wilmington, NC. Noelle Wiggins is with the Community Health Worker Common Indicators Project, Portland, OR. Mariana Garrettson is with The Health Alliance for Violence Intervention, Chapel Hill, NC. Dean Jones is with HOOPWAVE Sports Mentoring, Hartford, CT. Ashley Wennerstrom is with the Department of Behavioral and Community Health Sciences, School of Public Health, Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center, New Orleans. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Mariana Garrettson
- Colleen Barbero, Angie S. Guinn, Candace Girod, and Joivita Bradford are with the Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Abdul Hafeedh Bin Abdullah is with CommUnity Healing Through Activism and Strategic Mobilization and Sokoto House, Wilmington, NC. Noelle Wiggins is with the Community Health Worker Common Indicators Project, Portland, OR. Mariana Garrettson is with The Health Alliance for Violence Intervention, Chapel Hill, NC. Dean Jones is with HOOPWAVE Sports Mentoring, Hartford, CT. Ashley Wennerstrom is with the Department of Behavioral and Community Health Sciences, School of Public Health, Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center, New Orleans. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Dean Jones
- Colleen Barbero, Angie S. Guinn, Candace Girod, and Joivita Bradford are with the Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Abdul Hafeedh Bin Abdullah is with CommUnity Healing Through Activism and Strategic Mobilization and Sokoto House, Wilmington, NC. Noelle Wiggins is with the Community Health Worker Common Indicators Project, Portland, OR. Mariana Garrettson is with The Health Alliance for Violence Intervention, Chapel Hill, NC. Dean Jones is with HOOPWAVE Sports Mentoring, Hartford, CT. Ashley Wennerstrom is with the Department of Behavioral and Community Health Sciences, School of Public Health, Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center, New Orleans. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Angie S Guinn
- Colleen Barbero, Angie S. Guinn, Candace Girod, and Joivita Bradford are with the Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Abdul Hafeedh Bin Abdullah is with CommUnity Healing Through Activism and Strategic Mobilization and Sokoto House, Wilmington, NC. Noelle Wiggins is with the Community Health Worker Common Indicators Project, Portland, OR. Mariana Garrettson is with The Health Alliance for Violence Intervention, Chapel Hill, NC. Dean Jones is with HOOPWAVE Sports Mentoring, Hartford, CT. Ashley Wennerstrom is with the Department of Behavioral and Community Health Sciences, School of Public Health, Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center, New Orleans. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Candace Girod
- Colleen Barbero, Angie S. Guinn, Candace Girod, and Joivita Bradford are with the Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Abdul Hafeedh Bin Abdullah is with CommUnity Healing Through Activism and Strategic Mobilization and Sokoto House, Wilmington, NC. Noelle Wiggins is with the Community Health Worker Common Indicators Project, Portland, OR. Mariana Garrettson is with The Health Alliance for Violence Intervention, Chapel Hill, NC. Dean Jones is with HOOPWAVE Sports Mentoring, Hartford, CT. Ashley Wennerstrom is with the Department of Behavioral and Community Health Sciences, School of Public Health, Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center, New Orleans. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Joivita Bradford
- Colleen Barbero, Angie S. Guinn, Candace Girod, and Joivita Bradford are with the Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Abdul Hafeedh Bin Abdullah is with CommUnity Healing Through Activism and Strategic Mobilization and Sokoto House, Wilmington, NC. Noelle Wiggins is with the Community Health Worker Common Indicators Project, Portland, OR. Mariana Garrettson is with The Health Alliance for Violence Intervention, Chapel Hill, NC. Dean Jones is with HOOPWAVE Sports Mentoring, Hartford, CT. Ashley Wennerstrom is with the Department of Behavioral and Community Health Sciences, School of Public Health, Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center, New Orleans. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Ashley Wennerstrom
- Colleen Barbero, Angie S. Guinn, Candace Girod, and Joivita Bradford are with the Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Abdul Hafeedh Bin Abdullah is with CommUnity Healing Through Activism and Strategic Mobilization and Sokoto House, Wilmington, NC. Noelle Wiggins is with the Community Health Worker Common Indicators Project, Portland, OR. Mariana Garrettson is with The Health Alliance for Violence Intervention, Chapel Hill, NC. Dean Jones is with HOOPWAVE Sports Mentoring, Hartford, CT. Ashley Wennerstrom is with the Department of Behavioral and Community Health Sciences, School of Public Health, Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center, New Orleans. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
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Sang L, Liu H, Yan H, Rong J, Cheng J, Wang L, Li G, Guo Y, Zhang L, Ding H, Chen G, Chen R. Incentive Preferences and Its Related Factors Among Primary Medical Staff in Anhui Province, China: A Cross-Sectional Study. Front Public Health 2022; 9:778104. [PMID: 35071164 PMCID: PMC8769285 DOI: 10.3389/fpubh.2021.778104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022] Open
Abstract
Background: The shortage of primary medical staff is a major problem in the management of health human resources across many developing countries. By determining their preferences for various motivational and related factors, we examined the correlation between staff's motivation preference levels and staff turnover and turnover intention. This study aimed to further improve the incentive mechanism and to provide a reference for healthcare managers to formulate management strategies for the primary medical staff team. Methods: A self-reported questionnaire survey was conducted to collect data. The basic survey content included demographic characteristics. The absolute level questionnaire and relative level questionnaire on the factors affecting motivation preference were used as the main assessment scales. A total of 1,112 primary health workers in Anhui Province were investigated. T-test, analysis of variance (ANOVA), exploratory factor analysis, and multiple linear regression analysis were performed to analyze the data. Results: The survey respondents (45.1%) reported being satisfied with their relationship with colleagues, and other social relationships (46.9%). The Kaiser Meyer Olkin (KMO) value for the absolute preference degree for motivational factors was 0.951. Two factors (economic and non-economic factors), after using the maximum variance rotation axis method, explained 81.25% of the total variance. The regression analysis showed that primary medical staff members with low monthly income (B = −0.157) have a higher preference for non-economic factors; the higher the educational background (B = 0.133), the higher their preference for economic factors. In addition, with the increase in participants' age (B = −0.250), the preference for motivational factors gradually decreased. Conclusion: Both economic and non-economic factors play an important role in enhancing the enthusiasm of primary medical workers and improving their work attitude. Managers should use their influence to stabilize the primary medical staff.
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Affiliation(s)
- Lingzhi Sang
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Hongzhang Liu
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Huosheng Yan
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Jian Rong
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Jing Cheng
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Li Wang
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Guoqiang Li
- Affiliated Suzhou Hospital of Anhui Medical University, Suzhou, China
| | - Yan Guo
- Affiliated Suzhou Hospital of Anhui Medical University, Suzhou, China
| | - Lei Zhang
- Affiliated Suzhou Hospital of Anhui Medical University, Suzhou, China
| | - Hong Ding
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Guimei Chen
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Ren Chen
- School of Health Services Management, Anhui Medical University, Hefei, China.,Affiliated Suzhou Hospital of Anhui Medical University, Suzhou, China
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