Community health worker training on older adults: A qualitative needs assessment

Background: Community health workers (CHWs) are frontline public health personnel who serve as liaisons between vulnerable patient populations and the healthcare system. They are instrumental in health promotion and education for urban-dwelling older adults. However, no research exists on training that CHWs receive on age-friendly health care. This article explores CHW education on the 4Ms of an Age-Friendly Health System and identifies areas where additional training may be necessary. Methods: As part of a two-pronged qualitative needs assessment, four focus groups were held with a total of 17 CHWs and semistructured interviews were conducted with 10 clinicians, including both healthcare providers and social workers. Focus group and interview transcripts were then analyzed for major themes in Dedoose, a qualitative coding software. Results: Clinicians most often identified Mentation and Mobility as areas where CHWs can have the greatest impact. Correspondingly, CHWs felt under-equipped to assist patients in these areas and expressed strong interest in additional training. In general, CHWs and clinicians agreed that Medications and What Matters do not fall under CHW scope of practice. Conclusions: Our findings confirm the critical role that CHWs can play in promoting the health and well-being of urban-dwelling older adults. However, we also demonstrate that many CHWs lack adequate training in age-friendly care. To meet the social and medical needs of a rapidly aging US population, there is a pertinent need to develop a novel community health worker training curriculum on Mentation and Mobility.</p

Effectiveness of Community Health Worker-led Diabetes Self-Management Education on Type 2 diabetes patients: A Systematic Review and Meta-Analysis

Objective: Community Health Workers are important in building individual and community capacity through outreach, community education, informal counselling, social support and advocacy programs, which enhance health knowledge and self-sufficiency. Our aim was to examine the effectiveness of a Community Health Worker-led Diabetes Self-Management Education in improving clinical and psychosocial outcomes. Methods: A thorough systematic literature search was undertaken in Medline, Pubmed, Ovid, PsyINFO, EMBASE and JBI databases (searched from December 2018 to 31st January 2019). Once selected articles were retrieved, all titles and abstracts were screened, and eligible articles identified for full text inclusion. These retrieved full texts articles were screened for eligibility and selected according to established inclusion criteria. Of the 182 studies retrieved, 20 were included for examination. Results: HbA1c outcomes were statistically significant for short and long terms with effect sizes of –0.21 (95%CI -0.31, - 0.10) and -0.26 (95% CI -0.36, -0.15) respectively and favored the CHW group. Values for secondary outcomes measured except diabetes knowledge yielded statistical significance for the CHW group. Conclusion: The CHW-intervention is an effective model that has significant impact on glycemic control, diabetes knowledge, self-care behaviors and emotional distress and well-being

Funding Community Health Worker Programs and Services in Minnesota: Looking to the Future

This report is a supplement to the 2006 report "Advancing Community Health Worker Practice and Utilization: The Focus on Funding"

Evaluating the impact of a community health worker program on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi : protocol for a stepped-wedge, cluster randomized controlled trial

Introduction: This protocol concerns the implementation and evaluation of an intervention designed to realign the existing cadre of Community Health Workers (CHWs) in Neno District, Malawi to better support the care needs of the clients they serve. The proposed intervention is a ‘Household Model’ where CHWs will be reassigned to households, rather than to specific patients with HIV and/or TB. Methods and Analysis: Using a stepped-wedge, cluster-randomized design, this study investigates whether high HIV retention rates can be replicated for non-communicable diseases (NCDs), and the Model’s impact on TB and pediatric malnutrition case-finding, as well as the uptake of family planning and antenatal care. Eleven sites (health centres and hospitals) were arranged into six clusters (average cluster population 21,800). Primary outcomes include retention in care for HIV and chronic NCDs, TB case finding, pediatric malnutrition case finding, and utilization of early and complete antenatal. Clinical outcomes are based on routinely collected data the Ministry of Health’s District Health Information System 2 and an OpenMRS Electronic Medical Record supported by Partners In Health. Additionally, semi-structured qualitative interviews with various stakeholders will assess community perceptions and context of the Household Model. Ethics and dissemination: Ethics approval has been obtained from the Malawian National Health Science Research Committee (#16/11/1694) in Lilongwe, Malawi; Partners Healthcare Human Research Committee (#2017P000548/PHS) in Somerville, Massachusetts; and by the Biomedical and Scientific Research Ethics Sub-Committee (REGO-2017-2060) at the University of Warwick in Coventry, United Kingdom. Dissemination will include manuscripts for peer-reviewed publication as well as a full report detailing the findings of the intervention for the Malawian Ministry of Health. Registration: Registered on ClinicalTrials.gov in April 2017. Identifier: NCT0310672

Innovative Community Health Worker Strategies: Medicaid Payment Models for Community Health Worker Home Visits

Due to mounting evidence that community health workers (CHWs) can improve health outcomes, increase access to health care, and control medical costs, states are increasingly engaging their CHW workforce to replicate those successes at the state level. However, the policies and programs that regulate and pay for CHWs differ dramatically across states, and states facing difficulties advancing CHW initiatives can gain insights from the experiences of other programs across the country.The National Academy for State Health Policy (NASHP) recently up-dated its State Community Health Worker Models Map, and is currently identifying innovative state strategies that have helped CHW initiatives meet their goals. This case study, which explores payment models for CHWs conducting home visits in Minnesota, New York, Utah, and Washington State, is the second in a series of products that highlight those CHW program strategies

Peer support for discharge from inpatient to community mental health services: Study protocol clinical trial (SPIRIT Compliant).

INTRODUCTION: In the period shortly after discharge from inpatient to community mental health care, people are at increased risk of self-harm, suicide, and readmission to hospital. Discharge interventions including peer support have shown potential, and there is some evidence that community-based peer support reduces readmissions. However, systematic reviews of peer support in mental health services indicate poor trial quality and a lack of reporting of how peer support is distinctive from other mental health support. This study is designed to establish the clinical and cost effectiveness of a peer worker intervention to support discharge from inpatient to community mental health care, and to address issues of trial quality and clarity of reporting of peer support interventions. METHODS: This protocol describes an individually randomized controlled superiority trial, hypothesizing that people offered a peer worker discharge intervention in addition to usual follow-up care in the community are less likely to be readmitted in the 12 months post discharge than people receiving usual care alone. A total of 590 people will be recruited shortly before discharge from hospital and randomly allocated to care as usual plus the peer worker intervention or care as usual alone. Manualized peer support provided by trained peer workers begins in hospital and continues for 4 months in the community post discharge. Secondary psychosocial outcomes are assessed at 4 months post discharge, and service use and cost outcomes at 12 months post discharge, alongside a mixed methods process evaluation. DISCUSSION: Clearly specified procedures for sequencing participant allocation and for blinding assessors to allocation, plus full reporting of outcomes, should reduce risk of bias in trial findings and contribute to improved quality in the peer support evidence base. The involvement of members of the study team with direct experience of peer support, mental distress, and using mental health services, in coproducing the intervention and designing the trial, ensures that we theorize and clearly describe the peer worker intervention, and evaluate how peer support is related to any change in outcome. This is an important methodological contribution to the evidence base. TRIAL REGISTRATION: This study was prospectively registered as ISRCTN 10043328 on November 28, 2016

Inspiring health worker motivation with supportive supervision: a survey of lady health supervisor motivating factors in rural Pakistan

BACKGROUND: Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. Therefore, identifying health system interventions that address motivating factors in resource-strained settings is essential. This study is part of a larger implementation research project called Nigraan, which is intervening on supportive supervision in the Lady Health Worker Programme to improve community case management of pneumonia and diarrhea in rural Pakistan. This study explored the motivation of Lady Health Supervisors, a cadre of community health workers, with particular attention to their views on supportive supervision. METHODS: Twenty-nine lady health supervisors enrolled in Nigraan completed open-ended structured surveys with questions exploring factors that affect their motivation. Thematic analysis was conducted using a conceptual framework categorizing motivating factors at individual, community, and health system levels. RESULTS: Supportive supervision, recognition, training, logistics, and salaries are community and health system motivatingfactors for lady health supervisors. Lady health supervisors are motivated by both their role in providing supportive supervision to lady health workers and by the supervisory support received from their coordinators and managers. Family support, autonomy, and altruism are individual level motivating factors. CONCLUSIONS: Health system factors, including supportive supervision, are crucial to improving lady health supervisormotivation. As health worker motivation influences their performance, evaluating the impact of health system interventions on community health worker motivation is important to improving the effectiveness of community health worker programs

Advancing Community Health Worker Practice and Utilization: The Focus on Financing

There is a growing interest in the use of community health workers in various roles in the US health care system. These workers go by various titles and names -- including promotora and community health advisor -- but all assist members of the communities they serve. As the role of these workers becomes more accepted and desirable in the overall system of care, they face the challenges of moving from being an exceptional add-on to the system to being more a part of the mainstream. Issues such as educational preparation, formal credentialing, licensure and compensation are all part of this process. In particular, various organizations are interested in but challenged by the need for sustainable financing of the CHW position. It is time to explore and develop viable financing arrangements that go beyond short-term grants.To address these concerns, this research was undertaken to study sustainable financing mechanisms for community health workers. The focus is on existing and emerging funding, reimbursement and payment policies for community health workers. The study seeks to identify promising examples and models of payment programs for community health workers generally in the United States. To the authors' knowledge, this is the first national project with this exclusive focus.The audiences for this report include community health workers, directors of programs that employ or work with community health workers, and administrators of public and private coverage programs such as health plans, insurance companies and state Medicaid programs seeking options for improving health care access and quality at the same or lower costs. Businesses, non-profit organizations and consumers exploring the possibilities of using the services community health workers could provide might also be interested in the findings

Community Health Worker Certificate Program Evaluation.

Ph.D. Thesis. University of Hawaiʻi at Mānoa 2018

Factors Associated with Patient Satisfaction of Community Mental Health Services: A Multilevel Approach

Community care is increasingly the mainstay of mental healthcare provision in many countries and patient satisfaction is an important barometer of quality of patient care. This paper explores the key factors associated with patient satisfaction with community mental health services in England and then compares providers’ performance on patient satisfaction. Our analysis is based on patient-level responses from the community mental health survey, which is run annually by the Care Quality Commission (CQC) for the years 2010 to 2013. We perform a repeated cross-section analysis, identifying factors associated with patient satisfaction via a multi-level ordered probit model, including both patient- and provider-level variables. We identify hospital-specific effects via empirical Bayes estimation. Our analysis identifies a number of novel results. First, patient characteristics such as older age, being employed, and being able to work, are associated with higher satisfaction, while being female is associated with lower satisfaction. Service contact length, time since last visit, condition severity and admission to a mental health institution, are all associated with lower satisfaction. Second, treatment type affects satisfaction, with patients receiving talking therapies or being prescribed medications being more satisfied. Third, care continuity and involvement, as proxied by having a care plan, is associated with higher satisfaction. Fourth, seeing a health professional closer to the community improves satisfaction, with patients seeing a community-psychiatric nurse, a social worker or a mental-health support worker being more satisfied. Finally, our study identifies the need for service integration, with patients experiencing financial, accommodation, or physical health needs being less satisfied. At a provider level, we find a negative association between the percentage of occupied beds and satisfaction. We further identify significant provider-specific effects after accounting for observable differences in patient and provider characteristics which suggests significant differences in provider quality of care