The individual summaries include, whenever
appropriate, name and objective of the
program, population assisted, location,
study design, outcomes/limitations,
and community health worker recruitment
and type of interventions.
SUMMARIES
BY AUTHOR
Andersen MR, Yasui
Y, Meischke H et al. The effectiveness
of mammography promotion by volunteers
in rural communities. Am J Prev Med
2000; 18 (3):199-207.
Program: Community Trial of Mammography
Promotion
Objective: To assess the effectiveness
of mammography promotion by community
volunteer groups in rural areas.
Population and Location: Women between
the ages of 50 and 80 in rural communities
in Washington State.
Study Design: Randomized controlled
trial (sample size = 6592) with control
group and three interventions (individual
counseling, community activities, and
both).
Community Health Worker Recruitment:
Volunteers were recruited from the participating
communities.
Community Health Worker Interventions:
Volunteers were trained in promotion
through community activities (bingo
nights, video showings, beauty shop
promotions, display boards, mailings),
individual counseling (mailings and
telephone counseling), or both.
Outcomes/Limitations: All three interventions
increased the use of mammography, with
community activities the most successful.
Effectiveness appeared greater in communities
without a female physician. Limitations
include the quality of counseling provided
by different volunteers and the possibility
of asking too much of volunteers.
Barnes K, Friedman
S, Namerow P et al. Impact of community
volunteers on immunization rates of
children younger than 2 years. Arch
Pediatr Adolesc Med 1999; 153 (5):518-24.
Program: Not identified
Objective: To assess the effectiveness
of a volunteer-driven outreach program
on immunization rates in children under
2 years old.
Population and Location: Caregivers
of children under 2 in a largely Hispanic
(Dominican) community in New York City.
Study Design: Randomized controlled
trial (sample size = 434).
Community Health Worker Recruitment:
Program was initiated by an unnamed
volunteer group that was part of an
international charitable organization.
Community Health Worker Interventions:
Volunteers were organized by a coordinator
from the local branch of the organization.
The coordinator worked with the research
study director and kept records. Volunteers
provided study participants with basic
immunization education and referral,
as well as follow-up contact and immunization
assistance.
Outcomes/Limitations: The intervention
group had significantly better immunization
completion rates than the control group.
The control group was 2.8 times more
likely to be late for one or more vaccines.
Limitations included that participants
were enrolled based on clinic records,
thereby missing unimmunized children
who had never visited a clinic.
Bird J, McPhee
S, Ha N et al. Opening pathways to cancer
screening for Vietnamese-American women:
lay health workers hold a key. Prev
Med 1998; 27:821-9.
Program: Not identified
Objective: To assess the effectiveness
of a community outreach intervention
program to promote recognition, receipt,
and screening-interval maintenance of
clinical breast examinations (CBE),
mammograms, and Pap smears among Vietnamese-American
women.
Population and Location: Vietnamese
women in California (intervention group
in San Francisco, control group in Sacramento).
Study Design: Controlled trial (not
randomized - intervention and control
groups in separate cities).
Community Health Worker Recruitment:
Neighborhood Leaders and Neighborhood
Assistants were recruited from Vietnamese
women who currently or previously resided
in the area or who had family or friends
residing there.
Community Health Worker Interventions:
Neighborhood-based education programs
were presented by Leaders and Assistants
to small groups. A typical session included
a Leader, an Assistant, a research staff
person, a hostess, and four or more
invited participants. Leaders received
$65/session, Assistants $50, and hostesses
were given $50 to be shared equally
with participants. Culturally appropriate
Vietnamese-language educational materials
were distributed at the educational
sessions as well as at health fairs,
local physicians' offices, neighborhood
stores, etc. Health fairs staffed by
Vietnamese physicians, community volunteers,
and project staff were also conducted.
A contest was also held with drawing
for prizes among women who were up-to-date
on their screening, or who kept screening
appointments.
Outcomes/Limitations: At the end of
the intervention, more Vietnamese women
had heard of mammograms, CBEs, and Pap
tests, had received the test(s), and
had maintained screening behavior. Limitations
include self-reporting of results and
questions about the durability of the
screening behavior.
Brown SA, Garcia
AA, Kouzekanani K et al. Culturally
competent diabetes self-management education
for Mexican Americans: the Starr County
border health initiative. Diabetes Care
2002; 25 (2):259-68.
Program: Starr County Border Health
Initiative
Objective: To assess the effectiveness
of culturally competent diabetes self-management
education interventions in South Texas
Mexican Americans with type 2 diabetes.
Population and Location: Mexican Americans
aged 35 to 70 diagnosed with type 2
diabetes after the age of 35 in Starr
County, Texas. Study participants were
accompanied by a family member or close
friend.
Study Design: Randomized controlled
trial (sample size = 256). Control group
was "wait-listed" and received treatment
after the study group.
Community Health Worker Recruitment:
Not described
Community Health Worker Interventions:
Logistical support only. Originally,
nurses and dietitians were to provide
the educational component with community
lay workers trained to direct support
groups. However, subjects expressed
a preference to have health professionals
available throughout the intervention,
so community workers' roles were modified
to one of logistical support: making
reminder phone calls, providing transportation
for subjects, preparing food for demonstrations,
and keeping attendance logs.
Outcomes/Limitations: Statically significant
changes were achieved in diabetes knowledge
and in levels of HbA1c and
fasting blood glucose (FBG). Limitations
include the cost of testing monitors
and strips (for the organization), cost
of recommended foods (for participants),
and safety concerns for participants
during exercise. Volunteers were used
minimally in this program.
Burhansstipanov
L, Dignan M, Wound D et al. Native American
recruitment into breast cancer screening:
the NAWWA Project. J Cancer Educ 2000;
15 (1):28-32.
Program: Native American Women's Wellness
through Awareness (NAWWA)
Objective: To increase screening for
breast cancer among Native American
women through outreach to increase participation
in mammography, through a breast cancer
education program that would be culturally
acceptable.
Population and Location: Urban Native
American women in Denver.
Study Design: Interrupted-time-series
(comparing mammograms among Native American
women in Denver before and during the
program).
Community Health Worker Recruitment:
Local Native American women were recruited
and trained to provide outreach and
education. Volunteers were known as
"Native Sisters."
Community Health Worker Interventions:
Contacting women to increase awareness
of the need for breast cancer screening;
participating in community meetings
to speak about the project; mailing
the NAWWA project newsletter and educational
materials to women; providing support
by arranging transportation and accompanying
participants to appointments and follow-up
procedures; leading traditional social
support circles to discuss breast cancer
prevention and early detection.
Outcomes/Limitations: More Native American
women were recruited and had mammographies
after the Native Sisters program was
initiated.
Campbell MK, James
A, Hudson MA et al. Improving multiple
behaviors for colorectal cancer prevention
among African American church members.
Health Psychol 2004; 23 (5):492-502.
Program: Wellness for African-Americans
Through Churches (WATCH)
Objective: To compare the effectiveness
of two different strategies to promote
colorectal cancer preventive behavior.
Population and Location: African-American
members of 12 rural churches in North
Carolina.
Study Design: Randomized trial (sample
size = 587) comparing a targeted video/newsletter
campaign versus a lay health advisor
intervention versus a program combining
the two. Control churches were offered
health education sessions not directly
related to the study objectives.
Community Health Worker Recruitment:
Volunteer lay health advisors (LHAs)
were recruited from involved churches
based on nominations by church members.
Community Health Worker Interventions:
The LHA interventions included providing
information to church member through
existing networks and organizing/conducting
at least three church-wide activities
to spread information and enhance support
for desired behaviors.
Outcomes/Limitations: The hypothesis
was that tailored messages and feedback
would promote behavioral changes, with
an additional hypothesis that the intervention
would be enhanced with social support
through existing networks. This second
hypothesis was not confirmed. LHA intervention
did not prove more effective either
alone or in conjunction with tailored
information. Possible reasons included
limited reach of LHAs and that recipients
may not have identified the church-based
health activities as coming from LHAs.
Chernoff RG, Ireys
HT, DeVet KA et al. A randomized, controlled
trial of a community-based support program
for families of children with chronic
illness: pediatric outcomes. Arch Pediatr
Adolesc Med 2002; 156 (6):533-9.
Program: "Network Mothers"
Objective: To reduce risk for poor
adjustment and mental health problems
in chronically ill children.
Population and Location: Mothers and
chronically ill children (7-11 years
old with diabetes mellitus, sickle cell
anemia, cystic fibrosis, or moderate
to severe asthma) in Baltimore.
Study Design: Randomized controlled
trial (sample = 136 mothers and children).
Community Health Worker Recruitment:
Not described (see Ireys 2001).
Community Health Worker Interventions:
Professional child life specialists
visited and called children and parents.
Mothers of older children ("Network
Mothers") were trained to support those
with younger children and the same condition.
Outcomes/Limitations: Scores for intervention
participants show a decrease in anxiety
for all mothers, regardless of disease
group.
Corkery E, Palmer
C, Foley ME et al. Effect of a bicultural
community health worker on completion
of diabetes education in a Hispanic
population. Diabetes Care 1997; 20 (3):254-7.
Program: Not identified
Objective: To determine the effect
of a bicultural CHW on completion of
a diabetes education program.
Population and Location: Hispanic diabetics
20 years old and older, visiting a diabetes
management clinic in East Harlem, New
York, New York.
Study Design: Convenience sample of
64 patients visiting clinic who agreed
to take part in a diabetes education
program, divided into two groups - one
receiving a CHW intervention and one
not receiving the intervention.
Community Health Worker Recruitment:
"The CHW was a bicultural, bilingual
Hispanic-American of Puerto Rican heritage
who lived in the East Harlem community
and who had previously volunteered in
a diabetes clinic."
Community Health Worker Interventions:
The CHW attended clinic sessions with
patients, serving as interpreter, reinforcing
self-care instructions, reminding patients
of appointments and rescheduling them
when necessary.
Outcomes/Limitations: Eighty percent
of patients assigned to the CHW intervention
completed the program, compared with
only 47 percent of those without the
CHW Intervention.
Earp J, Eng E,
O'Malley M et al. Increasing use of
mammography among older, rural African
American women: results from a community
trial. Am J Public Health 2002; 92 (4):646-54.
Program: North Carolina Breast Cancer
Screening Program
Objective: To evaluate the effectiveness
of a Lay Health Advisor (LHA) intervention
to increase breast cancer screening.
Population and Location: Rural African-American
women 50 years and older in North Carolina.
Study Design: Randomized controlled
trial (sample = 390 intervention group;
411 comparison group).
Community Health Worker Recruitment:
Recruited 149 LHAs from within intervention
counties, from women to whom others
turned for guidance and support.
Community Health Worker Interventions:
After training by community outreach
specialists, LHAs worked individually
and together to promote awareness and
use of breast cancer screening. LHAs
spoke individually to approximately
two women per month. Approximately two
community activities were scheduled
per month, including presentation to
community groups and at community events.
Outcomes/Limitations: In the 2-year
study period, mammography use increased
by 17 percent among the intervention
group and by 11 percent in the comparison
group. The intervention was also more
effective among lower-income women.
However, the impact of the LHA activities
could not be separated from the impact
of the other supplemental activities,
which were mostly aimed at health professionals.
Erwin D, Spatz
T, Stotts R et al. Increasing mammography
practice by African American women.
Cancer Pract 1999; 7 (2):78-85.
Program: The Witness Project
Objective: To evaluate the use of trained
cancer survivors to promote early breast
cancer detection and increased breast
self-examination and mammography.
Population and Location: Rural African-American
women from the Mississippi River Delta
region of Arkansas.
Study Design: An intervention group
consisting of a convenience sample of
204 participants was taken from African-American
churches in 2 counties. A control group
of 206 African-American women was taken
from churches and the Cooperative Extension
Service of two similar counties.
Community Health Worker Recruitment:
Not described
Community Health Worker Interventions:
Seven local African-American women who
had survived breast or cervical cancer
spoke on their personal experiences,
highlighting the importance of personal
responsibility as well as early detection
and treatment, in groups of two to five
at local churches and community organization
meetings.
Outcomes/Limitations: Significant increase
in self-reported breast self-examination
(BSE) and mammography among the intervention
group. Control group tended to be younger
and recruited through membership in
the Cooperative Extension Service, rather
than through churches. The control counties
also had access to more mammography
facilities. Authors note that recruitment
of the control group was difficult because
churches generally did not want surveying
of members without the presentation
of a program.
Fedder DO, Chang
RJ, Curry S et al. The effectiveness
of a community health worker outreach
program on healthcare utilization of
west Baltimore City Medicaid patients
with diabetes, with or without hypertension.
Ethn Dis 2003; 13 (1):22-7.
Program: Community Health Worker Outreach
Program
Objective: To assess the effectiveness
of CHW case managers on health care
utilization in patients with diabetes
and/or hypertension, particularly emergency
room visits and hospitalization
Population and Location: One hundred
and seventeen African-American patients
in west Baltimore.
Study Design: Retrospective comparison.
Two years into the CHW Outreach program,
patients with five or more CHW contacts
were selected. The Maryland Medicaid
Claims databases provided data on their
emergency room visits and hospitalization
in the year prior to their enrollment
in the program and in the year after
enrollment.
Community Health Worker Recruitment:
CHWs were recruited from target neighborhoods
and required to have extensive previous
community service experience and commitment
to service. CHWs were provided with
a bus pass and small monthly stipend
($45-$75, depending on caseload). Sixty-eight
CHWs were trained and 38 were active
at the time of this study.
Community Health Worker Interventions:
CHWs received 60 hours of training in
chronic illnesses, particularly diabetes
and hypertension, resource identification,
and case management. CHWs were initially
assigned to 2 patients, working their
way up to as many as ten at a time.
They contacted patients at least once
a week, alternating between in-home
visits and phone calls, linking patients
with appropriate care, monitoring patients'
self care, and providing social support
to patients and their families.
Outcomes/Limitations: Emergency room
visits decreased 38 percent and hospital
admissions decreased by 53 percent.
Mean Medicaid expenditures decreased
27 percent. Possible limitations included
the fact that the patients were self-selected,
responding to an offer of free care,
and, therefore may have been more highly
motivated. The 12 month evaluation period
was also relatively short.
Gary TL, Bone
LR, Hill MN et al. Randomized controlled
trial of the effects of nurse case manager
and community health worker interventions
on risk factors for diabetes-related
complications in urban African-Americans.
Prev Med 2003; 37 (1):23-32.
Program: Project Sugar 1
Objective: To evaluate the use of nurse
case managers, CHWs, or nurse-CHW teams
to improved diabetic control in African-Americans.
Population and Location: African-American
adults with type 2 diabetes in East
Baltimore, Maryland.
Study Design: Randomized controlled
trial (sample size = 186) divided into
four cohorts: Usual care (control);
Usual care + Nurse Case Manager (NCM);
Usual care + Community Health Worker
(CHW); Usual care + Nurse Case Manager/CHW
team.
Community Health Worker Recruitment:
Not described. The CHW was a local part-time
college student with no formal training
in health care before the study.
Community Health Worker Interventions:
The CHW met with participants at home
or by telephone and facilitate care
by offering to schedule appointments,
providing education, reinforcing behavior,
mobilizing social support, and providing
physician feedback.
Outcomes/Limitations: The NCM/CHW Intervention
produced greater effects that the NCM
or CHW Interventions alone, while the
NCM and CHW group effects were similar
to each other. Limitations stated were
small group size; bias among those choosing
to take part; problems with follow-up
visits; lack of resources to track changes
in medication and complications.
Health Resources
and Services Administration. Impact
of community health workers on access,
use of services, and patient knowledge
and behavior. U.S. Department of Health
and Human Services, Health Resources
and Services Administration, Bureau
of Primary Health Care, 1998.
Objective: To inform the Bureau of
Primary Health Care (BPHC) on ways its
programs use CHWs, who they are, what
they can contribute and how they are
managed; to determine outcomes of using
CHWs on patient access to services and
on patient knowledge and behavior; to
provide background for further studies
on CHWs.
Location: Seven sites using CHWs in
California, Texas, Michigan, Maine,
New York and Alabama.
Study Design: BPHC provided a list
of 60 funded programs that used CHWs
to the study group. The list was narrowed
to 30 representative programs based
on geographic location; urban rural
or border; population served and number
of users served. Telephone interviews
identified whether records were sufficient
for review and if centers could link
CHW activities to health center activities.
Fourteen centers were profiled and seven
sites were selected for site visits.
During 2- to 3-day visits, the study
team met with executive directors, financial
officers, CHW program administrators
and supervisors, and representatives
of local social service agencies who
interacted with the programs, and clients.
Outcomes: The study group found each
program was tailored to meet the unique
needs of the community it serves but
there were some generalizations.
- CHW activities may be integrated
into primary care operations or kept
separate.
- Most CHWs are members of the community
they serve.
- Female CHWs predominate.
- The age range varies greatly. In
some cases, age is relevant to program
effectiveness.
- Educational levels vary.
- CHWs are recruited through traditional
means and word of mouth.
- CHWs work at or near full time,
and several programs have low turnover.
- CHWs complete comprehensive training
programs.
- CHWs help patients to properly use
the health care system and provide
translation. They helped ensure that
immunization, prenatal care, and screening
schedules were met.
- CHWs provided health education sessions.
- Some programs had problems with
supervisor expectations of CHWs, especially
when supervisors were not involved
in program planning and recruitment.
- The cost of programs varied greatly.
- Programs generally maintain adequate
data on activities, but information
systems may be inadequate to measure
the impact of interventions.
The seven study sites were reported
to have learned the following lessons:
- CHW time should be balanced between
the community and the health center.
- CHW programs require community participation
in needs assessment and planning.
- CHW programs should be fully integrated
into health center clinical services.
- CHWs can be used to extend existing
successful projects.
- Program administers should implement
policies and regulations that maximize
the effectiveness and minimize risk
to CHWs, as they can work with unsafe
areas and with at-risk populations.
- CHWs are most effective when they
are members of the community; however,
sometimes non-local CHWs can add fresh
perspectives to programs and communities.
- CHWs with few job skills can still
be valuable, as they are given the
opportunity to learn professional
skills, give back to the community,
and serve as role models.
- CHWs do not have to be of the same
demographics to serve the homeless,
although homeless clients respond
well to CHWs who have faced similar
challenges as homelessness and substance
abuse.
- Group training develops teamwork.
- CHWs need more individual assignments
rather than general orientations.
- CHWs must constantly maintain and
upgrade skills.
- Clear communication and involvement
of future supervisors in planning
is needed.
- Creative financing is needed to
keep successful programs going.
- Policymakers should recognize the
need for funding streams.
- CHW encounter records should be
included in patient records.
- Better and more outcomes measures
of CHW programs are needed.
Recommendations:
BPHC and others with an interest in
CHWs should conduct studies on the following:
- Program focus: Are community or
clinically focused programs more effective
in meeting community needs?
- Job Functions: What are the more
specific functions CHWs perform in
various categories, for example, in
health education?
- Populations: What are the target
populations served?
- Training: At all sites, CHWs undergo
comprehensive programs.
- Supervision: What are challenges
faced? How can supervisors be involved
early in program planning and CHW
selection? Because many CHWs have
not worked in professional atmosphere,
what are the challenges?
- Funding of Programs: Study sites
were diligent in finding funding,
but this was a challenge.
- Recordkeeping and Data Collection:
Information is further needed to conduct
program evaluation.
- Program Impact: The programs studied
generally had a positive impact on
patient access to services, proper
use of services and on health knowledge
and behavior.
- Limitations: Improved data collection
systems are needed for better measurement
of impact. Common patient identifiers
are needed. Patient encounter information
across programs needs to be entered
into a common database, rather than
on separate, paper-based systems.
Health Resources
and Services Administration. A literature
review and discussion of research studies
and evaluations of the roles and responsibilities
of community health workers (CHWs).
U.S. Department of Health and Human
Services, Health Resources and Services
Administration, Maternal and Child Health
Bureau, 2002.
Objective: To synthesize and discuss
research on CHWs; to provide a framework
for the design and implementation of
a National evaluation of the value of
CHW services.
Population and Location: Nationwide
Study Design: The study includes a
background with definitions, benefits
of CHWs (access to care, quality of
care, cost of care and community partnerships)
and barriers to expanded use of CHWs
(lack of standard definition, clear
concept, education and training, public
visibility, secure funding, and relatively
short life of programs). There are reviews
of eight programs with process evaluations
and six with outcome evaluations. The
section on the contribution of the literature
to designing a National evaluation includes
roles of CHWs, employment of CHWs by
Medicare-Medicaid managed care; data
and performance measures, and elements
of a successful evaluation. The report
includes potential funders of CHWs,
as well as a summary and bibliography
of 72 references.
Outcomes/Limitations: The study group
identified the following as elements
of a successful evaluation and important
in conducting a National CHW evaluation:
clear and measurable goals and objectives;
adequate evaluation support, training
and involvement of program staff; development
of outcome measures; sufficient study
time to show results; and avoidance
of contamination of the control group
by contact with the test group. The
study group suggests quasi-experimental
evaluation design might be preferable
to randomized controlled trials, because
random assignment to a group is generally
not possible in CHW studies.
Hill MN, Han H-R,
Dennison CR et al. Hypertension care
and control in underserved urban African
American men: behavioral and physiologic
outcomes at 36 months. Am J Hypertens
2003; 16 (11):906-13.
Program: Not identified
Objective: To evaluate the effectiveness
of two interventions (an intensive one
by a nurse practitioner-community health
worker-physician (NP/CHW/MD) team and
the other less intensive focusing on
education and referral) in controlling
blood pressure and minimizing progression
of left ventricular hypertrophy and
renal insufficiency in younger African
American men.
Population and Location: Hypertensive
African-American men (ages 21 to 54)
in inner-city Baltimore, Maryland.
Study Design: Randomized controlled
trial (157 in more intensive program,
152 in less intensive program) over
36 months.
Community Health Worker Recruitment:
Not described
Community Health Worker Interventions:
The CHW made one or more home visits
each year to assist the participants
support person, as well as making referrals
to social services and assist with housing.
Outcomes/Limitations: More intensive
intervention with CHWs showed greater
reduction in blood pressure and higher
rates of blood pressure control as well
as a greater slowing of progression
of left ventricular hypertrophy.
Humphry J, Jameson
L, Beckham S. Overcoming social and
cultural barriers to care for patients
with diabetes. West J Med 1997; 167
(3):138-44.
Program: Diabetes Prevention Project
Objective: To test whether a community-based
program, using a paraprofessional as
primary contact, would improve patient
compliance in diabetes.
Population and Location: Multiethnic
diabetic community in Waianae, Hawaii,
with a history of missed appointments,
or diabetes in pregnancy, or children
requiring insulin.
Study Design: Four-year project; 94
patients in a demonstration project
(no control group).
Community Health Worker Recruitment:
Not described. CHWs were medical assistants/paraprofessionals
who received 20 weeks of training and
monthly continuing education (CE).
Community Health Worker Interventions:
Acted as patients' primary contact and
first line health care worker. Helped
patients with self-management. Provided
nutrition and diabetic education.
Outcomes/Limitations: Patients: Fifty-two
non-pregnant adults, on average, lost
5.4 pounds (ranging from losing 25 or
more pounds to gaining 10 or more pounds).
Forty percent improved blood glucose
control. Systolic blood pressure dropped
by 20.5 mmHg on average. None of nineteen
pregnant women achieved pre-gestational
diabetes control. Limitations include
using relatively untrained community
health care workers as primary contact/first
line caregivers which sometimes led
to problems in providing care, especially
in the early phases of the project.
Ireys HT, Chernoff
R, DeVet KA et al. Maternal outcomes
of a randomized controlled trial of
a community-based support program for
families of children with chronic illnesses.
Arch Pediatr Adolesc Med 2001; 155 (7):771-7.
Program: Family-to-Family Network
Objective: To decrease risk for anxiety
and depression in mothers of children
aged 7 to 11 with chronic diseases (cystic
fibrosis, diabetes, sickle cell anemia,
moderate-to-sever asthma) by matching
them with mothers of older children
with the same chronic disease.
Population and Location: One hundred
sixty-one mothers (86 in the experimental
group, 75 in the control group), chosen
from patients at 16 clinics in Baltimore,
Maryland.
Study Design: Randomized controlled
trial; outcome measured with several
questionnaires.
Community Health Worker Recruitment:
"Network Mothers" (mothers of children,
18 or older, with the same chronic diseases)
nominated by directors and staff at
specialty clinics, who then underwent
a 30-hour training program. Network
Mothers (NMs) were paid at an hourly
rate. Eighteen NMs eventually worked
for the program.
Community Health Worker Interventions:
NMs provided support by linking families
with resources and information; by enhancing
the mother's confidence in parenting;
and by providing emotional support.
Control group mothers were offered the
opportunity to contact experienced but
untrained mothers of older patients.
Outcomes/Limitations: Scores for intervention
participants show a decrease in anxiety
for all mothers, regardless of disease
group.
Kegler MC, Malcoe
LH. Results from a lay health advisor
intervention to prevent lead poisoning
among rural Native American children.
Am J Public Health 2004; 94 (10):1730-5.
Program: Tribal Efforts Against Lead
(TEAL)
Objective: To test the effectiveness
of a community-based CHW intervention
for prevention of lead poisoning among
Native American children who lived in
a former lead and zinc mining area.
Population and Location: Children of
eight tribes and nations in northeastern
Oklahoma.
Study Design: Randomized controlled
trial comparing 331 Native American
(intervention group) children and 387
White (control group) children after
a 2-year intervention. Pre- and post-intervention
blood lead levels of the Native American
children were also compared.
Community Health Worker Recruitment:
Natural helpers (CHWs) were recruited
from the community and received 8 hours
of training. It is unclear if CHWs were
paid.
Community Health Worker Interventions:
CHWs educated individuals in their social
networks on sources of lead exposure
and lead poisoning prevention strategies,
including the importance of blood lead
screening, strategies for removing lead
sources, hand washing, playing in grass
rather than in dirt or mine tailings,
good nutrition, and housecleaning. For
over 2 years they made 27,000 contacts
and spent more than 5,000 hours conducting
education efforts (average 5.4 education/outreach
activities per month).
Outcomes/Limitations: Significant declines
in blood lead levels in the intervention
group were observed. Improvements were
also shown levels of knowledge. One
limitation was that the intervention
and control groups lived in the same
communities. This was necessary in order
for them to have the same environmental
risks, but may have caused "contamination"
of the control group with the preventive
messages meant for the intervention
group.
Krieger J, Collier
C, Song L et al. Linking community-based
blood pressure measurement to clinical
care: a randomized controlled trial
of outreach and tracking by community
health workers. Am J Public Health 1999;
89 (6):856-61.
Program: Seattle Hypertension Intervention
Project
Objective: To assess the effectiveness
of a tracking and outreach intervention
by CHWs in increasing medical follow-up
of persons with hypertension that was
detected during community blood pressure
(BP) screenings.
Population and Location: Four hundred
twenty-one Black or White adults with
blood pressure greater than or equal
to 140/90 and income equal or less than
200 percent of Federal poverty level,
located in low-income neighborhoods
in Seattle, Washington.
Study Design: Randomized controlled
trial (sample size = 421; 209 intervention
group, 212 control group).
Community Health Worker Recruitment:
CHWs were from low-income neighborhoods
similar to the project community. CHWs
received 100 hours of training and were
certified as blood pressure measurement
specialists. No information was provided
on how they were recruited or compensated.
Community Health Worker Interventions:
CHWs provided BP screening and provided
follow-up services including referral
to medical, help making an appointment,
an appointment reminder letter, appointment
follow-up and a new appointment if one
was missed (up to three), and assistance
in reducing barriers such as referral
to transportation, childcare, and other
services.
Outcomes/Limitations: 65.1 percent
of intervention group participants completed
a medical appointment within 90 days
of referral, while only 46.7 percent
of the control group did so. Fewer than
10 percent of the intervention group
participants who completed an appointment
required more than one appointment to
do so.
Krieger JW, Castorina
JS, Walls ML et al. Increasing influenza
and pneumococcal immunization rates:
a randomized controlled study of a senior
center-based intervention. Am J Prev
Med 2000; 18 (2):123-31.
Program: Seattle Senior Immunization
Project
Objective: To increase the rate of
pneumococcal and flu immunizations among
an urban senior population.
Population and Location: Adults 65
and older recruited from a senior center
and the five ZIP codes comprising the
senior center's service area.
Study Design: Randomized controlled
trial (sample size = 1246; 622 intervention
group, 624 control group).
Community Health Worker Recruitment:
CHWs were volunteers recruited from
the senior center membership. CHWs received
four hours of training, including role-playing.
Community Health Worker Interventions:
Intervention group members were mailed
an education brochure and a postage-paid
reply card for tracking immunization
status. CHWs followed up with unimmunized
participants and with those who did
not reply. CHWs encouraged immunization
and followed up, up to five times. Control
group members received the usual senior
center and community immunization activities
(including availability of vaccine at
the senior center).
Outcomes/Limitations: Intervention
group had a flu immunization rate of
88.2 percent (compared to 78.3 percent
the previous year) and a pneumococcal
immunization rate of 66.5 percent (41.7
percent the year before). The control
group had a flu immunization decrease,
from 83 percent to 81.7 percent, and
a pneumococcal immunization increase
from 40.5 percent to 50.9 percent. The
program was also successful in increasing
flu immunizations among those who had
not received an immunization the previous
year. Limitations included the possibility
of self-selection among those more motivated
to receive immunizations, and that it
relied on self-report. Control group
members may also have been influenced
by intervention group members.
Krieger JW, Takaro
TK, Song L et al. The Seattle-King County
Healthy Homes Project: a randomized,
controlled trial of a community health
worker intervention to decrease exposure
to indoor asthma triggers. Am J Public
Health 2005; 95 (4):652-9.
Program: Seattle-King County Healthy
Homes
Objective: To assess the effectiveness
of a CHW intervention designed to reduce
exposure to indoor asthma triggers.
Population and Location: Two hundred
seventy-four low-income households in
King County, Washington, with an asthmatic
child 4 to 12 years of age.
Study Design: Randomized controlled
trial with 138 high-intensity intervention
group families, 136 low-intensity intervention/control
group families.
Community Health Worker Recruitment:
Not described
Community Health Worker Interventions
(described in another paper): CHWs conducted
a home environmental assessment, and
with the participant, prepared an action
plan. CHWs made up to eight more visits
to encourage completion of action plan,
provide support, deliver resources,
including pillow and mattress covers,
vacuums, cleaning kits, roach bait,
etc. Control group families received
a single CHW visit, an action plan,
limited education, and bedding encasements.
Community members were also trained
as interviewers to collect baseline
and exit data.
Outcomes/Limitations: Outcomes were
measured with the Pediatric Asthma Caregiver
Quality of Life Scale (QoL), participant
and caregiver reports and interviewer
observation. Caregivers in the intervention
showed significantly great QoL benefit.
Urgent health service use declined significantly,
and symptom days decreased. Except for
reduction of dust exposure and use of
bedding encasements, few behaviors changed
significantly.
Lam TK, McPhee
SJ, Mock J et al. Encouraging Vietnamese-American
women to obtain Pap tests through lay
health worker outreach and media education.
J Gen Intern Med 2003; 18 (7):516-24.
Program: REACHing Vietnamese-American
Women: A Community Model for Promoting
Cervical Cancer Screening
Objective: To increase Vietnamese-American
women's cervical cancer awareness, knowledge,
and screening, using lay health worker
outreach and a media education campaign.
Population and Location: Vietnamese-American
women in Santa Clara Country, California.
Study Design: Four hundred women randomized
into an intervention group, receiving
CHW activities as well as media-based
education, and a control group, which
received only media-based education.
Community Health Worker Recruitment:
Twenty CHWs were selected from agencies
working with Vietnamese-American women.
CHWs were trained in two 3-hour sessions
about female reproductive anatomy, cervical
cancer, risk factors, and early detection
as well as recruiting, partisans, program
leadership, and presentation skills.
Each CHW received a stipend of $1500.
Community Health Worker Interventions:
CHWs each recruited 20 women to take
part in the program. These women were
randomized into intervention and control
groups. CHWs organized women into groups
for presentations with discussions and
questions. They explained how to access
medical services and helped some women
to schedule Pap tests. Pre- and post-intervention
questionnaires were administered. Originally,
CHWs were to be involved in data collection;
however, the university review board
would not allow this without National
Institutes of Health (NIH) human subjects
certification.
Outcomes/Limitations: Cervical cancer
knowledge and receipt/intent of a Pap
test increased in both groups, but significantly
more in the intervention group. Limitations
include the fact that participants were
self-selected. There was also a lack
of understanding about scientific research
method which may have affected the outcome.
Levine D, Bone
L. Impact of a planned health education
approach on the control of hypertension
in a high-risk population. J Human Hypertension
1990; 4 (4):317-21.
Program: Not identified
Objective: To improve identification
of individuals with hypertension, to
enhance continuity of care, to decrease
drop-out rates, and to improve adherence
to prescribed treatment for control
of hypertension.
Population and Location: Community
of approximately 80,000 individuals
in Maryland with the highest rate for
uncontrolled hypertension and complications.
This group was primarily Black, poor,
and under-educated. The target group
within this population was males, 18
to 49 years old that tend to be less
aware of, or were not receiving treatment,
for hypertension.
Study Design: Program report
Community Health Worker Recruitment:
Recruited from those already involved
in community service. CHWs received
training to provide BP screening, education
counseling, monitoring, follow-up, and
outreach.
Community Health Worker Interventions:
Provided BP screening, education counseling,
monitoring, follow-up, and outreach.
Special emphasis was given to target
population in the hospital emergency
room.
Outcomes/Limitations: A long-term project.
There was no control group, but between
1978 and 1986, surveys showed that the
percentage of individuals with hypertension
who were aware of their condition increased
from 65 percent to 80 percent. The percentage
receiving treatment increased from 45
percent to 66 percent and those achieving
BP control increased from 32 percent
to 50 percent. However, this paper gives
no indication as to direct links between
the improvements and CHW activities.
Levine DM, Hill
MN, Gelber AC et al. The effectiveness
of a community/academic health center
partnership in decreasing the level
of blood pressure in an urban African-American
population. Ethn Dis 2003; 13 (3):354-61.
Program: Sandtown-Winchester High Blood
Pressure Control Program
Objective: To investigate the effectiveness
of using CHWs in decreasing hypertension
in an urban African-American population.
Population and Location: Sandtown-Winchester,
the inner city of Baltimore. Study population
was 100 percent African-American, 62
percent female, average age of 54; 42
percent had the equivalent of a high
school education; 45 percent had less
than a ninth grade education; 32 percent
were unemployed; 65 percent had an annual
income less than $10,000; and 20 percent
had no health insurance.
Study Design: Randomized clinical trial
over a 30-month period. Interviewers
identified 2,736 adults eligible for
the study, with 2,196 completing the
first interview; 817 with hypertension
were invited to participate. Most (97
percent) agreed. Participants were randomly
assigned to one of two groups. One group
had more intensive intervention with
CHWs and one had less.
Community Health Worker Recruitment:
A community health advisory board helped
recruit, select, and monitor CHWs whose
training took place over a 3-month period.
Training, which took place over a period
of 3 months is described in another
article by Strogatz and James (1986).
Community Health Worker Interventions:
CHWs were trained and certified to monitor,
educate, counsel, and follow-up with
blood pressure management. Participants
with less intensive intervention were
visited by CHWs and given counseling,
cards to record levels of blood pressure,
educational pamphlets, and information
on access to health care. Those with
more intensive intervention received
five home visits over 30 months. In-depth
education included food preparation,
family member support, health insurance,
and more.
Outcomes/Limitations: Both systolic
and diastolic blood pressure decreased
in those studied during 13 months of
the study, resulting in a statistically
significant increase in the percent
with controlled hypertension. More intensive
intervention, with home visits, did
not result in better outcomes. One-third
of participants available at baseline
were unavailable for follow-up at 40
months.
Lewin SA, Dick
J, Pond P et al. Lay health workers
in primary and community health care
(review). Cochrane Database Syst Rev
2005; (1): Art. No.: CD004015. DOI:
10.1002/14651858.CD004015.pub2.
Program: Cochrane Collaboration
Objective: To review articles and summarize
the effects of lay health worker (LHW)
interventions on patient health outcomes
and satisfaction with care.
Study Design: Major databases such
as MEDLINE, EMBASE, Science Citation
Index, CINAHL, and more were searched
for randomized controlled trial reports
of interventions delivered by LHWs.
Reports were reviewed by two independent
reviewers who extracted data and rated
study quality. Similar studies were
grouped together and results were combined,
when possible.
Outcomes/Limitations: The reviewers
found 43 reports for inclusion. These
studies had impact on 210,110 individuals.
Most studies were too diverse to combine
or draw conclusions from; however, the
authors found the use of LHW interventions
were positive in promoting immunization,
improving outcomes for certain infectious
diseases, and promoting breastfeeding.
The authors found a small positive effect
in promoting breast cancer screening.
The authors conclude more rigorous research
is needed to determine the effectiveness
of LHWs on health outcomes.
Love MB, Gardner
K. The emerging role of the community
health worker in California: results
of a Statewide survey and San Francisco
Bay area focus groups on the community
health workers in California's public
health system. Center for Health Promotion,
CHW Certificate Training, and California
Department of Health Services, 1992.
Program: Statewide Survey and Focus
Groups on Community Health Workers
Objective: To explore the extent of
use of CHWs in California, determine
an ethnic profile, and identify job
responsibilities and training needs
for these individuals.
Population and Location: California
health departments, community centers
and hospitals in Northern and Central
California.
Study Design: Surveys were mailed to
310 Statewide health departments, community
health centers, as well as hospitals
limited to Northern and Central California.
The survey covered workers who both
worked in clinics and in the communities.
Focus groups were held in Bay Area Hospitals.
Outcomes/Limitations: There was a 60
percent overall response rate. More
than half of the facilities employed
CHWs. About half of the CHWs had the
following characteristics: earned $20,000-$30,000
annually; were people of color; and
had a high school degree or less. CHWs
took health histories and vital signs,
provided advice, information, referrals,
translation, and advocated for the community.
Areas of work included sexually transmitted
diseases, maternal and child health,
family planning, and work with youth.
Most facilities provided training for
CHWs; about half said they would send
CHWs for certificate training. Training,
if offered, should include communication,
interviewing, medical terminology, screening,
counseling, advocacy, and referral skills.
Training should also include how to
manage a stressful and sometimes dangerous
job. Most became CHWs because they were
already known for working as community
volunteers and had been clients of the
programs that later hired them.
Margolis K, Lurie
N, McGovern P et al. Increasing breast
and cervical cancer screening in low
income women. J Gen Intern Med 1998;
13 (8):515-21.
Program: Women's Cancer Screening Clinic
and Berman Center for Outcomes and Clinical
Research
Objective: To test a hypothesis that
women in non-primary care clinics would
have higher breast and Pap smear screening
rates if lay health advisers recommended
screening and offered convenient screening
with a female health practitioner.
Population and Location: Women, aged
40 or over, attending non-primary care
outpatient clinics (surgery, orthopedics,
ophthalmology, dental, and psychiatry)
at Hennepin County Medical Center, the
urban country teaching hospital in Minneapolis
Study Design: Controlled trial.
Community Health Worker Recruitment:
Volunteer senior aides - low income
elderly lay women with salaries paid
by a Federal job training program and
trained to participate in the study.
Community Health Worker Interventions:
Lay health advisers (LHAs) assessed
breast and Pap smear screening status
by classifying participants as "due"
or "up-to-date." Those due for the screenings
were told so by an LHA and offered the
opportunity for the screening at the
Women's Cancer Screening Clinic with
a female nurse practitioner.
Outcomes/Limitations: Outcome measures
were the completion of mammograms or
Pap smears between the time of the questionnaire
and follow-up 1 year later. Intervention
was related with a higher rate of screening
completions. Breast and cervical cancer
screening rates improved, especially
among older women of color, who are
most in need of the services. Study
was not randomized. Results are based
on a combination of database analysis
and participant self-reports of screening.
Massachusetts
Department of Public Health. Community
health workers: essential to improving
health in Massachusetts. Findings from
the Massachusetts Community Health Worker
Survey. Division of Primary Care and
Health Access, Bureau of Family and
Community Health, 2005.
Program: Massachusetts Community Health
Worker Survey
Objective: To identify characteristics
of CHWs, what they do, their defining
issues as a workforce, and to help better
understand and support community health
works and improve health outcomes.
Population and Location: Eight thousand
agencies and individuals in Massachusetts.
Study Design: Surveys were mailed to
CHWs and supervisors. Surveys included
51 questions for workers and eight questions
for supervisors.
Outcomes/Limitations: Surveys were
returned by 46 percent of CHWs and 68
percent of supervisors. Seventy-six
percent of CHWs were female. Supervisors
are 87 percent female. Eighty percent
responded they were White but 15 percent
did not respond to the question. Those
surveyed represented more than 20 ethnicities.
Many spoke two or more languages. Wages
were low and turnover was high among
the workers. Most (78 percent) shared
the same ethnicity as those they served.
When CHWs were male, they targeted male
populations 73 percent of the time.
Those conducting the survey concluded
that CHWs faced difficult working conditions,
poor compensation, lack of benefits,
inadequate training and supervision,
and few opportunities for promotion.
However, the unique skills and high
commitment to their communities meant
CHWs played an important role in addressing
certain health care problems. The authors
suggest the establishment of core competencies,
a career ladder for this workforce,
training and supervision for CHWs, fair
and equitable pay, a collaboration with
the Massachusetts Community Health Worker
Network, further research on the unique
contribution of the workforce, more
education for health providers and policymakers,
and identification of stable funding
for long-term program planning. The
lack of a standard definition for CHWs
hindered the study. Because the profession
was emerging, it was difficult to determine
the number of workers in the State.
The survey identified 800 such workers.
There might have been selection bias
in this self-reporting survey. Workers
may not have replied due to time constraints,
literacy level, etc. The survey was
only presented in English, and the CHWs'
first language may not be English.
May M, Kash B,
Contreras R. Southwest Rural Health
Research Center: community health worker
(CHW) certification and training - a
national survey of regionally and State-based
programs. U.S. Department of Health
and Human Services, Health Services
and Resources Administration, Office
of Rural Health Policy, May 2005.
Program: Southwest Rural Health Research
Center, School of Rural Public Health,
Texas A&M University System Health
Science Center. Funded by: 5-U1C-RH00033,
U.S. Department of Health and Human
Services, Health Services and Resources
Administration, Office of Rural Health
Policy
Objective: To provide a National overview
of State policy and involvement in training
and certification of CHWs; to analyze
potential effects of policy trends;
to report on certificate and training
programs, including history, structure
of programs, goals of programs, curricula,
evaluation of programs, impact, and
future of programs.
Population and Location: Nationwide
State public health officials, offices
of rural health, primary health care
associations, departments of social
services, CHW networks and associations,
community colleges with CHW training
programs and training service providers.
Study Design: State legislative Web
sites were used to find legislation
or laws related to CHWs. In-depth interviews
were then conducted with 17 States:
Alaska, Arizona, California, Connecticut,
Florida, Indiana, Kentucky, Massachusetts,
Mississippi, North Carolina, New Mexico,
Nevada, Ohio, Oregon, Texas, Virginia,
and West Virginia.
Outcomes/Limitations: All 17 States
have some kind of training or certification
for CHWs. Alaska, Indiana and Texas
had State certification programs. Arizona,
California, Kentucky, Massachusetts,
Nevada, New Mexico, and Ohio were considering
State certification. Ohio, North Carolina
and Nevada have State standards for
training. There are three major trends:
- Most States use community college
or agency-based training with a standardized
curriculum.
- On-the-job training is offered.
- Certificate at the State level raises
the possibility for reimbursement
for CHW activities.
Five policy implications for State
standardized training and certification
programs were offered:
- Definitions, roles and purposes
of CHWs must be considered as part
of the training and certification
process plan.
- The social and health service needs
of the communities where the CHWs
work must be considered when creating
curricula.
- Evaluation research is needed on
various aspects of training, program
use, satisfaction, patient outcomes
and cost-effectiveness.
- Policies and strategies are needed
to increase retention of CHWs; facilitate
integration of CHWs into the health
system and identify sources of long-terms
funding.
- While systematically integrating
CHWs into the health system, be cognizant
of the strengths that make CHWs unique
- community attachment, cultural and
linguistic similarity to those they
serve, local knowledge, and more.
Meister JS. Community
outreach and community mobilization:
options for health at the U.S.-Mexico
border. J Border Health 1997; 2 (4):32-8.
This review article discusses the various
roles of promotoras as well as
community mobilization leaders (community
members working on broader goals). Seven
general themes are discussed: culture
of the border, professional/community
interface, indigenous leadership, the
expanding definition of health, immigration/migration,
transborder utilization, and economic
development.
Meister JS, Warrick
LH, de Zapien JG et al. Using lay health
workers: case study of a community-based
prenatal intervention. J Community Health
1992; 17 (1):37-51.
Program: Un Comienzo Sano (A
Healthy Beginning)
Objective: To promote more adequate
prenatal care, fewer pregnancy complications,
earlier high risk intervention and better
birth outcomes.
Population and Location: Low-income
Hispanic women in three migrant communities
in Yuma County, Arizona.
Study Design: Description of demonstration
program.
Community Health Worker Recruitment:
A bilingual nurse midwife was recruited
as coordinator. A Mexican American woman
who had worked with the county Women,
Infants, and Children (WIC) nutritional
program and was a former farmworker
served as a consultant. Names of potential
promotoras were gathered from
community contacts. Promotoras
needed to be bilingual, have children
of their own and make a 1 year commitment.
Promotoras were hired for 10
hours per week and paid equal to an
entry level health aide. All completed
32 hours of training, including teaching
skills.
Community Health Worker Interventions:
Each promotora recruited up to
10 women for her class. Classes about
prenatal care were held in Spanish.
Classes were held in three target communities
for 2 to 3 hours each week, for 12 weeks.
Outcomes/Limitations: The program grew
to be both a prenatal education program
and a family support system. More people
than expected applied for the program,
and people outside the target audience
also attended. In order to accommodate
excessive size, the program sacrificed
support staff, educational materials
and transportation reimbursements. It
was felt more thorough needs assessments
could have helped anticipate possible
concerns. Lessons learned include: maintaining
cultural relevance, conducting community
assessment to overcome resistance; empowering
community-based workers and collecting
data for documentation and evaluation.
Information on health outcomes was not
available.
Morisky DE, Lees
NB, Sharif BA et al. Reducing disparities
in hypertension control: a community-based
hypertension control project (CHIP)
for an ethnically diverse population.
Health Promot Pract 2002; 3 (2):264-75.
Program: Community Hypertension Intervention
Program (CHIP), a 4-year program to
identify effective strategies to help
patients manage their high blood pressure.
Funded by National Health, Lung and
Blood Institute, Award R0-H251119
Objective: To investigate the value
of three interventions, including those
with CHWs; to improve hypertension treatment
adherence.
Population and Location: Low-income,
inner-city Black and Hispanic adults
(1,367) in a large west coast city.
Participants were recruited from the
county hospital clinic or a private
health clinic in the community; 98 percent
of those approached agreed to participate.
At time of entry into the study only
35 percent of the participants had their
blood pressure under control; 41 percent
were male, average age was 54; most
were Black (77 percent) and Hispanic
(21 percent); 49 percent had not completed
high school; 40 percent had a high school
diploma; and more than half reported
income of less than $5,000 per year.
Most (84 percent) had either no insurance
or health coverage by a public assistance
program.
Study Design: 6- and 12-month study
results of the clinical trial of a 4-year
longitudinal study. Participants randomized
to one of three interventions. Participants
were randomly assigned to either usual
care or one of three interventions:
individualized counseling with CHWs;
a computerized appointment tracking
system, with mailed reminder cards 10
days before appointments, or home visits
and focus group discussions with CHWs.
Community Health Worker Recruitment:
Not described. CHWs received 1 month
training in interviewing, American Heart
Association guidelines and certified
for blood pressure monitoring. CHWs
conducted interviews, counseling sessions
and home visits.
Community Health Worker Interventions:
Individualized session consisted of
a 5 to 10 minute counseling with a CHW
to reinforce healthy lifestyles, taking
medications and keeping appointments
followed by three home visits that included
family members to reinforce adherence
to the treatment plan and discuss risk
factors such as weight loss and smoking
cessation.
Outcomes/Limitations: The study reports
6 and 12 month results. After 6 months,
the most significant improvements in
blood pressure control and appointment
keeping was with those participants
in the patient tracking intervention.
However, after a year, those who had
individualized counseling and home visits
with CHWs had significant, sustained
improvements both in the control of
their blood pressure and in keeping
appointments.
Navaie-Waliser
M, Martin SL, Tessaro I et al. Social
support and psychological functioning
among high-risk mothers: the impact
of the Baby Love Maternal Outreach Worker
Program. Public Health Nurs 2000; 17
(4):280-91.
Program: Baby Love Maternal Outreach
Worker (MOW) Program
Objective: To evaluate a maternal home
visit program to learn whether program
participation was associated with improvements
in mothers' psychological functioning
and whether improvements in psychological
functioning were associated with type
and intensity of support.
Population and Location: Medicaid-eligible
mothers and infants in 18 counties in
North Carolina.
Study Design: Part of a comprehensive
longitudinal evaluation of the program.
Comparison of 221 mothers who participated
in the program versus 198 from similar
counties who did not. Comparisons were
on proportion of births to African-American
mothers, births to teen mothers, preterm
births, low birth weight infants and
births to mothers in rural areas. The
sample of pregnant women from the counties
was identified by maternity care coordinators.
Community Health Worker Recruitment:
Not described but was patterned after
the South Carolina "natural helpers"
program. The community health advocates/MOWs
received 60 hours of training each and
worked with a maximum of 25 to 30 families
per year.
Community Health Worker Interventions:
Program services began before 28 weeks
gestation and continued through the
first birthday of the infant. Participants
received prenatal home visits at least
monthly from community health advocates.
The MOWs encouraged using preventive
health services, healthy behaviors,
improving parenting skills, and enhanced
psychological health.
Outcomes/Limitations: Two hundred twenty-one
mothers who participated in the home
visit program were compared with 198
who had not participated. Participants
with more intensive home visit support
had higher self-esteem and were less
depressed. However, improvements in
psychological functioning did not seem
to be related to the specific type of
support received.
Rico C. Community
health advisors: emerging opportunities
in managed care. Annie E. Casey Foundation,
Seedco--Partnerships for Community Development,
1997.
Program: Not identified
Objective: To examine demand for community
health advisors (CHAs), especially in
managed care organizations and with
Medicaid managed care. To evaluate whether
developing a start-up community health
advisor agency could create new jobs
and influence the acceptance and use
of community health advisors in health
care.
Population and Location: New York,
New York; Philadelphia, Pennsylvania;
Milwaukee, Wisconsin; and Alameda and
Solano counties in California.
Study Design: Interviews of CHA agency
directors, managed care organization
executives, public health official,
directors of community health center
and local funders. These interviews
gathered information about CHAs and
relationships between CHA agencies and
managed care organizations. Conversations
focused on developing an independent
CHA agency that would contract with
Medicaid managed care plans. The interviewers
sought to understand reimbursement potential
for CHA use.
Outcomes/Limitations: The interviewers
found the market for CHA serves in managed
care organizations was emerging. The
interviewers found little data on cost
effectiveness, but said what evidence
there is suggests CHAs can help reduce
the inappropriate use of emergency rooms,
increase use of preventive and primary
care, improve compliance with health
regiments and improve outcomes for high
risk patients, all of which have impacts
on cost containment. Almost every city
visited had, what could be considered,
experimental contractual relationships
between CHAs and managed care organizations,
mostly in services for prenatal and
maternal child health care. However,
for CHAs to be used on a large scale
by managed care organizations the effectiveness
must be documented for both health outcomes
and cost effectiveness; there must be
consensus on definitions of services,
pricing and payment; and the CHA provider
must increase capacity to meet the demands
of managed care organizations.
Rogers MM, Peoples-Sheps
MD, Suchindran C. Impact of a social
support program on teenage prenatal
care use and pregnancy outcomes. J Adolesc
Health 1996; 19 (2):132-40.
Program: Resource Mothers for Pregnant
Teens Project
Objective: To evaluate the effectiveness
of home visits to pregnant teens by
resource mothers; to increase use of
prenatal care use and improve teen pregnancy
outcomes.
Population and Location: Thirteen rural
and three moderately urban South Carolina
counties. These counties were identified
as having high pregnancy, abortion,
and birth rates as well as poor perinatal
outcomes in teens.
Study Design: Retrospective comparison
study. Resource mothers (RMs) recruited
pregnant teens to the program through
community education and outreach, and
through referrals such as the food program
for WIC, prenatal clinics, human services
agencies, school churches and physicians.
The program targeted young, unmarried
Black teens.
Community Health Worker Recruitment:
RMs were local community paraprofessional
health workers selected for personal
warmth, successful parenting and knowledge
of community resources.
Community Health Worker Interventions:
RMs visited the homes of pregnant teens
at least once a month before delivery.
Information was provided about the need
for early and regular health care, and
reduction of smoking, drug use and poor
nutrition.
Outcomes/Limitations: Those visited
by the RMs were more likely to initiate
early prenatal care and to receive adequate
care than teens in other counties. Unmarried
teens in the study group were less likely
to have premature births than teens
in other counties. Limitations to the
study were that it was retrospective
and it was subject to selection bias,
since it was not possible to randomize
teens into program and control groups.
Rosenthal EL,
Wiggins N, Brownstein JN et al. The
final report of the National Community
Health Advisor Study. A policy project
of the Annie E. Casey Foundation. Tucson,
AZ: University of Arizona, 1998.
Program: National Community Health
Advisor Study; Weaving the Future, A
policy research project of the University
of Arizona funded by the Annie E. Casey
Foundation.
Objective: To provide guidance and
recommendations to policymakers and
practitioners that could improve the
overall status of the CHA field.
Population and Location: Two hundred
eighty-one CHAs and program supervisors
from 31 States and the District of Columbia
completed the survey. A convenience
sample was selected to represent a broad
spectrum of programs and diverse geographic
regions.
Study Design: Methods included a literature
review, a survey, one-on-one interviews,
site visits, group interviews, and focus
groups. CHAs and supervisors completed
an eight page survey about description
of programs and pressing issues. A 36-member
Advisory Council, representative of
programs and regions, refined the agenda,
interpreted data and developed recommendations.
Outcomes/Limitations: Most (82 percent)
of those responding were currently working
as CHAs. Most (66 percent) had worked
as CHAs or supervisors for less than
3 years. More than half said the CHAs
were of the same ethnicity as those
they served. Most programs (85 percent)
served Hispanic audiences. Over 50 health
concerns were described as being addressed
by programs with HIV/AIDS and cancer
mentioned most often. Often described
were women's health, prenatal care,
maternal health, domestic violence and
advocacy with poverty, housing, food,
and employment. Most CHAs provided services
in homes and community centers, followed
by schools, clinics or hospitals, religious
organizations, work sites, shelters
and migrant labor camps. Key recommendations
from this comprehensive study are to
adopt and refine CHA roles and competencies;
to promote a comprehensive research
agenda; to develop evaluation guidelines
and tools and to establish an evaluation
database of evaluators, tools and findings;
to establish a National certification
program with core curriculum guidelines
and supervisor training; to develop
best practice guidelines for programs;
to educate managed care organizations
and State health agencies about CHAs;
to build sustainability for programs
through public policy and financing
mechanisms; and to form a National association
or organization to provide leadership
to the field, with CHAs in key roles
in governance.
Staten LK, Gregory-Mercado
KY, Ranger-Moore J et al. Provider counseling,
health education, and community health
workers: the Arizona WISEWOMAN project.
J Womens Health 2004; 13 (5):547-56.
Program: The Arizona WISEWOMAN Project
Objective: To increase women's physical
activity and fruit and vegetable consumption
over 1 year.
Population and Location: Two hundred
seventeen women, three-fourths of whom
were Hispanic, were recruited from two
Tucson clinics.
Study Design: Participants were randomly
assigned to three groups: professional
counseling only; professional counseling
and health education; professional counseling
and health education and CHW support.
Participants were recruited from those
participating in the National Breast
and Cervical Cancer Early Detection
Program. Five hundred thirty-four were
approached, 12 percent were not medically
eligible, 12 percent chose not to participate;
eight percent withdrew before the initial
visit and one percent was dropped because
of missing information. Others died,
moved, became insured, or did not have
insurance for the return visit.
Community Health Worker Recruitment:
Six bilingual Hispanic women ages 50
and over. Most CHWs had been previously
trained to provide outreach, translation,
and transportation services to health
clients.
Community Health Worker Interventions:
Each CHW assigned up to 20 participants
near her local area. She contacted participants
by phone every 2 weeks to talk about
benefits of eating more fruits and vegetables,
other education, and invitations to
bimonthly walks. At the walks, CHWs
encouraged participants to find walking
partners and support each other.
Outcomes/Limitations: Of the eligible
participants, 67 percent, or 217, returned
at 12 months. All groups increased physical
activity levels. Only the group with
CHW support significantly improved in
meeting National recommendations for
eating fruits and vegetables. The results
were similar to other WISEWOMAN studies.
The study is limited by a small sample
size and lower follow-up rate than desirable,
although this rate is not uncommon for
minority follow-up.
Suarez L, Roche
R, Pulley L et al. Why a peer intervention
program for Mexican-American women failed
to modify the secular trend in cancer
screening. Am J Prev Med 1997; 13 (6):411-7.
Program: Luces de Salud (Lights
of Health)
Objective: To determine if cancer control
interventions to increase Pap smear
and mammography screening among Mexican
American women were effective.
Population and Location: Mexican American
women ages 40 and older. Study population
in El Paso, Texas; comparison community
in Houston, Texas.
Study Design: Comparison of two Spanish-speaking,
poverty-level immigrant communities
(one with the intervention and one without)
using pre- and post-test design.
Community Health Worker Recruitment:
Staff recruited volunteers and role
models by making about ten presentations
each quarter with average attendance
of 24. The network of volunteers ranged
from 20 to 100 per quarter. Role models
for the study were 45 Mexican American
women, ages 40 or older, from low-income
neighborhoods in central El Paso, who
spoke only Spanish.
Community Health Worker Interventions:
The intervention strategy used social
modeling and social reinforcement based
on Social Learning Theory. Early adopters
of the desired behavior in the community
served as role models. The media featured
stories about these role models in local
television, radio, and newspaper. Local
volunteers reinforced the message verbally
and distributed a quarterly bilingual
newsletter that provided information
about clinics with low-cost examinations.
Outcomes/Limitations: Results were
identified from pre- and post-tests
with residents of El Paso, Texas, and
Houston, Texas. Peer intervention did
not demonstrate a significant increase
in screening in this group of Mexican
American women in comparison to a control
population. Program participants reported
an increase of 6 percent in Pap smear
and a 17 percent increase in mammography
screenings; versus a 7 percent increase
in Pap smears and a 19 percent increase
in mammographies in the comparison population.
The impact of the study interventions
could not be isolated from other social
forces at work with this population.
There were some differences between
the two communities. Those receiving
the intervention were older, had lower
incomes, and were more likely to be
on public assistance for health care
and to use Spanish. In addition, there
were substantially fewer cancer care
resources in El Paso, Texas, and Houston,
Texas, relative to the population. The
local health department was not able
to gain media cooperation for developing
and airing role model stories. Only
11 percent of women interviewed had
heard of the program after the intervention.
The ratio of volunteers to those participating
was lower than previous studies. Other
pervasive cancer-screening initiatives
were a confounding factor to the study.
The authors felt that program promotional
activities were too diffuse to have
an effect and the comparison community
had multiple similar program exposures
that made it difficult to measure the
impact of any single health promotional
program.
Sung JF, Blumenthal
DS, Coates RJ et al. Effect of a cancer
screening intervention conducted by
lay health workers among inner-city
women. Am J Prev Med 1997; 13 (1):51-7.
Program: Cooperative partnership with
the National Black Women's Health Project
(NBWHP)
Objective: To see if in-home education
by lay health workers could increase
adherence to breast and cervical cancer
screening schedules.
Population and Location: Three hundred
twenty-one low income, African-American
women from diverse inner-city sources
in Atlanta, Georgia, including contacting
women in public housing projects, inner-city
businesses and churches, and through
the NBWHP.
Study Design: Participants were randomly
assigned to either the intervention
with lay health workers or a control
group.
Community Health Worker Recruitment:
Lay health workers were recruited from
self-help support group leaders in a
community women's health organization,
the NBWHP. Each received 10 weeks of
training in interviewing and health
education topics.
Community Health Worker Interventions:
Lay health workers visited those in
the intervention group three times in
their homes over a period of 11 months,
and provided education on cancer screening,
prevention, and encouragement to schedule
appointments.
Outcomes/Limitations: There was an
increase in screening for pap smears
which was similar for both groups. There
was a modest increase for clinical breast
exams and a larger increase in mammography
in the group visited by lay health workers.
Limitations include difficulty in recruitment
and retention, and an unwillingness
to participate in research by those
who may feel minorities were exploited
by research in the past.
Swider SM. Outcome
effectiveness of community health workers:
an integrative literature review. Public
Health Nurs 2002; 19 (1):11-20.
Objective: To review the literature
indexed in key databases and document
the effectiveness of CHWs, which could
include providing increased access to
care in underserved populations, better
outcomes in increased health knowledge,
or improved health outcomes and behavioral
changes.
Population and Location: U.S. studies.
Study Design: Definitions for CHWs
and synonyms for the term were established
and criteria for the literature search
were determined. Only U.S. studies and
studies that focused on outcomes or
effectiveness were included. The time
frame of 1980 to 1999 was established.
The databases MEDLINE and PubMed, HealthStar,
CINAHL, EBM Review Best Evidence, and
PsycInfo databases were searched for
articles. Articles were examined and
analyzed for frequencies, common themes,
weaknesses, gaps, and need for future
studies. Of 275 abstracts, only 19 studies
reported in 20 articles met the criteria
established and were reviewed.
Outcomes/Limitations: All studies documented
the use of CHWs to serve hard to reach
populations. Studies agree that outcomes
should include culturally appropriate
health education, increasing health
care access and decreasing costs of
care. Most of the included studies (74
percent) reported positive impacts in
access to care. Over a third of articles
did not measure outcomes in comparison
to a control group. Of four studies
on health status, three studies reported
positive health status increases. Of
the six studies on behavior change,
five reported positive results from
CHW programs. Only two studies address
cost of care, and the results were inconclusive.
In many articles (63 percent), the roles
or details of the interventions provided
by the CHWs were not reported, so the
effectiveness could not be measured.
The author concludes that reports on
CHWs show some promise, but many studies
show lack of focus and documentation.
More research is needed, and attention
should be paid to strength of study
design, documentation of CHW activities,
and carefully defining target audiences.
Work is needed to determine if CHWs
are cost effective. Limitations were
that only a few studies were identified
for analysis. Detailed information on
the reasons articles were excluded was
not included.
Virginia Center
for Health Outreach. Final report on
the status, impact, and utilization
of community health workers. Richmond,
VA: James Madison University, Institute
for Innovation in Health Human Services,
2005.
Program: James Madison University,
Virginia Center for Health Outreach,
House Document No. 9, Report directed
by House Joint Resolution No. 195
Objective: Identify ways to elevate
the role of CHWs in the health care
system; to integrate CHWs into public
agencies; to examine the potential of
CHWs for Medicaid and other contacted
providers; to explore the development
of a statewide curriculum for training
CHWs, and to recommend other steps to
maximize the value and use of CHWs.
Population and Location: CHWs in Virginia.
Description: The final report offers
seven recommendations for shaping a
more effective and increasingly responsive
health and human services workforce.
The report provides descriptions of
CHWs who work in multiple sectors. Collaboration
with the Virginia Department of Human
Resource Management has resulted in
the addition of CHWs to the Direct Service
Career Grouping within the Occupational
Family of Health and Human Services.
Watkins E, Larson
K, Harlan C et al. Model program for
providing health services for migrant
farmworker mothers and children. Public
Health Rep 1990; 105 (6):567-75.
Program: SPRANS Project MCJ 373415,
funded through the Health Resources
and Services Administration, Maternal
and Child Health Bureau
Objective: To develop a model program
for primary health care service delivery
for migrant farmworker women and children.
Population and Location: Migrant farmworker
women and children up to 5 years of
age in North Carolina receiving services
at a migrant health center in North
Carolina. Participants were 359 pregnant
migrant farmworkers and 560 children
who received primary care services between
April 1985 and September 1987.
Study Design: Model program description
and retrospective analysis of data.
Community Health Worker Recruitment:
Migrant farmworker women with an ability
to help others were recruited. They
received classes in their native languages
on health practices and health and social
services. Classes were held at convenient
locations such as labor camps, churches
and the Migrant Head Start center. Forty-two
women completed training to strengthen
existing social networks and become
leaders and advocates for their communities.
Community Health Worker Interventions:
A multidisciplinary team delivered coordinated
services including transportation, translation,
follow-up, and advocacy. Staff included
public health nurses, a nutritionist,
and a social worker. On-site workers
were Spanish speaking. One strategy
trained migrant farmworker women as
health advisors who offered home visits.
The purpose of the program was not to
create an extension of the center staff
but to strengthen existing social networks.
A subsequent project evaluated the impact
of the LHAs.
Outcomes/Limitations: Project staff
gathered and reported demographic, physical,
nutritional and psychosocial information
on migrant workers. By the end of the
project, there were increased numbers
of prenatal visits, more women entering
prenatal care in the first trimester,
and more use of well-child services.
Project staff found LHAs were valuable
in increasing consumer participation.
Advisors were elected to the board of
directors of the health center. Some
LHAs testified at a Federal hearing
on farmworker housing and others were
motivated to continue their education.
Only limitation was that a small part
of the project was devoted to LHAs.
Watkins EL, Harlan
C, Eng E et al. Assessing the effectiveness
of lay health advisors with migrant
farmworkers. Fam Community Health 1994;
16 (4):72-87.
Program: SPRANS grant 3736003 from
the U.S. Department of Health and Human
Services, Health Resources and Services
Administration, Maternal and Child Health
Bureau
Objective: To determine the extent
to which assistance from lay health
advisors was associated with improved
health practices and status. To improve
mother and infant health status and
increase use of perinatal and child
health services by expanding knowledge
of maternal-child health and community
resources.
Population and Location: Latina migrant
farmworker women enrolled for prenatal
care and infants receiving child health
services at five health agencies in
four North Carolina sites. Pregnant
Latina farmworkers who sought treatment
between October 1987 and December 1988
were enrolled in the study.
Study Design: Analysis of a data subset
from a quasi-experimental longitudinal
study. A program for recruitment, training
and implementation of LHAs was implemented
at two health centers, with two other
sites serving as controls. The intervention
lasted for 1 year. Pre-intervention
and post-intervention data was compared
for 290 mothers and 122 newborns.
Community Health Worker Recruitment:
Project staff interviewed clinic staff,
Migrant Head Start staff and outreach
workers to identify Latina farmworker
women with the following characteristics:
leadership ability, empathetic and caring
attitudes; interest in learning more
about health; understanding of importance
of sharing knowledge with others.
Community Health Worker Interventions:
A total of 40 LHAs completed all 24
hours of training. Women were given
minimum wage for time spent in training
in the initial project but not for later
training. Payment did not appear to
have a relation to attrition rate. LHAs
were given a knowledge test and a helping
contacts questionnaire to assess the
impact of the program. Members of the
target population were given a knowledge
test and an exposure questionnaire to
assess the effect of interactions. Groups
were compared on knowledge of health
practices, exposure to LHAs and health
status and health practices.
Outcomes/Limitations: LHAs improved
their health knowledge before and after
training and retained their knowledge
6 weeks after training. They reported
more than three helping contacts every
2 weeks, generally dealing with child
care, family planning, prenatal care
and cancer screening. Participants reported
a greater frequency of assistance with
child care problems than reported by
LHAs. The majority of respondents (66
percent) interacted with LHAs. Overall,
there was no difference in the number
of prenatal visits, unless sites were
examined separately. The authors speculate
that the differences may be due to differences
in how established the LHA programs
were at different sites. Mothers with
sick children and exposure to LHAs were
more likely to bring those children
for treatment. At the sites where LHAs
were established, a higher proportion
of women with LHA exposure made recommended
numbers of prenatal visits. Limitations
included data which was taken from five
convenience samples, rather than a randomized
controlled trial, which would have been
difficult to administer. All clients
could not be administered questionnaires
due to small project size, so pre- and
post-intervention comparisons might
not reflect assistance provided by lay
health advisors. There was substantial
loss to follow-up of participants. The
project of LHA intervention was limited
to 1 year.
Weber B, Reilly
B. Enhancing mammography use in inner
city. A randomized trial of intensive
case management. Arch Intern Med 1997;
157 (20):2345-9.
Program: Study conducted by HealthReach,
the community outreach program of St.
Mary's Hospital, the community teaching
hospital for the University of Rochester
School of Medicine and Dentistry.
Objective: To determine if use of community
health educators (CHEs) and physician
reminders would increase the rate of
screening among the target population.
Population and Location: Women, ages
52 to 77, in the inner city of Rochester,
NY, who had not had a screening mammogram
in 2 years.
Study Design: Randomized controlled
trial comparison of two interventions.
Women in the MD group received a personalized
letter reminding them to have mammograms.
Those in the CHE group received the
same letter followed by a second letter
(written at a fourth grade reading level),
in English and Spanish and signed by
the local CHE. The CHE intervention
included telephone calls, home visits,
and removal of barriers to care.
Community Health Worker Recruitment:
Six women from the community were recruited
as CHEs. They were selected based on
characteristics of literacy, communication
skills, charisma, and concern about
community health. CHE ethnicity was
similar to those served.
Community Health Worker Interventions:
CHEs worked with participants to increase
knowledge of primary care, preventive
care, mammogram screening, and overcoming
barriers to care. All CHEs worked in
the community approximately 50 percent
of the time in soup kitchens, churches,
health fairs, homeless shelters, emergency
rooms, and more.
Outcomes/Limitations: Women in the
CHE group were nearly three times more
likely to receive screening mammograms
than women in the MD group. Generalizability
of the results is limited to those with
similar characteristics, and the study
did not isolate specific interventions
that had more or less impact.
Weinrich S, Weinrich
M, Stromborg M et al. Using elderly
educators to increase colorectal cancer
screening. Gerontologist 1993; 33 (4):491-6.
Program: Elderly Educator Method, Colorectal
Cancer Project
Objective: To study the effects of
four educational methods on elder participation
in fecal occult blood screening.
Population and Location: Reports on
180 participants (recipients of meals)
at 12 randomly selected Council on Aging
congregate meal sites in South Carolina.
Most (75 percent or 171) of those receiving
services agreed to participate in the
study. Seventy-seven percent of the
participants were female; 50 percent
were Black and 50 percent were White;
the average age was 72 years; the average
education level completed was eighth
grade; and more than half had incomes
below the poverty level.
Study Design: Factorial design (2x2)
used to compare four approaches to fecal
occult blood screening. The study sites
were divided into four groups. The traditional
method served as a control. This was
a presentation of the standard American
Cancer Society (ACS) slide tape presentation
and handout on colorectal cancer. Other
approaches were adapted from the ACS
presentation and handout. With the Elderly
Educator method, elderly persons were
used as teachers and demonstrators of
the cancer presentation. The Adaptation
for Aging Changes method used the ACS
slide-tape presentation, but used techniques
to allow for aging changes in learning.
(The presentation was adapted to low
reading levels, larger print was used
and reminder notes were provider.) The
Combination method combined both the
Elderly Educator method and the Adaptation
for Aging Changes method. Participants
received education and were given occult
blood kits to take home. Six days later
a registered nurse returned for the
kits.
Community Health Worker Recruitment:
Elderly educators came from the local
Aging Network and a high-rise apartment
for the elderly.
Community Health Worker Interventions:
Under the Elderly Educator and Combination
methods, elderly people served as teachers,
demonstrators, and role models. They
encouraged conversation on sensitive
or difficult topics by developing rapport
and trust.
Outcomes/Limitations: Participants
taught by Elderly Educator methods (93
percent in the Combination Group and
61 percent for the Elderly Educator
only group) were more likely to participate
in and return their fecal occult blood
kits. In the other groups, 43 percent
of those in the Adaptation for Aging
Changes method and 56 percent of those
in the Traditional method returned the
kits for screening. The authors emphasize
that high quality of recruitment and
training is vital to success with the
Elderly Educator method.
LISTINGS
BY TITLE
Assessing the effectiveness of lay
health advisors with migrant farmworkers:
Watkins 1994
Community health advisors: emerging
opportunities in managed care: Rico
Community health workers: essential
to improving health in Massachusetts:
Massachusetts Department of Public Health
Community outreach and community mobilization:
options for health at the U.S.-Mexico
border: Meister 1997
Culturally competent diabetes self-management
education for Mexican Americans: the
Starr County border health initiative:
Brown
Effect of a bicultural community health
worker on completion of diabetes education
in a Hispanic population: Corkery
Effect of a cancer screening intervention
conducted by lay health workers among
inner-city women: Sung
The effectiveness of a community health
worker outreach program on healthcare
utilization of west Baltimore City Medicaid
patients with diabetes, with or without
hypertension: Fedder
The effectiveness of a community/academic
health center partnership in decreasing
the level of blood pressure in an urban
African-American population: Levine
2003
The effectiveness of mammography promotion
by volunteers in rural communities:
Andersen
The emerging role of the community
health worker in California: results
of a Statewide survey and San Francisco
Bay Area focus groups on the community
health workers in California's public
health system: Love
Encouraging Vietnamese-American women
to obtain Pap tests through lay health
worker outreach and media education:
Lam
Enhancing mammography use in inner
city: Weber
The final report of the National Community
Health Advisor Study: Rosenthal
Hypertension care and control in underserved
urban African American men: behavioral
and physiologic outcomes at 36 months:
Hill
Impact of a planned health education
approach on the control of hypertension
in a high-risk population: Levine 1990
Impact of a social support program
on teenage prenatal care use and pregnancy
outcomes: Rogers
Impact of community health workers
on access, use of services, and patient
knowledge and behavior: Health Resources
and Services Administration 1998
Impact of community volunteers on immunization
rates of children younger than 2 years:
Barnes
Improving multiple behaviors for colorectal
cancer prevention among African American
church members: Campbell
Increasing breast and cervical cancer
screening in low income women: Margolis
K
Increasing influenza and pneumococcal
immunization rates: a randomized controlled
study of a senior center-based intervention:
Krieger
Increasing mammography practice by
African American women: Erwin
Increasing use of mammography among
older, rural African American women:
results from a community trial: Earp
Final Report on the Status, Impact,
and Utilization of Community Health
Workers: Virginia Center for Health
Outreach
Lay health workers in primary and community
health care (review): Lewin
Linking community-based blood pressure
measurement to clinical care: a randomized
controlled trial of outreach and tracking
by community health workers: Krieger
1999
A literature review and discussion
of research studies and evaluations
of the roles and responsibilities of
community health workers (CHWs): Health
Resources and Services Administration
2002
Maternal outcomes of a randomized controlled
trial of a community-based support program
for families of children with chronic
illnesses: Ireys
Model program for providing health
services for migrant farmworker mothers
and children: Watkins
Native American recruitment into breast
cancer screening: the NAWWA Project:
Burhansstipanov
Opening pathways to cancer screening
for Vietnamese-American women: lay health
workers hold a key: Bird
Outcome effectiveness of community
health workers: an integrative literature
review: Swider
Overcoming social and cultural barriers
to care for patients with diabetes:
Humphry
Provider counseling, health education,
and community health workers: the Arizona
WISEWOMAN project: Staten
Randomized controlled trial of the
effects of nurse case manager and community
health worker interventions on risk
factors for diabetes-related complications
in urban African-Americans: Gary
A randomized, controlled trial of a
community-based support program for
families of children with chronic illness:
pediatric outcomes: Chernoff
Reducing disparities in hypertension
control: a community-based hypertension
control project (CHIP) for an ethnically
diverse population: Morisky
Results from a lay health advisor intervention
to prevent lead poisoning among rural
Native American children: Kegler
The Seattle-King County Healthy Homes
Project: a randomized, controlled trial
of a community health worker intervention
to decrease exposure to indoor asthma
triggers: Krieger 2005
Social support and psychological functioning
among high-risk mothers: the impact
of the Baby Love Maternal Outreach Worker
Program: Navaie-Waliser
Southwest Rural Health Research Center:
community health worker (CHW) certification
and training - a national survey of
regionally and State-based Programs:
May
Using elderly educators to increase
colorectal cancer screening: Weinrich
Using lay health workers: case study
of a community-based prenatal intervention:
Meister 1992
Why a peer intervention program for
Mexican-American women failed to modify
the secular trend in cancer screening:
Suarez
INDEX
BY TOPICS
Diseases