1
|
Houston K, Arellano F, Imany-Shakibai H, Jackson A, Saleeby E, Dudovitz R, Schickedanz A. "MAMA's is like a second mom:" Client and Staff Experiences in a Comprehensive Social Risk Care Management Program Within a Perinatal Medical Home. Matern Child Health J 2024; 28:1198-1209. [PMID: 38294604 PMCID: PMC11180014 DOI: 10.1007/s10995-024-03896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Addressing persistent racial inequities in preterm birth requires innovative health care approaches. The Los Angeles County Maternity Assessment and Management Access Service Synergy Neighborhood program (MAMA's) is a perinatal medical home program designed to alleviate the impacts of chronic stress by addressing social determinants of health. It reduced odds of preterm birth rates in Black participants, yet it is unclear which program components most contributed to this reduction. This study seeks to understand the experiences of staff and clients within the MAMA's program to identify what factors decrease stress, how the program addresses racism and the challenges and opportunities of optimizing health during the COVID-19 pandemic. METHODS 21 staff and 34 clients completed semi-structured interviews from November 2020-December 2021. Separate interview guides for staff and clients explored experiences within the program, experiences during the COVID-19 pandemic, and how racism affects clients. Interviews were recorded and transcribed. Analysis used a phenomenologic framework. Coding was performed using grounded theory to identify themes. RESULTS Analysis revealed six key themes: Stressors clients face, barriers for undocumented, Latina, and Spanish-speaking clients, exceptional care, emotional support, naming and responding to racism and discrimination, and impacts of COVID-19 pandemic. DISCUSSION Staff and clients work together to address social needs in order to address chronic stress and racism in their lives, especially during the COVID-19 pandemic. Interviews revealed relationship building is a cornerstone of the program's success and plays a significant role in alleviating chronic stress in this population.
Collapse
Affiliation(s)
- Kasee Houston
- Southern California Permanente Medical Group, Department of Neonatal-Perinatal Medicine, Kaiser Permanente Riverside Medical Center, 10800 Magnolia Ave, Riverside, CA, 92505, USA.
| | - Flor Arellano
- Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Helia Imany-Shakibai
- Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Ashaki Jackson
- Los Angeles County Department of Health Services, 313 N Figueroa St., Los Angeles, CA, 90012, USA
| | - Erin Saleeby
- Los Angeles County Department of Health Services, 313 N Figueroa St., Los Angeles, CA, 90012, USA
- Harbor UCLA Medical Center, 1000 W Carson St., Torrance, CA, 90502, USA
| | - Rebecca Dudovitz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| |
Collapse
|
2
|
Wennerstrom A, Sugarman M, Haywood CG, Jindal D, True G. Roles and Responsibilities of Community Health Workers in Louisiana Medicaid Managed Care Organizations. J Ambul Care Manage 2024; 47:22-32. [PMID: 37994511 DOI: 10.1097/jac.0000000000000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
We explored the roles of community health workers (CHWs) working in Medicaid Managed Care Organizations in Louisiana by conducting 10 interviews with CHWs, supervisors, and administrators. We identified 6 themes: CHWs' backgrounds and training; roles as they related to nationally recognized competencies; team integration; who CHWs serve and how members are identified; metrics for success; and the effects of COVID. CHWs are hired for their community connections. CHWs generally do not receive core competency training, and they focus primarily on improving individual-level health outcomes. Administrators and supervisors may need training and support on CHW competencies, supervision, and using common evaluation indicators.
Collapse
Affiliation(s)
- Ashley Wennerstrom
- Department of Behavioral and Community Health Sciences, School of Medicine, Center for Healthcare Value and Equity, School of Public Health, LSU Health-New Orleans, New Orleans, Louisiana (Dr Wennerstrom); Sugarman Research Group, New Orleans, Louisiana (Ms Sugarman); Louisiana Community Health Outreach Network, New Orleans (Ms Haywood); Center for Community Health Alignment, University of South Carolina, Columbia (Ms Jindal); Section of Community and Population Medicine, School of Medicine, LSU Health-New Orleans, New Orleans, Louisiana (Dr True); and Southeast Louisiana Veterans Healthcare System, South Central Mental Illness Research, Education, and Clinical Center, Washington, District of Columbia (Dr True)
| | | | | | | | | |
Collapse
|
3
|
Crocker ME, Stout JW. A qualitative study of perspectives on the acceptability and feasibility of "virtual home visits" for asthma. BMC Public Health 2023; 23:2546. [PMID: 38124054 PMCID: PMC10734151 DOI: 10.1186/s12889-023-17485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Asthma home-visit programs delivered by community health workers (CHWs) are an effective way to improve asthma outcomes and cost of care, through performing home environmental inspections, delivering education and hands-on demonstrations, and providing personalized behavior change support. During the COVID-19 pandemic, many in-person asthma CHW programs have been adapted to be delivered virtually, but it is unclear whether this is acceptable or feasible for clients with asthma. This qualitative study sought to identify perspectives of prior clients of the Public Health-Seattle & King County Asthma Program on acceptability and feasibility of a hypothetical virtual asthma program. METHODS We performed semi-structured interviews with participants speaking English, Spanish, and Somali. An a priori codebook was developed based on the Theoretical Framework of Acceptability and was revised iteratively during coding. Intra-rater reliability was established, and thematic analysis was used to determine major themes. RESULTS A total of 19 individuals participated (9 speaking English, 8 Spanish, and 2 Somali). Krippendorf's alpha was 0.848, indicating high intra-rater reliability. Our results demonstrated that many participants felt positively about the prospect of completing the program virtually, but they also expected a variety of challenges, the most important of which were lack of engagement with the CHW and lack of confidence in the accuracy of a virtual home inspection. Participants also varied widely in their comfort level with videoconferencing platforms and their access to adequate internet connectivity. CONCLUSIONS Acceptability and feasibility of virtual programming varies widely between participants, indicating that there may be no "one-size-fits-all" approach. We present several recommendations for adapting in-person asthma home visit programs to a virtual format, including considering a hybrid approach to delivery, making concerted efforts to build rapport when using videoconferencing, and deliberately evaluating the effectiveness of new adaptations, especially if a virtual environmental assessment is attempted.
Collapse
Affiliation(s)
- Mary E Crocker
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA, USA.
- Division of Pulmonary & Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - James W Stout
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
4
|
Mallaiah J, Leon RD, Williams O, Allegrante JP. Cardiovascular Disease and Stroke-Focused Competency Assessment Tools for Community Health Workers in the United States: A Scoping Review. Health Promot Pract 2023; 24:1183-1195. [PMID: 36062599 DOI: 10.1177/15248399221120809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease (CVD) and stroke are major contributors to chronic disease burden in the United States. Despite the high prevalence of stroke, 90% of all stroke events are preventable and can be attributed to seven key modifiable risk factors (MRFs)-high blood pressure (BP), high cholesterol, diabetes mellitus (DM), smoking, obesity, unhealthy diet, and physical inactivity. In the United States, stroke prevention interventions led by community health workers (CHWs) have been proven to be highly effective in preventing the onset of MRFs. We conducted a scoping review of the competency assessment methods used in CVD and stroke-focused CHW training programs. We searched six online databases: PubMed, Cochrane, CINAHL, Embase, Web of Science, and HaPI, from all available years until January 2021. Of the 1,774 initial articles found, we identified 30 eligible articles to be included in the review. Nine of these studies used previously validated instruments, whereas the remaining 21 studies used tools from the training curriculum or independently developed instruments. Only five of these validated tools reported psychometric properties; none of them were designed for the CHW population. Our scoping review of literature revealed that CHW-specific competency assessment methods were limited, with few or no domain-referenced tools on CVD or stroke risk factors that complied with established measurement standards. We conclude that there is an urgent need for the development of a comprehensive and valid assessment instrument in CVD and stroke prevention to evaluate CHW performance and optimize their credibility, representing important first steps toward integrating CHWs into health care systems.
Collapse
|
5
|
Rodriguez B, Saunders M, Octavia-Smith D, Moeti R, Ballard A, Pellechia K, Fragueiro D, Salinger S. Community Health Workers During COVID-19: Supporting Their Role in Current and Future Public Health Responses. J Ambul Care Manage 2023; 46:203-209. [PMID: 36939634 PMCID: PMC11009117 DOI: 10.1097/jac.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Community health workers advance health equity and foster community-clinical linkages. By promoting culturally relevant care, sharing their own stories, and bridging gaps, they can reach populations burdened with higher rates of chronic diseases due to adverse social determinants of health and structural racism. Given the disproportionate impacts of COVID-19, lessons learned from a forum, an expert group, and a survey showed a need by community health workers for (1) training, (2) health and safety practices, (3) workplace guidance, and (4) mental health resources. Community health workers are integral to expanding access to services and require a robust infrastructure for their growth.
Collapse
Affiliation(s)
- Betsy Rodriguez
- Divisions of Diabetes Translation (Ms Rodriguez and Drs Saunders and Ballard) and Heart Disease and Stroke Prevention (Ms Moeti), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; National Association of Community Health Workers, Boston, Massachusetts (Ms Octavia-Smith); and FHI 360, Washington, District of Columbia (Mss Pellechia, Fragueiro, and Salinger)
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Jewell T, Gillespie KH, Schmuhl NB, Gilbert S, Grant B, Watts L, Ehrenthal DB. Caring for community members during the COVID-19 pandemic: results of a statewide survey. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-10. [PMID: 37361316 PMCID: PMC10233524 DOI: 10.1007/s10389-023-01953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/12/2023] [Indexed: 06/28/2023]
Abstract
Aim Community health workers (CHWs) and home visitors (HVs) are members of the public health workforce who are uniquely poised to support vulnerable populations during the COVID-19 pandemic. In this study, we assess the experiences of CHWs and HVs in Wisconsin during the early stages of the COVID-19 pandemic to learn about their experiences related to mitigation strategies and vaccination efforts. Subject and methods Working closely with community partners, we recruited CHWs and HVs via email to complete an online survey between June 24 and August 10, 2021. Participants were eligible if they worked at any time since March 25, 2020, when the Safer at Home Order was put into place. The survey asked CHWs and HVs about their experiences during the COVID-19 pandemic and vaccination efforts. Results Eligible respondents included 48 HVs and 26 CHWs. Most CHWs (96%) and HVs (85%) reported discussing the COVID-19 vaccine with clients, and 46% of HVs and 85% of CHWs said they planned to encourage their clients to vaccinate themselves against COVID-19. We found that many CHWs and HVs identified the COVID-19 pandemic as a threat to the health of the US population, and many reported that they thought mitigation strategies were effective at keeping people safe from COVID-19. There was inconsistency in regard to respondents plans to encourage their clients to receive vaccination for COVID-19. Conclusion Future study, training, and support for CHWs and HVs should focus on facilitating vaccination efforts and other emerging public health interventions.
Collapse
Affiliation(s)
- Tess Jewell
- University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | | | | | - Sharon Gilbert
- Wisconsin Department of Health Services, WI Madison, USA
| | | | | | - Deborah B. Ehrenthal
- Social Science Research Institute (SSRI), The Pennsylvania State University, University Park, PA USA
| |
Collapse
|
7
|
Smithwick J, Nance J, Covington-Kolb S, Rodriguez A, Young M. "Community health workers bring value and deserve to be valued too:" Key considerations in improving CHW career advancement opportunities. Front Public Health 2023; 11:1036481. [PMID: 36969656 PMCID: PMC10030954 DOI: 10.3389/fpubh.2023.1036481] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 02/06/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction Community health workers (CHWs) are critical members of the public health workforce, who connect the individuals they serve with resources, advocate for communities facing health and racial inequities, and improve the quality of healthcare. However, there are typically limited professional and career building pathways for CHWs, which contribute to low wages and lack of career advancement, further resulting in turnover, attrition, and workforce instability. Methods The Center for Community Health Alignment (CCHA), within the Arnold School of Public Health at the University of South Carolina, utilized a mixed-method data collection strategy to provide a more in-depth understanding of this issue and ways that employers, advocates, and CHWs can address it. Results Themes across data sources emphasized the importance of retaining skilled and experienced CHWs and educating other health professions about CHWs' critical roles, and reported that doing so will result in decreased attrition professional growth, and improved program quality. CHWs and allies concluded that higher wages, valuing lived experience over formal education, and participation in additional training opportunities should be the primary factors considered for career advancement. Discussion Utilizing input from experienced CHWs and CHW allies nationally, this article describes the importance of supporting CHW career advancement, shares best practices, and suggestions for designing strategies that organizations/employers can use to improve CHW career pathways to better support the CHW workforce and reduce attrition.
Collapse
Affiliation(s)
- Julie Smithwick
- Center for Community Health Alignment, The University of South Carolina Arnold School of Public Health, Columbia, SC, United States
- *Correspondence: Julie Smithwick
| | - Jenesha Nance
- Center for Applied Research and Evaluation, The University of South Carolina Arnold School of Public Health, Columbia, SC, United States
| | - Sarah Covington-Kolb
- Center for Community Health Alignment, The University of South Carolina Arnold School of Public Health, Columbia, SC, United States
| | | | - Mike Young
- Center for Community Health Alignment, The University of South Carolina Arnold School of Public Health, Columbia, SC, United States
| |
Collapse
|
8
|
Hernandez-Salinas C, Marsiglia FF, Oh H, Campos AP, De La Rosa K. Community Health Workers as Puentes/Bridges to Increase COVID-19 Health Equity in Latinx Communities of the Southwest U.S. J Community Health 2022; 48:398-413. [PMID: 36536085 PMCID: PMC9762869 DOI: 10.1007/s10900-022-01182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
This study documents the pivotal role that Community Health Workers (CHW) played while supporting underserved Latinx communities affected by COVID-19-related health inequities. With the support of CHWs' agencies historically serving three Latinx-dense counties in Arizona, we recruited CHWs who participated in a state-wide COVID-19 testing project. Using phenomenology and narrative qualitative research methods, five focus groups were facilitated in Spanish between August and November 2021. Bilingual research team members conducted the analysis of the Spanish verbatim transcripts and CHWs reviewed the results for validity. Three interconnected themes reflected the CHWs experiences: (1) CHWs as puentes/bridges with deep community embeddedness through shared experiences and social/cultural context, (2) CHWs as communication brokers and transformational agents, playing a pivotal role in responding to the health and socioeconomic challenges posed by the COVID-19 pandemic, (3) CHWs satisfaction and frustration due to their dual role as committed community members but unrecognized and undervalued frontline public health workers. These findings emphasize the CHWs' commitment towards supporting their communities, even amidst the stressors of the pandemic. It is important to continue to integrate the role of CHWs into the larger healthcare system as opposed to relegating them to short term engagements as was the case during the COVID-19 pandemic. This article provides a set of practice, policy, and future research recommendations, emphasizing the need to allocate greater budgetary and training resources in support of CHWs.
Collapse
Affiliation(s)
- Christopher Hernandez-Salinas
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Flavio F. Marsiglia
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Hyunsung Oh
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Ana Paola Campos
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Kate De La Rosa
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| |
Collapse
|
9
|
Iglesias A, Ambrose A, Coronel-Mockler S, Kilbourn K, Bonaca MP, Estacio RO, Krantz MJ. Impact of transitioning to virtual delivery of a cardiovascular health improvement program for Latinos during the COVID-19 pandemic. BMC Public Health 2022; 22:1935. [PMID: 36258185 PMCID: PMC9579581 DOI: 10.1186/s12889-022-14291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community Heart Health Actions for Latinos at Risk (CHARLAR) is a promotora-led cardiovascular disease (CVD) risk-reduction program for socio-demographically disadvantaged Latinos and consists of 11 skill-building sessions. The COVID-19 pandemic has led to worsening health status in U.S. adults and necessitated transition to virtual implementation of the CHARLAR program. METHODS A mixed-methods approach was used to evaluate virtual delivery of CHARLAR. Changes in health behaviors were assessed through a pre/post program survey. Results from virtual and historical (in-person delivery) were compared. Key informant interviews were conducted with promotoras and randomly selected participants and then coded and analyzed using a thematic approach. RESULTS An increase in days of exercise per week (+ 1.52), daily servings of fruit (+ 0.60) and vegetables (+ 0.56), and self-reported general health (+ 0.38), were observed in the virtual cohort [all p < 0.05]. A numeric decrease in PHQ-8 (-1.07 p = 0.067) was also noted. The historical cohort showed similar improvements from baseline in days of exercise per week (+ 0.91), daily servings of fruit (+ 0.244) and vegetables (+ 0.282), and PHQ-8 (-1.89) [all p < 0.05]. Qualitative interviews revealed that the online format provided valuable tools supporting positive behavior change. Despite initial discomfort and technical challenges, promotoras and participants adapted and deepened valued relationships through additional virtual support. CONCLUSION Improved health behaviors and CVD risk factors were successfully maintained through virtual delivery of the CHARLAR program. Optimization of virtual health programs like CHARLAR has the potential to increase reach and improve CVD risk among Latinos.
Collapse
Affiliation(s)
- Amelia Iglesias
- University of Colorado School of Public Health, Aurora, CO, USA
| | | | | | - Kristin Kilbourn
- Department of Psychology, University of Colorado, Denver, CO, USA
| | - Marc P Bonaca
- CPC Community Health, Aurora, CO, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Raymond O Estacio
- CPC Community Health, Aurora, CO, USA.,Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA
| | - Mori J Krantz
- CPC Community Health, Aurora, CO, USA.,Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA
| |
Collapse
|
10
|
Navigating fear and care: The lived experiences of community-based health actors in the Philippines during the COVID-19 pandemic. Soc Sci Med 2022; 308:115222. [PMID: 35930848 PMCID: PMC9293854 DOI: 10.1016/j.socscimed.2022.115222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/05/2022] [Accepted: 07/13/2022] [Indexed: 11/22/2022]
Abstract
The activities of community-based health actors are widely recognized as critical to pandemic response; yet, there exists a lack of clarity concerning who is included in this ecosystem of actors and how these actors experience the complexity of delivering community-level care in the context of a public health emergency. The objectives of this study were (1) to characterize the lived experiences of community-based health actors during the COVID-19 pandemic in the Philippines; and (2) to identify opportunities for further supporting these critical actors in the health workforce. Virtual semi-structured interviews were conducted (January–February 2021) with 28 workers employed by a Philippines-based non-governmental organization (NGO) to explore their lived experiences during the COVID-19 pandemic. Data were analyzed thematically using a hybrid inductive-deductive coding process, informed by Tronto's conceptualization of an ethic of care. Lived experiences among study participants were shaped by discourses of fear and care, and the interaction between these two affects. Participants reported everyday experiences of fear: NGO workers' fears of contracting and transmitting COVID-19 to others; perceived fear among community members where they worked; and fears around COVID-19 testing, recognizing the personal and social implications (e.g. stigma) of a positive test. Amid fear, participants had everyday experiences of care: care was a powerful motivator to continue their work; they felt supported by a caring organization that implemented safety protocols and provided material supports to those in quarantine; and they engaged in self-care practices. These findings contribute to understanding the ecosystem of actors involved in community-based health care and engagement efforts and the challenges they encounter in their work, particularly in a pandemic context. We highlight implications for civil society organizations charged with protecting the mental and physical well-being of their workers and describe how these actions can contribute to local health systems strengthening.
Collapse
|
11
|
Impact of the COVID-19 on the Health System and Healthcare Workers: A Systematic Review. HEALTH SCOPE 2022. [DOI: 10.5812/jhealthscope-123211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: The coronavirus disease 2019 (COVID-19) pandemic has affected all sectors of life. The health system and healthcare workers also have been affected by the COVID-19 pandemic. Healthcare workers (HCWs) have faced major challenges in working in the hospitals due to COVID-19 pandemic. There is a need to provide evidence regarding challenges to working during the COVID-19 pandemic, specifically in developing countries. Objectives: The objective of this study was to evaluate the effect of the COVID-19 pandemic on health professionals and the health system. Methods: Ten studies conducted from January 1, 2020, to December 31, 2021were included in this review. Common search terms were impact, health, healthcare, providers, abuses, burden, and system. Different databases, such as Scopus, Web of Science, PubMed, and Google Scholar, were used. Data extraction was performed following the PRISMA recommendations. Results: The results of the systematic review showed that the hospitalization rate and numbers of out-patients have increased, leading to imposing a burden on the health system and healthcare workers (HCWs). A serious type of disease may need hospitalization and ventilatory support. The quality of healthcare institutions is unique and complex. HCWs, in their routine activities, face diverse challenges. The unexpected development of the COVID-19 pandemic was a great challenge faced by the health system and health professionals. Conclusions: The pandemic has altered the healthcare system and healthcare practice with innovative workplaces and social challenges confronted by the HCWs.
Collapse
|
12
|
Chemali S, Mari-Sáez A, El Bcheraoui C, Weishaar H. Health care workers' experiences during the COVID-19 pandemic: a scoping review. HUMAN RESOURCES FOR HEALTH 2022; 20:27. [PMID: 35331261 PMCID: PMC8943506 DOI: 10.1186/s12960-022-00724-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/09/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND COVID-19 has challenged health systems worldwide, especially the health workforce, a pillar crucial for health systems resilience. Therefore, strengthening health system resilience can be informed by analyzing health care workers' (HCWs) experiences and needs during pandemics. This review synthesizes qualitative studies published during the first year of the COVID-19 pandemic to identify factors affecting HCWs' experiences and their support needs during the pandemic. This review was conducted using the Joanna Briggs Institute methodology for scoping reviews. A systematic search on PubMed was applied using controlled vocabularies. Only original studies presenting primary qualitative data were included. RESULTS 161 papers that were published from the beginning of COVID-19 pandemic up until 28th March 2021 were included in the review. Findings were presented using the socio-ecological model as an analytical framework. At the individual level, the impact of the pandemic manifested on HCWs' well-being, daily routine, professional and personal identity. At the interpersonal level, HCWs' personal and professional relationships were identified as crucial. At the institutional level, decision-making processes, organizational aspects and availability of support emerged as important factors affecting HCWs' experiences. At community level, community morale, norms, and public knowledge were of importance. Finally, at policy level, governmental support and response measures shaped HCWs' experiences. The review identified a lack of studies which investigate other HCWs than doctors and nurses, HCWs in non-hospital settings, and HCWs in low- and lower middle income countries. DISCUSSION This review shows that the COVID-19 pandemic has challenged HCWs, with multiple contextual factors impacting their experiences and needs. To better understand HCWs' experiences, comparative investigations are needed which analyze differences across as well as within countries, including differences at institutional, community, interpersonal and individual levels. Similarly, interventions aimed at supporting HCWs prior to, during and after pandemics need to consider HCWs' circumstances. CONCLUSIONS Following a context-sensitive approach to empowering HCWs that accounts for the multitude of aspects which influence their experiences could contribute to building a sustainable health workforce and strengthening health systems for future pandemics.
Collapse
Affiliation(s)
- Souaad Chemali
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Almudena Mari-Sáez
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Heide Weishaar
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| |
Collapse
|
13
|
Olateju Z, Olufunlayo T, MacArthur C, Leung C, Taylor B. Community health workers experiences and perceptions of working during the COVID-19 pandemic in Lagos, Nigeria-A qualitative study. PLoS One 2022; 17:e0265092. [PMID: 35259204 PMCID: PMC8903241 DOI: 10.1371/journal.pone.0265092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Community Health Workers are globally recognised as crucial members of healthcare systems in low and middle-income countries, but their role and experience during COVID-19 is not well-understood. This study aimed to explore factors that influence CHWs' ability and willingness to work in the COVID-19 pandemic in Lagos. DESIGN A generic qualitative study exploring Community Health Workers experiences and perceptions of working during the COVID-19 pandemic in Lagos, Nigeria. METHODS 15 semi-structured, in-depth, video interviews were conducted with Community Health Workers purposively sampled across seven of Lagos' Local Government Areas with the highest COVID-19 burden. Interviews explored Community Health Workers' attitudes towards COVID-19, its management, and their experiences working in Lagos. Data was analysed thematically using the framework method. RESULTS Three main themes were identified. 1. Influences on ability to undertake COVID-19 Role: Trust and COVID-19 knowledge were found to aid Community Health Workers in their work. However, challenges included exhaustion due to an increased workload, public misconceptions about COVID-19, stigmatisation of COVID-19 patients, delayed access to care and lack of transportation. 2. Influences on willingness to work in COVID-19 Role: Community Health Workers' perceptions of COVID-19, attitudes towards responsibility for COVID-19 risk at work, commitment and faith appeared to increase willingness to work. 3. Suggested Improvements: Financial incentives, provision of adequate personal protective equipment, transportation, and increasing staff numbers were seen as potential strategies to address many of the challenges faced. CONCLUSION Despite Community Health Workers being committed to their role, they have faced many challenges during the COVID-19 pandemic in Nigeria. Changes to their working environment may make their role during disease outbreaks more fulfilling and sustainable. International input is required to enhance Nigeria's policies and infrastructure to better support Community Health Workers during both current and future outbreaks.
Collapse
Affiliation(s)
- Zahra Olateju
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Tolulope Olufunlayo
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Yaba, Lagos State, Nigeria
| | - Christine MacArthur
- Department of Maternal Health, Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
| | - Charlotte Leung
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Beck Taylor
- Department of Public Health, Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
| |
Collapse
|
14
|
Méllo LMBDDE, Santos RCD, Albuquerque PCD. Agentes Comunitárias de Saúde na pandemia de Covid-19: scoping review. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-11042022e125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este artigo teve por objetivo sistematizar e analisar a literatura que aborda o trabalho das Agentes Comunitárias de Saúde (ACS) no enfrentamento da pandemia de Covid-19. Trata-se de uma revisão de escopo, realizada na Embase, Lilacs, SciELO, Medline e Cochrane Library. Envolve publicações no período de janeiro a dezembro de 2020, tendo os estudos selecionados sido submetidos à análise, considerando as seguintes categorias: práticas, formação, condições de trabalho e legitimidade. Foram incluídos 29 estudos na revisão cujo cenário de atuação das ACS foram países da África, América do Sul, América do Norte, Ásia e Europa. Os resultados revelaram enfoques diversificados de práticas nos países estudados que envolvem ações de cuidado, vigilância, comunicação e educação em saúde, práticas administrativas, articulação intersetorial e mobilização social. A formação recebida parece não corresponder ao rol de práticas e impacto esperado do trabalho das ACS. As condições de trabalho continuam precarizadas com alguns incentivos extras sendo ofertados em diferentes cenários. O reconhecimento e a legitimidade perante as autoridades sanitárias revelam a disputa em torno do próprio rumo dos modelos de atenção à saúde e abrangência dos sistemas de proteção social nos diversos países.
Collapse
|
15
|
Carter J, Hassan S, Walton A. Meeting the Needs of Vulnerable Primary Care Patients Without COVID-19 Infections During the Pandemic: Observations From a Community Health Worker Lens. J Prim Care Community Health 2022; 13:21501319211067669. [PMID: 35068240 PMCID: PMC8796095 DOI: 10.1177/21501319211067669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the height of the COVID-19 pandemic, healthcare systems were forced to focus their efforts on the rapidly rising numbers of patients contracting COVID-19. Although a myriad of publications focused on COVID-19 care have rapidly emerged, few have studied the impact of the pandemic on care received by patients without COVID-19. OBJECTIVES To identify the experiences of Medicaid patients without COVID-19 related illness during the pandemic through the lens of community health worker outreach. METHODS From July 15, 2020 through February 1, 2021 patients previously enrolled in the C-CAT initiative were contacted by telephone for patient check-ins by CHW staff. RESULTS A total of 24 patients were contacted telephonically. Six patients had no active needs. Of the remaining patients, 70% of participants indicated that they had been unable to communicate with PCP or physician specialist care teams since the beginning of the pandemic and requested assistance from our CHW. Resulting unmet needs included the inability to obtain prescriptions drugs, necessary medical equipment, or supplies. CONCLUSION The shift to COVID-19 focused care during the pandemic limited access to primary care for patients without COVID-19. The identified unmet patient needs included obtaining prescription medications, acute on chronic clinical condition management, healthcare services at home, and connection to social services. CHWs are uniquely positioned to assist patients as they connect to necessary clinical care, whether it be virtual or in-person, as they recover from the pandemic experience.
Collapse
Affiliation(s)
| | | | - Anne Walton
- Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
16
|
Méllo LMBDDE, Santos RCD, Albuquerque PCD. Community Health Workers in the Covid-19 pandemic: scoping review. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-11042022e125i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This paper aimed to systematize and analyze the literature that addresses the role of Community Health Workers (CHWs) in addressing the Covid-19 pandemic. This scoping review was conducted in the Embase, Lilacs, SciELO, Medline, and Cochrane Virtual Libraries databases. It includes publications from January to December 2020, and the selected studies were submitted to analysis, considering the following categories: practices, training, working conditions, and legitimacy. Twenty-nine studies were included in the review whose CHW performance backdrops were African, South American, North American, Asian, and European countries. The results revealed diversified approaches to practice in the countries studied that involve care, surveillance, health communication, education, administrative, intersectoral articula- tion, and social mobilization actions. The training received does not seem to correspond to the list of practices and expected impact of the CHWs. Working conditions remain substandard, with some extra incentives offered in different backdrops. The recognition and legitimacy before the health authorities reveal the dispute over the direction of health care models and the scope of social protection systems in different countries.
Collapse
|
17
|
Byrd-Williams C, Ewing M, Rosenthal EL, St. John JA, Menking P, Redondo F, Sieswerda S. Training Needs of Community Health Workers Facing the COVID-19 Pandemic in Texas: A Cross-Sectional Study. Front Public Health 2021; 9:689946. [PMID: 34195172 PMCID: PMC8236534 DOI: 10.3389/fpubh.2021.689946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has required the professional healthcare workforce not only to adjust methods of delivering care safely but also act as a trusted sources of information during a time of uncertainty and rapid research and discovery. The Community Health Worker COVID-19 Impact Survey is a cross-sectional study developed to better understand the impact of COVID-19 on this sector of the healthcare workforce, including training needs of those working through the pandemic. The survey was distributed in Texas, New Mexico, and Arizona. This study focuses on Texas, and the data presented (n = 693) is a sub-set of qualitative data from the larger survey. Results of the content analysis described in this paper are intended to inform current COVID-19-related CHW training curriculum, in addition to future infectious disease prevention and preparedness response trainings.
Collapse
Affiliation(s)
- Courtney Byrd-Williams
- Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
| | - Mollie Ewing
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
| | - E. Lee Rosenthal
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, United States
| | - Julie Ann St. John
- Julia Jones Matthews Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Abilene, TX, United States
| | - Paige Menking
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | | | - Stephanie Sieswerda
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
| |
Collapse
|
18
|
Turner S, Botero-Tovar N, Herrera MA, Borda Kuhlmann JP, Ortiz F, Ramírez JC, Maldonado LF. Systematic review of experiences and perceptions of key actors and organisations at multiple levels within health systems internationally in responding to COVID-19. Implement Sci 2021; 16:50. [PMID: 33962635 PMCID: PMC8103061 DOI: 10.1186/s13012-021-01114-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND COVID-19 has presented challenges to healthcare systems and healthcare professionals internationally. After one year of the pandemic, the initial evidence on health system responses begins to consolidate, and there is a need to identify and synthesise experiences of responding to COVID-19 among healthcare professionals and other health system stakeholders. This systematic review of primary qualitative studies depicts the experiences and perceptions of organisations and actors at multiple levels of health systems internationally in responding to COVID-19. METHODS Six main databases of biomedical information, public health and health administration research were searched over the period October 1, 2019, to October 21, 2020. Information extracted from included studies was analysed thematically. RESULTS Thirty-four studies were eligible for data extraction. Nine of those studies, of lower methodological quality, were removed from the thematic analysis of study results. Considering the professional level experiences, predominant themes of the studies consisted of the new roles and responsibilities of healthcare workers, burnout and distress, recognition of ´unseen´ healthcare workers, and positive changes and emergent solutions amid the crisis. Organisational level findings of the studies included provision of psychological support, COVID-19 as "catalyst" for change, and exercise of more "open" leadership by managers and health authorities. Continuous training, regulation of working conditions, providing supportive resources, coordinating a diversity of actors, and reviewing and updating regulations were roles identified at the local health system level. CONCLUSIONS The experiences of frontline healthcare workers have been the focus of attention of the majority of primary qualitative studies as of October 2020. However, organisational and wider system level studies indicate that some responses to COVID-19 have been characterised by increased emphasis on coordination activities by local health system actors, making service adaptations at pace, and reliance on expanded roles of front-line workers. The need for theory-informed qualitative studies was identified at the organisational level. TRIAL REGISTRATION CRD42020202875.
Collapse
Affiliation(s)
- Simon Turner
- School of Management, University of los Andes, Bogotá, Colombia
| | | | | | | | - Francisco Ortiz
- School of Management, University of los Andes, Bogotá, Colombia
| | | | | |
Collapse
|
19
|
Nana-Sinkam P, Kraschnewski J, Sacco R, Chavez J, Fouad M, Gal T, AuYoung M, Namoos A, Winn R, Sheppard V, Corbie-Smith G, Behar-Zusman V. Health disparities and equity in the era of COVID-19. J Clin Transl Sci 2021; 5:e99. [PMID: 34192054 PMCID: PMC8167251 DOI: 10.1017/cts.2021.23] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/28/2021] [Accepted: 03/04/2021] [Indexed: 01/21/2023] Open
Abstract
Over the last year, COVID-19 has emerged as a highly transmissible and lethal infection. As we address this global pandemic, its disproportionate impact on Black, Indigenous, and Latinx communities has served to further magnify the health inequities in access and treatment that persist in our communities. These sobering realities should serve as the impetus for reexamination of the root causes of inequities in our health system. An increased commitment to strategic partnerships between academic and nonacademic health systems, industry, local communities, and policy-makers may serve as the foundation. Here, we examine the impact of the recent COVID-19 pandemic on health care inequities and propose a strategic roadmap for integration of clinical and translational research into our understanding of health inequities.
Collapse
Affiliation(s)
| | - Jennifer Kraschnewski
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Ralph Sacco
- Department of Neurology, University of Miami Health, Miami, FL, USA
| | | | - Mona Fouad
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Tamas Gal
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Asmaa Namoos
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Robert Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vanessa Sheppard
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Giselle Corbie-Smith
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | |
Collapse
|
20
|
Franklin P, Gkiouleka A. A Scoping Review of Psychosocial Risks to Health Workers during the Covid-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2453. [PMID: 33801517 PMCID: PMC7967576 DOI: 10.3390/ijerph18052453] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Abstract
The Covid-19 pandemic has exposed health workers to a diverse set of hazards impacting their physical, psychological and social wellbeing. This review aims to provide an overview of the categories of the psychosocial risk factors and hazards affecting HCWs during the Covid-19 pandemic and the recommendations for prevention. We used the scoping review methodology to collate categories of psychosocial risks, the related health outcomes, interventions, and data gaps. The review was conducted on global peer-reviewed academic and authoritative grey literature, published between 1. January-26. October 2020; in total, 220 articles were included into the review and the subsequent analysis. Analysis of the extracted data found PSRs related to four sources: personal protective equipment (PPE), job content, work organisation, and social context. is. Women health workers and nurses reported worst health outcomes. Majority of the research to date concerns health workers in secondary care, while data on psychosocial risks at primary and community-based settings are scarce. However, the emerging research implies that the pandemic creates psychosocial risks also to non-clinical health workers. The intervention and mitigation measures address individual and organisational levels. Preventative and mitigating measures for social and societal risks-such as staff shortages, intersecting inequalities, and financial stressors require further research.
Collapse
Affiliation(s)
- Paula Franklin
- Occupational Safety & Health and Working Conditions Unit, European Trade Union Institute (ETUI), Boulevard du Roi Albert II, 1210 Brussels, Belgium
| | - Anna Gkiouleka
- Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK;
| |
Collapse
|
21
|
Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9223. [PMID: 33321718 PMCID: PMC7764816 DOI: 10.3390/ijerph17249223] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 01/09/2023]
Abstract
Rural populations in the United States are faced with a variety of health disparities that complicate access to care. Community health workers (CHWs) and their Spanish-speaking counterparts, promotores de salud, are well-equipped to address rural health access issues, provide education, and ultimately assuage these disparities. In this article, we compare community health workers in the states of Indiana and Texas, based on the results of two separate research studies, in order to (1) investigate the unique role of CHWs in rural communities and (2) understand how their advocacy efforts represent a central form of caregiving. Drawing on ethnographic, qualitative data-including interviews, photovoice, and participant observation-we analyze how CHWs connect structurally vulnerable clients in rural areas to resources, health education, and health and social services. Our primary contribution to existing scholarship on CHWs is the elaboration of advocacy as a form of caregiving to improve individual health outcomes as well as provoke structural change in the form of policy development. Finally, we describe how CHWs became especially critical in addressing disparities among rural populations in the wake of COVID-19, using their advocacy-as-caregiving role that was developed and well-established before the pandemic. These frontline workers are more vital than ever to address disparities and are a critical force in overcoming structural vulnerability and inequities in health in the United States.
Collapse
Affiliation(s)
- Ryan I. Logan
- Department of Anthropology, Geography & Ethnic Studies, California State University Stanislaus, Turlock, CA 95382, USA
| | - Heide Castañeda
- Department of Anthropology, University of South Florida, Tampa, FL 33620, USA;
| |
Collapse
|