Evaluating Community Health Advisor (CHA) Core Competencies: The CHA Core Competency Retrospective Pretest/Posttest (CCCRP)

Community-engaged healthcare model for currently under-served individuals involved in the healthcare system

In the US, many people are excluded from healthcare structures and systems, due to multiple macro and micro factors. Poverty, health ecosystems, mental health, and community amenities are some of the issues confronting those who are not able to access appropriate support. This population is often referred to as 'high needs, high cost' (HNHC), a term that has been applied to refer to people who repeatedly utilize services without significant benefit (we have replaced this term with 'currently under-served'; C-US). For many traditional health solutions may not address the fundamental issues confronting their health. Community-Engaged Healthcare (CEH) is an approach that equips members of the community to levy power to advocate for their own health or social solutions, designing their own interventions to address needs with support from health providers. A realist review was conducted to identify the existing literature around CEH. This yielded ten papers that were reviewed by at least two authors and rated in terms of quality. A model describing the processes underpinning CEH was then iteratively generated, resulting in additional terms that were used in a second review of the literature. A further 16 peer-reviewed articles were identified and were independently reviewed and quality rated. These articles were used to refine further iterations of the model and included in the review where appropriate. The resulting model schematically posits a set of relational factors identified to be important in the establishment of CEH. Notably, the transfer of autonomy and power over health decision-making processes is emphasized, which will require revolutionary thinking about how healthcare is delivered for patients.

Addressing the Social Vulnerability of Mississippi Gulf Coast Vietnamese Community through the Development of Community Health Advisors

Background

Resiliency is the ability to prepare for, recover from, and adapt to stressors from adverse events. Social vulnerabilities (limited access to resources, political power, and representation; lack of social capital; aspects of the built environment; health inequities; and being in certain demographic categories) can impact resiliency. The Vietnamese population living along the Mississippi Gulf Coast is a community that has unique social vulnerabilities that impact their ability to be resilient to adverse events.

Objectives

The purpose of this project was to address social vulnerability by implementing and evaluating a volunteer Community Health Advisor (CHA) project to enhance community resiliency in this community.

Methods

A program implemented over 8 three-hour sessions was adapted from the Community Health Advisor Network curriculum that focused on healthy eating, preventing chronic conditions (hyperlipidemia, Diabetes, hypertension, cancer, poor mental health). Topics also included leadership and capacity development skills.

Results

Participants (n=22) ranged from 35-84 years of age. Most were female (63.6%), married (45.5%), unemployed (63.6%), had annual incomes of <$10,000, and had high school diplomas (68.2%). Community concerns were crime (50.0%), volunteerism (40.0%), language barriers (35.0%), and food insecurity (30.0%). Approximately 75% had experienced war trauma and/or refugee camps, and 10% had experienced domestic violence. Scores on the Community Health Advisor Core Competency Assessment increased from pre-test to post-test (t=-5.962, df=11, p<0.0001), as did SF-8 scores (t=5.759, df=17, p<0.0001).

Conclusion

Strategies to reduce vulnerabilities in the Vietnamese community should include developing interventions that address health risks and strengths and focus on root causes of vulnerability.