Training Community Residents to Address Social Determinants of Health in Underresourced Communities

Action to Improve Social Determinants of Health: Outcomes of Leadership and Advocacy Training for Community Residents

Racial and ethnic disparities remain a public health problem and are largely due to social determinants of health (SDOH). Using an adapted 36-hour community health worker (CHW) curriculum, we trained 42 lay community residents in New Orleans, Louisiana, neighborhoods experiencing disparities in leadership and advocacy skills to address SDOH. Six months posttraining, 29 participants completed a follow-up survey and interview. Participants described increases in knowledge, self-efficacy, and activities related to leadership and advocacy at all levels of the social ecological model. We also found a significant increase in communicating with Louisiana state senators or representatives (p < .0339). Our findings show that an adapted CHW training curriculum focused on SDOH, leadership, and advocacy can be used to train lay community residents in how to make changes in the community conditions that affect health and prompt new engagement to address SDOH at all levels of the social ecological model. Future efforts to increase lay community participation in addressing SDOH may benefit from providing ongoing support to participants such as organizing meetings with residents interested in similar topics, offering opportunities to “shadow” experienced CHWs, or hosting additional skills building workshops.

A Participatory Curricula for Community Health Workers and Supervisors to Increase HIV Health Outcomes

Community Health Workers (CHWs) are becoming essential members of the HIV workforce as emerging evidence demonstrates their effectiveness in engaging people with HIV into care and treatment. In 2018, among the estimated 37,000 persons who received an HIV diagnosis, the majority were from racial ethnic minority communities. CHWs serve as a bridge between the community and health care system and have the potential to address structural inequities and reduce the stigma, discrimination and other barriers that prevent people with HIV from seeking and staying in care and treatment. Effective CHW integration into the HIV primary care team requires a training and supervision system that is culturally responsive to the complex social and medical needs of people with HIV. This article describes a comprehensive training approach and curricula for CHWs and supervisors and its impact on the health care team. Grounded in a Popular Education model and using the CHW core consensus competency (C3) framework, a team of experts in HIV, training and supervision, including CHWs working in HIV care and treatment developed an 80-h CHW and 20-h supervisor curricula. The trainings were delivered via in-person and virtual sessions over the course of 2 years. Using a mixed method evaluation, 23 CHWs and 22 supervisors across 10 clinic sites in eight states participated in the training sessions. Measures included knowledge and confidence related to HIV-specific content, supporting clients with managing stigma and discrimination, ability to communicate with other team members and helping clients navigate the services system. CHWs reported improved skills with documentation in the electronic health record, helping clients with treatment adherence challenges and educating on lab results. Supervisors reported learning strategies for assigning clients to CHWs, self-care techniques, providing strengths-based feedback, and mentoring and coaching. The participatory practice-based curricula allowed supervisors and CHWs to share experiences and solicit input from peers for problem resolution and implementation of new policies and practices. This training approach focused on HIV specific content with core competency training could serve as a model for CHWs working in primary care settings and with populations experiencing multiple chronic health conditions and social needs.