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Coco L, Leon K, Navarro C, Piper R, Carvajal S, Marrone N. "Close to My Community": A Qualitative Study of Community Health Worker-Supported Teleaudiology Hearing Aid Services. Ear Hear 2024:00003446-990000000-00286. [PMID: 38812073 DOI: 10.1097/aud.0000000000001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Given well-documented disparities in rural and minority communities, alternative service delivery models that help improve access to hearing care are needed. This article reports on a study of older Latino adults with hearing loss who received hearing aid services with Community Health Workers (CHWs) providing support via teleaudiology. The present study used qualitative data to explore perceptions of this novel service delivery model. DESIGN Participants completed semistructured interviews related to their experiences in the intervention approximately 17 weeks after the hearing aid fitting appointment. Two coders independently coded the data, using an iterative deductive and inductive thematic analysis approach. Inter-rater reliability was good (κ = 0.80). RESULTS Of the 28 participants, 19 were interviewed (CHW group: n = 9, 8 females; non-CHW group: n = 10, 9 females). Both groups of participants reported experiencing barriers in access to care and reported positive experiences with teleaudiology and with hearing aids as part of the trial. CHW group participants reported interactions with patient-site facilitators that were indicative of patient-centeredness. CONCLUSIONS Results demonstrate the feasibility and potential effectiveness of trained CHWs as patient-site facilitators in teleaudiology-delivered hearing aid services for adults.
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Affiliation(s)
- Laura Coco
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California, USA
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona, USA
| | - Kimberly Leon
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona, USA
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | | | - Rosie Piper
- Mariposa Community Health Center, Nogales, Arizona, USA
| | - Scott Carvajal
- Health Promotion Sciences Department, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona, USA
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Onakomaiya D, Ali SH, Islam T, Mohaimin S, Kaur J, Pillai S, Monir A, Mehdi A, Mehmood R, Mammen S, Hussain S, Zanowiak J, Wyatt LC, Alam G, Lim S, Islam NS. Stakeholder Perspectives on the Impact of COVID-19 on the Implementation of a Community-Clinic Linkage Model in New York City. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:56-71. [PMID: 37145181 PMCID: PMC10161181 DOI: 10.1007/s11121-023-01534-0] [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: 04/07/2023] [Indexed: 05/06/2023]
Abstract
Community-clinical linkage models (CCLM) have the potential to reduce health disparities, especially in underserved communities; however, the COVID-19 pandemic drastically impacted their implementation. This paper explores the impact of the pandemic on the implementation of CCLM intervention led by community health workers (CHWs) to address diabetes disparities among South Asian patients in New York City. Guided by the Consolidated Framework for Implementation Research (CFIR), 22 stakeholders were interviewed: 7 primary care providers, 7 CHWs, 5 community-based organization (CBO) representatives, and 3 research staff. Semi-structured interviews were conducted; interviews were audio-recorded and transcribed. CFIR constructs guided the identification of barriers and adaptations made across several dimensions of the study's implementation context. We also explored stakeholder-identified adaptations used to mitigate the challenges in the intervention delivery using the Model for Adaptation Design and Impact (MADI) framework. (1) Communication and engagement refers to how stakeholders communicated with participants during the intervention period, including difficulties experienced staying connected with intervention activities during the lockdown. The study team and CHWs developed simple, plain-language guides designed to enhance digital literacy. (2) Intervention/research process describes intervention characteristics and challenges stakeholders faced in implementing components of the intervention during the lockdown. CHWs modified the health curriculum materials delivered remotely to support engagement in the intervention and health promotion. (3) community and implementation context pertains to the social and economic consequences of the lockdown and their effect on intervention implementation. CHWs and CBOs enhanced efforts to provide emotional/mental health support and connected community members to resources to address social needs. Study findings articulate a repository of recommendations for the adaptation of community-delivered programs in under-served communities during a time of public health crises.
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Affiliation(s)
- Deborah Onakomaiya
- Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, New York, NY, USA
| | - Shahmir H Ali
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Tanzeela Islam
- New York Institute of Technology College of Osteopathic Medicine, New York, NY, USA
| | - Sadia Mohaimin
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | | | | | | | - Aasma Mehdi
- Council of Peoples Organization, New York, NY, USA
| | - Rehan Mehmood
- South Asian Council for Social Services, New York, NY, USA
| | - Shinu Mammen
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Sarah Hussain
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Jennifer Zanowiak
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Laura C Wyatt
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Gulnahar Alam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Nadia S Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
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Moheize S, Hsu M, Matiz LA, Peretz P, Medina K, Esteves A, Meyer D, Maletz B, Pineda L, Berger-Jenkins E. The Role of an Early Childhood Community Health Worker in Addressing Psycho-Social Needs in the Perinatal and Early Childhood Period. J Prim Care Community Health 2024; 15:21501319241234478. [PMID: 38444152 PMCID: PMC10916458 DOI: 10.1177/21501319241234478] [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: 11/29/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Addressing family psychosocial and mental health needs in the perinatal and early childhood period has a significant impact on long-term maternal and child health and is key to achieving health equity. We aimed to (1) describe and evaluate the role of an Early Childhood Community Health Worker (EC-CHW) to address psychosocial needs and improve psychosocial well-being for families in the perinatal period, and (2) examine factors associated with completion of goals. METHODS An EC-CHW program was modeled after an existing hospital CHW program for children with special healthcare needs and chronic disease. An evaluation was conducted using repeated measures to assess improvements in psychosocial outcomes such as family stress and protective factors after participating in the EC-CHW program. Linear regression was also used to assess factors associated with completion of goals. RESULTS Over a 21-month period (January 2019-September 2020), 161 families were referred to the EC-CHW. The most common reasons for referral included social needs and navigating systems for child developmental and behavioral concerns. There were high rates of family engagement in services (87%). After 6 months, families demonstrated statistically significant improvements in protective factors including positive parenting knowledge and social support. Only 1 key predictor variable, maternal depression, showed significant associations with completion of goals in the multivariable analysis. CONCLUSIONS This study demonstrated the need for, and potential impact of an EC-CHW in addressing psychosocial and mental health needs in the perinatal period, and in a primary care setting. Impacts on protective factors are promising.
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Affiliation(s)
- Sahar Moheize
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mandy Hsu
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Luz Adriana Matiz
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | | | | | - Amanda Esteves
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Dodi Meyer
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Beth Maletz
- NewYork-Presbyterian Hospital, New York, NY, USA
- Columbia University School of Nursing, New York, NY, USA
| | - Lucie Pineda
- Greater Harlem Healthy Start at the Northern Manhattan Perinatal Partnership, New York, NY, USA
| | - Evelyn Berger-Jenkins
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
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4
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Jimenez N, Williams CN, Keenan H, Rinaldi R, Fuentes M, Woodward D, Rivara FP, Zhou C, Ko LK, Bell K. Bilingual randomized controlled trial design, of a telephone-based intervention to promote rehabilitation adherence; A study focus on recruitment of Hispanic children with traumatic brain injury. Contemp Clin Trials 2023; 135:107362. [PMID: 37852531 PMCID: PMC10990393 DOI: 10.1016/j.cct.2023.107362] [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: 05/25/2023] [Revised: 09/30/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND While Hispanic children experience large long-term disparities in disability after traumatic Brain Injury (TBI), there is a gap in evidenced-based interventions to improve outcomes among this rapidly growing and at high-risk population. We developed and pilot tested a bilingual/bicultural intervention informed by Hispanic families consisting of Brain Injury Education and outpatient Navigation (1st BIEN). It integrates bilingual in-person education enriched by video content delivered through mobile phone devices, with outpatient navigation by bilingual and bicultural navigators during transitions of care and school return. METHODS Randomized controlled trial to test the efficacy of 1st BIEN to maintain long-term adherence to rehabilitation and determine its effect on children's functional outcomes. The primary outcome is treatment adherence at 6 months post-discharge at centralized acute facilities and community providers. Secondary outcomes are functional status of the child using PROMIS parental report measures and parental health literacy, self-efficacy, and mental health; measured at baseline (pre-injury and discharge) 3-,6- and 12- months post discharge. Children's academic performance is assessed using school records the year before and the year after injury. DISCUSSION Our study evaluates a novel, flexible and scalable approach using mobile phone devices to aid transitions of care, increase treatment adherence and improve TBI outcomes. It addresses the needs of an understudied population and builds upon their strengths. It is implemented by a bilingual and bicultural team with a deep understanding of the study population. It can serve as a model for TBI family centered interventions for at risk groups. TRIAL REGISTRATION ClinicalTrials.govNCT05261477. Registered on March 2, 2022.
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Affiliation(s)
- Nathalia Jimenez
- Anesthesiology and Pain Medicine, University of Washington, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA 98101, USA.
| | - Cydni N Williams
- Division of Pediatric Critical Care, Doernbecher Children's Hospital, Oregon Health & Science University, USA
| | - Heather Keenan
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, USA
| | - Robert Rinaldi
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, USA
| | - Molly Fuentes
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle Children's Research Institute, USA; Department of Physical Medicine and Rehabilitation, Univeristy of Washington, USA
| | - Danielle Woodward
- Director of Survey Research Division/SDRG, University of Washington, USA
| | | | - Chuan Zhou
- Department of Pediatrics, University of Washington, USA
| | | | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, USA
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Darling KE, Hayes JF, Evans EW, Sanchez I, Chachra J, Grenga A, Elwy AR, Jelalian E. Engaging Stakeholders to Adapt an Evidence-Based Family Healthy Weight Program. Transl Behav Med 2023; 13:423-431. [PMID: 36893021 PMCID: PMC10314725 DOI: 10.1093/tbm/ibac113] [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: 03/10/2023] Open
Abstract
Childhood obesity is associated with negative physical and psychosocial outcomes, especially for children from low-income backgrounds. It is critical to adapt evidence-based family healthy weight programs to meet the needs of this population. The Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions was used to describe the process of using qualitative data from community and intervention stakeholders, children with overweight or obesity from low-income backgrounds, and caregivers to guide adaptations to the JOIN for ME pediatric weight management intervention. Qualitative interviews were conducted with key community and intervention stakeholders (e.g., nurse care managers, prior JOIN for ME coaches; N = 21). Focus groups were conducted in both Spanish and English with children with overweight or obesity from low-income backgrounds (N = 35) and caregivers of children with overweight or obesity from low-income backgrounds (N = 71). Qualitative data analysis informed modifications including content adaptations to simplify and tailor materials, contextual adaptations to improve intervention engagement and framing, resource awareness, and modality of delivery, training adaptations, and implementation/scale-up activities to increase connections with community partners. The process of engaging multiple stakeholder perspectives to tailor an existing intervention can provide a model for future researchers to improve the potential disseminability of an intervention.
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Affiliation(s)
- Katherine E Darling
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Jacqueline F Hayes
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - E Whitney Evans
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Irene Sanchez
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Jessica Chachra
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Andrea Grenga
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - A Rani Elwy
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
| | - Elissa Jelalian
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
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Carson SL, Hong C, Behforouz H, Chang E, Dixon LZ, Factor D, George SM, Lewis J, Majeno A, Morales M, Porter C, Shah A, Vassar S, Brown AF. Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting. J Ambul Care Manage 2022; 45:22-35. [PMID: 34812754 PMCID: PMC8622376 DOI: 10.1097/jac.0000000000000405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Medically and socially complex patients disproportionately face barriers to primary care, contributing to health inequities and higher health care costs. This study elicited perspectives on how community health workers (CHWs) act upon barriers to primary care in 5 patient (n = 25) and 3 CHW focus groups (n = 17). Participants described how CHWs acted on patient-level barriers through social support, empowerment, and linkages, and system-level barriers by enhancing care team awareness of patient circumstances, optimizing communication, and advocating for equitable treatment. Limitations existed for influencing entrenched community-level barriers. CHWs, focusing on patient preferences, motivators, and circumstances, intervened on multilevel barriers to primary care, including advocacy for equitable treatment. These mechanisms have implications for existing CHW conceptual models.
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Affiliation(s)
- Savanna L. Carson
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
| | - Clemens Hong
- Los Angeles County, Department of Health Services, 241 N. Figueroa Street Los Angeles, CA 90012
| | - Heidi Behforouz
- Los Angeles County, Department of Health Services, 241 N. Figueroa Street Los Angeles, CA 90012
| | - Emily Chang
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
| | - Lydia Z. Dixon
- Health Science Program, California State University, Channel Islands, 1 University Dr, Camarillo, CA 93012
| | - Diane Factor
- Worker Education & Resource Center, Inc, 1545 Wilshire Blvd #500, Los Angeles, CA 90017
| | - Sheba M. George
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, College of Science and Health, 1731 E 120th St, Los Angeles, CA 90059
| | - Jenebah Lewis
- USC Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA 90089
| | - Angelina Majeno
- Department of Psychological Science, University of California Irvine, 510 E Peltason Dr. Irvine, California 92697
| | - Maria Morales
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
| | - Courtney Porter
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
- Worker Education & Resource Center, Inc, 1545 Wilshire Blvd #500, Los Angeles, CA 90017
| | - Ami Shah
- Los Angeles County, Department of Health Services, 241 N. Figueroa Street Los Angeles, CA 90012
| | - Stefanie Vassar
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
- Olive View-UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342
| | - Arleen F. Brown
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
- Olive View-UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342
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Lim S, Wyatt LC, Mammen S, Zanowiak JM, Mohaimin S, Troxel AB, Lindau ST, Gold HT, Shelley D, Trinh-Shevrin C, Islam NS. Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative. BMC Endocr Disord 2021; 21:233. [PMID: 34814899 PMCID: PMC8609264 DOI: 10.1186/s12902-021-00885-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A number of studies have identified patient-, provider-, and community-level barriers to effective diabetes management among South Asian Americans, who have a high prevalence of type 2 diabetes. However, no multi-level, integrated community health worker (CHW) models leveraging health information technology (HIT) have been developed to mitigate disease among this population. This paper describes the protocol for a multi-level, community-clinical linkage intervention to improve glycemic control among South Asians with uncontrolled diabetes. METHODS The study includes three components: 1) building the capacity of primary care practices (PCPs) to utilize electronic health record (EHR) registries to identify patients with uncontrolled diabetes; 2) delivery of a culturally- and linguistically-adapted CHW intervention to improve diabetes self-management; and 3) HIT-enabled linkage to culturally-relevant community resources. The CHW intervention component includes a randomized controlled trial consisting of group education sessions on diabetes management, physical activity, and diet/nutrition. South Asian individuals with type 2 diabetes are recruited from 20 PCPs throughout NYC and randomized at the individual level within each PCP site. A total of 886 individuals will be randomized into treatment or control groups; EHR data collection occurs at screening, 6-, 12-, and 18-month. We hypothesize that individuals receiving the multi-level diabetes management intervention will be 15% more likely than the control group to achieve ≥0.5% point reduction in hemoglobin A1c (HbA1c) at 6-months. Secondary outcomes include change in weight, body mass index, and LDL cholesterol; the increased use of community and social services; and increased health self-efficacy. Additionally, a cost-effectiveness analysis will focus on implementation and healthcare utilization costs to determine the incremental cost per person achieving an HbA1c change of ≥0.5%. DISCUSSION Final outcomes will provide evidence regarding the effectiveness of a multi-level, integrated EHR-CHW intervention, implemented in small PCP settings to promote diabetes control among an underserved South Asian population. The study leverages multisectoral partnerships, including the local health department, a healthcare payer, and EHR vendors. Study findings will have important implications for the translation of integrated evidence-based strategies to other minority communities and in under-resourced primary care settings. TRIAL REGISTRATION This study was registered with clinicaltrials.gov: NCT03333044 on November 6, 2017.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA.
| | - Laura C Wyatt
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Shinu Mammen
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Jennifer M Zanowiak
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Sadia Mohaimin
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Andrea B Troxel
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Stacy Tessler Lindau
- Departments of Obstetrics and Gynecology and Medicine-Geriatrics, The University of Chicago, 5841 Maryland Avenue MC 2050, Chicago, IL, 60637, USA
| | - Heather T Gold
- Department of Population Health, NYU Grossman School of Medicine, 550 First Ave, VZ30, 6th floor, New York, NY, 10016, USA
| | - Donna Shelley
- Department of Public Health Policy and Management Department, NYU Global School of Public Health, 665 Broadway, 11th Floor, New York, NY, 10012, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Nadia S Islam
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
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Jelalian E, Evans W, Darling KE, Seifer R, Vivier P, Goldberg J, Wright C, Tanskey L, Warnick J, Hayes J, Shepard D, Tuttle H, Elwy AR. Protocol for the Rhode Island CORD 3.0 Study: Adapting, Testing, and Packaging the JOIN for ME Family-Based Childhood Obesity Program in Low-Income Communities. Child Obes 2021; 17:S11-S21. [PMID: 34569839 PMCID: PMC8575054 DOI: 10.1089/chi.2021.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Overweight and obesity in children is a public health crisis in the United States. Although evidence-based interventions have been developed, such programs are difficult to access. Dissemination of evidence-based pediatric weight management interventions (PWMIs) to families from diverse low-income communities is the primary objective of the CDC Childhood Obesity Research Demonstration (CORD) projects. Methods: The goal of the Rhode Island CORD 3.0 project is to adapt the evidence-based PWMI, JOIN for ME, for delivery among diverse families from low-income backgrounds and to test it in a hybrid effectiveness-implementation trial design in which the aims are to examine implementation and patient-centered outcomes. Children between the ages of 6 and 12 years with BMI ≥85th percentile and a caregiver will be recruited through two settings, a federally qualified health center, which serves as a patient-centered medical home, or low-income housing. Dyads will receive a remotely delivered group-based intervention that is 10 months in duration and includes 16 weekly sessions, followed by 4 biweekly and 4 monthly meetings. Assessments of child and caregiver weight status and child health-related quality of life will be conducted at baseline, and at 4 and 10 months after the start of intervention. Implementation outcomes assessing intervention acceptability, adoption, feasibility, fidelity, and penetration/reach will be collected to inform subsequent dissemination. Conclusions: If the adapted version of the JOIN for ME intervention can be successfully implemented and is shown to be effective, this project will provide a model for a scalable PWMI for families from low-income backgrounds. ClinicalTrials.gov no. NCT04647760.
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Affiliation(s)
- Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA.,Address correspondence to: Elissa Jelalian, PhD, Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI 02903, USA.
| | - Whitney Evans
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Katherine E. Darling
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Ronald Seifer
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patrick Vivier
- School of Public Health, Brown University, Providence, RI, USA
| | - Jeanne Goldberg
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Catherine Wright
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | | | - Jennifer Warnick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jacqueline Hayes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Donald Shepard
- Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
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Mistry SK, Harris E, Harris M. Community Health Workers as Healthcare Navigators in Primary Care Chronic Disease Management: a Systematic Review. J Gen Intern Med 2021; 36:2755-2771. [PMID: 33674916 PMCID: PMC8390732 DOI: 10.1007/s11606-021-06667-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND This review was carried out to synthesize the evidence of the effectiveness of community health worker (CHW) navigation in primary care chronic disease management. METHODS We searched the English language literature between January 1990 and March 2020 in Medline, Embase, Emcare, PubMed, Psych Info, CINAHL, Scopus, and Medline Epub ahead of print. Data extraction, quality rating, and assessment of the reporting of interventions were performed by two reviewers independently and the findings were synthesized narratively. RESULTS Twenty-nine articles met the inclusion criteria. All but two were carried out in the USA and half were randomized controlled trials. Six of the 29 studies were of strong methodological quality while 12 were moderate and 11 weak. Overall, CHW navigation interventions were effective in increasing adherence to cancer screening and improving use of primary care for chronic disease management. There was insufficient evidence that they improved clinical outcomes or risk factors and reduced use of secondary or tertiary care or that they were cost-effective. However, criteria for recruitment, duration, and mode of training and supervision arrangements varied greatly between studies. DISCUSSION CHW navigation interventions improved aspects of chronic disease management. However, there is insufficient evidence of the impact on patient experience, clinical outcomes, or cost-effectiveness of the interventions. Future research should focus on standardizing organizational components of the CHW navigation interventions and evaluating their cost-effectiveness. PROTOCOL REGISTRATION The review protocol was published in PROSPERO (CRD42020153921).
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Affiliation(s)
- Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Jimenez N, Fuentes M, Virtue A, Alonso-Gonzalez L, Lopez E, Zhou C, Crawley D, Apkon S, Johnston B, Rivara F. Feasibility and Acceptability of a Telephone-Based Intervention for Hispanic Children to Promote Treatment Adherence After Traumatic Brain Injury: A Pilot Study. J Head Trauma Rehabil 2021; 36:274-281. [PMID: 33656480 PMCID: PMC8249323 DOI: 10.1097/htr.0000000000000658] [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: 11/26/2022]
Abstract
OBJECTIVE To assess the feasibility and acceptability of a telephone-based education and navigation program for Hispanic parents of children hospitalized with traumatic brain injury (TBI). SETTING Level I trauma hospital and pediatric inpatient rehabilitation unit in the Northwestern United States. PARTICIPANTS Fourteen Hispanic parent-child dyads. Parents were 85% female, with a mean age of 35 years. Children were 58% male, with a mean age of 9.7 years, and had been hospitalized for complicated mild/moderate (n = 5) or severe (n = 9) TBI. DESIGN Pilot prospective cohort design. MAIN MEASURES Feasibility measures include recruitment, retention, and intervention adherence rates. Acceptability of intervention was measured by parents' use of educational materials and satisfaction with navigation program. We also evaluated study processes, including completion of baseline, 3, 6, and 12 months functional assessments of the child; assessment of parental health literacy and self-efficacy; and adherence to follow-up rehabilitation appointments. RESULTS Eighty-two percent of approached potential participants were recruited into the study. One hundred percent of participants completed the intervention, and 85% had 1-year follow-up. Intervention acceptability was high: 90% reported satisfaction with navigator, and 92% used the educational manual. Assessments demonstrated significant improvement in parents' TBI caregiving and community self-efficacy; 92% attendance to follow-up rehabilitation appointments; and improvement in the child's functional measures, except communication skills. CONCLUSIONS Findings support feasibility and acceptability of a culturally relevant program to facilitate transitions of care for Hispanic children with TBI. A future randomized trial is warranted to determine the efficacy of the intervention on long-term treatment adherence and the child's post-TBI function.
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Affiliation(s)
- Nathalia Jimenez
- Departments of Anesthesiology and Pain Medicine (Dr Jimenez), Rehabilitation Medicine (Drs Fuentes and Apkon), Pediatrics (Drs Johnston and Rivara), Epidemiology (Dr Rivara), and Harborview Injury Prevention and Research Center (Drs Jimenez, Fuentes, and Rivara, Ms Virtue, and Mr Lopez), University of Washington, Seattle; Brain Injury Alliance of Washington, Seattle (Ms Crawley); and Center for Child Health, Behavior and Development, Seattle Children's Research Center, Seattle, Washington (Drs Jimenez, Fuentes, Zhou, and Rivara and Ms Alonso-Gonzalez)
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Kolla A, Lim S, Zanowiak J, Islam N. The Role of Health Informatics in Facilitating Communication Strategies for Community Health Workers in Clinical Settings: A Scoping Review. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:E107-E118. [PMID: 33512874 PMCID: PMC7994181 DOI: 10.1097/phh.0000000000001092] [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: 11/26/2022]
Abstract
BACKGROUND Community health workers (CHWs) have been identified as effective members of health care teams in improving health outcomes and reducing health disparities, especially among racial and ethnic minorities. There is a growing interest in integrating CHWs into clinical settings using health informatics-based strategies to help provide coordinated patient care and foster health-promoting behaviors. OBJECTIVE In this scoping review, we outline health informatics-based strategies for CHW-provider communication that aim to improve integration of CHWs into clinical settings. DESIGN A scoping review was conducted. ELIGIBILITY CRITERIA US-based sources between 2013 and 2018 were eligible. STUDY SELECTION Literature was identified through PubMed and Google queries and hand searching key reference lists. Articles were screened by title, abstract, and then full-text. MAIN OUTCOME MEASURES Health informatics-based strategies for CHW-provider communication and their impacts on patient care were documented and analyzed. RESULTS Thirty-one articles discussed health informatics-based strategies for CHW-provider communication and/or integration of CHWs into clinical settings. These strategies include direct CHW documentation of patient encounters in electronic health records (EHRs) and other Web-based applications. The technologies were used to document patient encounters and patient barriers to health care providers but were additionally used for secure messaging and referral systems. These strategies were found to meet the needs of providers and CHWs while facilitating CHW-provider communication, CHW integration, and coordinated care. CONCLUSIONS Health informatics-based strategies for CHW-provider communication are important for facilitating CHW integration and potentially improving patient outcomes and improving disparities among minority populations. This integration can support the development of future disease prevention programs and health care policies in which CHWs are an established part of the public health workforce. However, further investigation must be done on overcoming implementation challenges (eg, lack of time or funding), especially in smaller resource-challenged community-based clinics that serve minority patients.
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Affiliation(s)
- Avani Kolla
- Department of Population Health, New York University School of Medicine, New York, New York
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Lockhart E, Turner D, Martinez-Tyson D, Baldwin JA, Marhefka SL. Opportunities for and Perceptions of Integrating Community Health Workers Via the Affordable Care Act: Medicaid Health Homes. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:193-200. [PMID: 32011591 PMCID: PMC8690535 DOI: 10.1097/phh.0000000000001118] [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: 11/26/2022]
Abstract
CONTEXT The Affordable Care Act created opportunities for innovative, cost-saving measures to improve health care access. Community health workers (CHWs) are frontline public health workers who have a close understanding of the communities they serve. States that expanded Medicaid coverage could also create Medicaid Health Homes (MHHs)-virtual health care networks-to coordinate care for people with chronic conditions. New York was the second state to implement MHHs and gave the option to include CHWs as part of the health care team. OBJECTIVE To understand the perceptions of MHH administrators regarding CHW engagement in MHHs, as well as the facilitators and barriers to adoption in MHHs that are unknown. DESIGN, SETTING, AND PARTICIPANTS Semistructured qualitative interviews (n = 18) were conducted with MHH administrators throughout New York State guided by the Diffusion of Innovations (DOI) framework. Qualitative thematic analysis was used to explore the domains and themes. RESULTS Most MHH administrators believed that CHWs fit within MHHs. The DOI constructs of compatibility and complexity and the Consolidated Framework for Implementation Research construct of external policies helped explain CHW integration. CHWs were compatible with MHHs by enrolling patients, helping coordinate patient care, and providing social support. The complexities of CHW integration into MHHs included barriers to CHW integration, no direct reimbursement for their services, lack of clarity for CHW roles and responsibilities, and no explicit external policy for their use in MHHs. CONCLUSIONS CHWs can, and have, been integrated into the relatively novel Health Home system. While some barriers have prevented their integration into all MHHs, lessons learned could provide guidance for CHW integration into other health care systems in the United States.
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Affiliation(s)
- Elizabeth Lockhart
- College of Public Health, University of South Florida, Tampa, Florida (Drs Lockhart, Martinez-Tyson, and Marhefka); Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut (Dr Turner); and Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona (Dr Baldwin)
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Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the role, responsibilities, hiring, training, and retention of community health workers (CHWs) on clinical care teams in the United States. RECENT FINDINGS CHWs are unique members of clinical care teams because of their ability to foster a deep trust and understanding with patients by sharing similar life experiences, participating in home visits, and providing constant support and advocacy. By partnering with CHWs, other clinical care members also gain a better understanding of their patients allowing them to deliver more culturally competent, patient/family-centered care. CHWs when incorporated into interdisciplinary teams have shown to lower healthcare costs, reduce hospital stays and admissions, and improve health outcomes and quality of life for children and families. However, the lack of standardization among CHW programs makes it difficult to quantify the overall effect and impact of integrating CHWs into clinical care teams. SUMMARY CHWs are able to improve health outcomes and address social determinants of health when properly integrated into clinical care teams. However, without adequate support, integration, funding, and training, CHWs are not able to reach their full potential. The standardization of CHWs' responsibilities and training, like other clinical care team members, is lacking within the United States, making it a challenge to evaluate programs and maintain sustainable funding for these vital members of the clinical care team.
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Hsu C, Cruz S, Placzek H, Chapdelaine M, Levin S, Gutierrez F, Standish S, Maki I, Carl M, Orantes MR, Newman D, Cheadle A. Patient Perspectives on Addressing Social Needs in Primary Care Using a Screening and Resource Referral Intervention. J Gen Intern Med 2020; 35:481-489. [PMID: 31792864 PMCID: PMC7018904 DOI: 10.1007/s11606-019-05397-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Interest is growing in interventions to address social needs in clinical settings. However, little is known about patients' perceptions and experiences with these interventions. OBJECTIVE To evaluate patients' experiences and patient-reported outcomes of a primary care-based intervention to help patients connect with community resources using trained volunteer advocates. DESIGN Qualitative telephone interviews with patients who had worked with the volunteer advocates. Sample and recruitment targets were equally distributed between patients who had at least one reported success in meeting an identified need and those who had no reported needs met, based on the database used to document patient encounters. PARTICIPANTS One hundred two patients. INTERVENTIONS Patients at the study clinic were periodically screened for social needs. If needs were identified, they were referred to a trained volunteer advocate who further assessed their needs, provided them with resource referrals, and followed up with them on whether their need was met. APPROACH Thematic analysis was used to code the data. KEY RESULTS Interviewed patients appreciated the services offered, especially the follow-up. Patients' ability to access the resource to which they were referred was enhanced by assistance with filling out forms, calling community resources, and other types of navigation. Patients also reported that interacting with the advocates made them feel listened to and cared for, which they perceived as noteworthy in their lives. CONCLUSIONS This patient-reported information provides key insights into a human-centered intervention in a clinical environment. Our findings highlight what works in clinical interventions addressing social needs and provide outcomes that are difficult to measure using existing quantitative metrics. Patients experienced the intervention as a therapeutic relationship/working alliance, a type of care that correlates with positive outcomes such as treatment adherence and quality of life. These insights will help design more patient-centered approaches to providing holistic patient care.
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Affiliation(s)
- Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Stephanie Cruz
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | - Hilary Placzek
- Data Science, Clarify Health Solutions, San Francisco, CA, USA.,Health Leads, Boston, MA, USA
| | | | - Sara Levin
- Contra Costa Health Services, Martinez, CA, USA
| | | | | | - Ian Maki
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | | | - Allen Cheadle
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Lim S, Wyatt LC, Mammen S, Zanowiak JM, Mohaimin S, Goldfeld KS, Shelley D, Gold HT, Islam NS. The DREAM Initiative: study protocol for a randomized controlled trial testing an integrated electronic health record and community health worker intervention to promote weight loss among South Asian patients at risk for diabetes. Trials 2019; 20:635. [PMID: 31752964 PMCID: PMC6868710 DOI: 10.1186/s13063-019-3711-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/09/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Electronic health record (EHR)-based interventions that use registries and alerts can improve chronic disease care in primary care settings. Community health worker (CHW) interventions also have been shown to improve chronic disease outcomes, especially in minority communities. Despite their potential, these two approaches have not been tested together, including in small primary care practice (PCP) settings. This paper presents the protocol of Diabetes Research, Education, and Action for Minorities (DREAM) Initiative, a 5-year randomized controlled trial integrating both EHR and CHW approaches into a network of PCPs in New York City (NYC) in order to support weight loss efforts among South Asian patients at risk for diabetes. METHODS/DESIGN The DREAM Initiative was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (National Institutes of Health). A total of 480 individuals at risk for type 2 diabetes will be enrolled into the intervention group, and an equal number will be included in a matched control group. The EHR intervention components include the provision of technical assistance to participating PCPs regarding prediabetes-related registry reports, alerts, and order sets. The CHW intervention components entail group education sessions on diabetes prevention, including weight loss and nutrition. A mixed-methods approach will be used to evaluate the feasibility, adoption, and impact (≥ 5% weight loss) of the integrated study components. Additionally, a cost effectiveness analysis will be conducted using outcomes, implementation costs, and healthcare claims data to determine the incremental cost per person achieving 5% weight loss. DISCUSSION This study will be the first to test the efficacy of an integrated EHR-CHW intervention within an underserved, minority population and in a practical setting via a network of small PCPs in NYC. The study's implementation is enhanced through cross-sector partnerships, including the local health department, a healthcare payer, and EHR vendors. Through use of a software platform, the study will also systematically track and monitor CHW referrals to social service organizations. Study findings, including those resulting from cost-effectiveness analyses, will have important implications for translating similar strategies to other minority communities in sustainable ways. TRIAL REGISTRATION This study protocol has been approved and is made available on ClinicalTrials.gov by NCT03188094 as of 15 June 2017.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Laura C. Wyatt
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Shinu Mammen
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Jennifer M. Zanowiak
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Sadia Mohaimin
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Keith S. Goldfeld
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Donna Shelley
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Heather T. Gold
- Department of Population Health, NYU School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Nadia S. Islam
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
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Lee L, Montgomery S, Gamboa-Maldonado T, Nelson A, Belliard JC. Perceptions of organizational readiness for training and implementation of clinic-based community health workers. J Health Organ Manag 2019; 33:478-487. [PMID: 31282813 DOI: 10.1108/jhom-06-2018-0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to assess perceptions of organizational readiness to integrate clinic-based community health workers (cCHWs) between traditional CHWs and potential cCHW employers and their staff in order to inform training and implementation models. DESIGN/METHODOLOGY/APPROACH A cross-sectional mixed-methods approach evaluated readiness to change perceptions of traditional CHWs and potential employers and their staff. Quantitative methods included a printed survey for CHWs and online surveys in Qualtrics for employers/staff. Data were analyzed using SPSS software. Qualitative data were collected via focus groups and key informant interviews. Data were analyzed with NVIVO 11 Plus software. FINDINGS CHWs and employers and staff were statistically different in their perceptions on appropriateness, management support and change efficacy (p<0.0001, 0.0134 and 0.0020, respectively). Yet, their differences lay within the general range of agreement for cCHW integration (4=somewhat agree to 6=strongly agree). Three themes emerged from the interviews which provided greater insight into their differences and commonalities: perspectives on patient-centered care, organizational systems and scope of practice, and training, experiences and expectations. ORIGINALITY/VALUE Community health workers serve to fill the gaps in the social and health care systems. They are an innovation as an emerging workforce in health care settings. Health care organizations need to learn how to integrate paraprofessionals such as cCHWs. Understanding readiness to adopt the integration of cCHWs into clinical settings will help prepare systems through trainings and adapting organizational processes that help build capacity for successful and sustainable integration.
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Affiliation(s)
- Lily Lee
- San Manuel Gateway College, Loma Linda University , San Bernardino, California, USA
| | - Susanne Montgomery
- School of Behavioral Health, Loma Linda University , Loma Linda, California, USA
| | | | - Anna Nelson
- School of Public Health, Loma Linda University , Loma Linda, California, USA
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Evaluating a Community-Placed and Clinically Integrated Community Health Worker Program: A Realist Approach. J Ambul Care Manage 2019; 42:116-127. [PMID: 30768430 DOI: 10.1097/jac.0000000000000268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Community health worker (CHW) programs can act as bridges between patients and health care teams, but the complexity and variability of program components and outcomes make them difficult to evaluate. This evaluation used a realist approach to identify underlying mechanisms and contextual factors associated with successful implementation of a community-placed CHW program affiliated with a primary care practice in the Midwest United States. The analysis identified mechanisms by which stakeholders built trust, self-efficacy, and empowerment to improve patient-centered outcomes and experiences. It also identified conditions that support activation of these mechanisms, including the ability of CHWs to make home visits, effective communication between members of the care team across settings, and clarity about the role of the CHW relative to other support services for patients. This type of context-mechanism-outcome evaluation facilitated development of recommendations responsive to local context.
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Molnar BE, Lees KE, Roper K, Byars N, Méndez-Peñate L, Moulin C, McMullen W, Wolfe J, Allen D. Enhancing Early Childhood Mental Health Primary Care Services: Evaluation of MA Project LAUNCH. Matern Child Health J 2018; 22:1502-1510. [PMID: 29909431 PMCID: PMC6153762 DOI: 10.1007/s10995-018-2548-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives The purpose of this study was to evaluate the efficacy of an innovative early childhood mental health intervention, Massachusetts Project LAUNCH. Early childhood mental health clinicians and family partners (paraprofessionals with lived experience) were embedded within community pediatric medical homes. Methods A longitudinal study design was used to test the hypotheses that (1) children who received services would experience decreased social, emotional and behavioral problems over time and (2) caregivers' stress and depressive symptoms would decrease over time. Families who were enrolled in services and who consented to participate in the evaluation study were included in analyses (N = 225). Individual growth models were used to test longitudinal effects among MA LAUNCH participants (children and caregivers) over three time points using screening tools. Results Analyses showed that LAUNCH children who scored in age-specific clinically significant ranges of social, emotional and behavioral problems at Time 1 scored in the normal range on average by Time 3. Caregivers' stress and depressive symptoms also declined across the three time points. Results support hypotheses that the LAUNCH intervention improved social and emotional health for children and caregivers. Conclusions for Practice This study led to sustainability efforts, an expansion of the model to three additional communities across the state and development of an online toolkit for other communities interested in implementation.
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Affiliation(s)
- Beth E. Molnar
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
- Bouvé College of Health Sciences, Institute on Urban Health Research, Northeastern University, 360 Huntington Ave, M/S 314 INV, Boston, MA 02115 USA
| | - Kristin E. Lees
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
| | - Kate Roper
- Massachusetts Department of Public Health, 250 Washington St., Boston, MA 02118 USA
| | - Natasha Byars
- Boston Public Health Commission, 1010 Massachusetts Ave, Boston, MA 02118 USA
| | - Larisa Méndez-Peñate
- Massachusetts Department of Public Health, 250 Washington St., Boston, MA 02118 USA
| | - Christy Moulin
- Boston Public Health Commission, 1010 Massachusetts Ave, Boston, MA 02118 USA
| | - William McMullen
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
| | - Jessica Wolfe
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
| | - Deborah Allen
- Los Angeles County Department of Public Health, 313 N. Figueroa St., Los Angeles, CA 90012 USA
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Schladen MM, Ljungberg IH, Underwood JA, Groah SL. Exploration of the Personal Health Record as a Tool for Spinal Cord Injury Health Self-Management and Coordination of Care. Top Spinal Cord Inj Rehabil 2018; 23:218-225. [PMID: 29339897 DOI: 10.1310/sci2303-218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: A personal health record (PHR) is a collection of electronic health data drawn from multiple sources but managed by the patient. The PHR is a strategy that enables patients to be proactive in the coordination of their care. Objective: The purpose of this clinical improvement study was to discover what worked, what did not work, and what could be improved in the initial implementation of MyPHR, a PHR tailored to patients with spinal cord injury (SCI), to make it a useful tool for care coordination and health self-management. Methods: Five individuals with chronic (>1 year) SCI carried out trial use of MyPHR. Twelve hours of interactions, including screen navigation and think-aloud reflection, were recorded and analyzed using formative research, a qualitative method and type of case study research. Results: Two key themes emerged to guide the implementation of PHR technology: selectivity in the identification of information for the patient to track, and continual support and communication with the clinical team. Conclusion: Given the volume of electronic data available to patients with SCI, the data identified to import, manage, and keep current in a PHR have to be thoughtfully selected to make sure the patient is convinced of the worth of this data record and is willing to invest the time and effort it will take to maintain it. A PHR should be implemented with a deliberate focus on its function as a tool that patients and providers use together to expand communication as they work toward their common goal of optimizing health after SCI.
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Affiliation(s)
- Manon Maitland Schladen
- MedStar Health Research Institute, Hyattsville, MD.,Georgetown University Department of Rehabilitation Medicine, Washington, DC
| | | | | | - Suzanne L Groah
- Paralysis and Recovery Program, MedStar National Rehabilitation Hospital, Washington, DC.,Rehabilitation Medicine, Georgetown University Hospital, Washington, DC
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Successes and Lessons Learned From Implementing Community Health Worker Programs in Community-Based and Clinical Settings: Insights From the Gulf Coast. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23 Suppl 6 Suppl, Gulf Region Health Outreach Program:S85-S93. [PMID: 28961658 DOI: 10.1097/phh.0000000000000653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Community health workers (CHWs) are an increasingly viable component of the American health system. While organizations may be interested in incorporating CHWs into the health care workforce, there are challenges to doing so. OBJECTIVE This study characterizes the successes and lessons learned from implementing new CHW programs in clinical and community-based settings in 4 US Gulf states. DESIGN Semistructured interviews were conducted with CHWs and their supervisors. SETTING Interviews were conducted with participants in 16 community-based organizations and federally qualified health centers located in coastal counties and parishes of Louisiana, Florida, Alabama, and Mississippi. PARTICIPANTS Study participants consisted of 22 CHWs and 17 CHW supervisors. RESULTS Although most challenges and strategies were reported by participants working in both clinical and community-based settings, some were workplace-specific. Participants from predominantly clinical settings described the importance of strengthening organizational cohesion and coordination, whereas participants from community-based participants discussed the need for specialized training for CHWs. In both work environments, participants indicated that CHW functioning was constrained by limited organizational resources, difficulty accessing the client population, and limited knowledge regarding the CHW's scope of practice. Strategies to improve CHW functioning in both settings included investing in local partnerships, streamlining resources, prioritizing strong communication and outreach, and establishing explicit operating procedures. The majority of participants noted that challenges lessened over time. CONCLUSIONS Evaluating successes and lessons learned in CHW work is critical to maximize CHWs' abilities to address clients' health needs and promote health in underserved communities. This study provides important insights into how to successfully integrate CHWs into the public health workforce.
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Sheaff R, Brand SL, Lloyd H, Wanner A, Fornasiero M, Briscoe S, Valderas JM, Byng R, Pearson M. From programme theory to logic models for multispecialty community providers: a realist evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets.
Objectives
To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly.
Design
Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way.
Data sources
Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions.
Results
The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs.
Limitations
The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed.
Conclusions
Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience.
Study registration
This study is registered as PROSPERO CRD42016038900.
Funding
The National Institute for Health Research (NIHR) Health Services and Delivery Research programme and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Affiliation(s)
- Rod Sheaff
- School of Law, Criminology and Government, University of Plymouth, Plymouth, UK
| | - Sarah L Brand
- Y Lab Public Service Innovation Lab for Wales, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Helen Lloyd
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Amanda Wanner
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Mauro Fornasiero
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Simon Briscoe
- NIHR CLAHRC for the South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Jose M Valderas
- NIHR CLAHRC for the South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Richard Byng
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Mark Pearson
- NIHR CLAHRC for the South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Documenting Community Health Worker Roles in Primary Care: Contributions to Evidence-Based Integration Into Health Care Teams, 2015. J Ambul Care Manage 2018; 40:305-315. [PMID: 28350634 DOI: 10.1097/jac.0000000000000178] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements.
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Hartzler AL, Tuzzio L, Hsu C, Wagner EH. Roles and Functions of Community Health Workers in Primary Care. Ann Fam Med 2018; 16:240-245. [PMID: 29760028 PMCID: PMC5951253 DOI: 10.1370/afm.2208] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/13/2017] [Accepted: 01/11/2017] [Indexed: 11/09/2022] Open
Abstract
Community health workers have potential to enhance primary care access and quality, but remain underutilized. To provide guidance on their integration, we characterized roles and functions of community health workers in primary care through a literature review and synthesis. Analysis of 30 studies identified 12 functions (ie, care coordination, health coaching, social support, health assessment, resource linking, case management, medication management, remote care, follow-up, administration, health education, and literacy support) and 3 prominent roles representing clusters of functions: clinical services, community resource connections, and health education and coaching. We discuss implications for community health worker training and clinical support in primary care.
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Affiliation(s)
- Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Edward H Wagner
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Implementation of Practice Transformation: Patient Experience According to Practice Leaders. Qual Manag Health Care 2018; 26:140-151. [PMID: 28665905 DOI: 10.1097/qmh.0000000000000141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Examine practice leaders' perceptions and experiences of how patient-centered medical home (PCMH) transformation improves patient experience. SUBJECTS Thirty-six interviews with lead physicians (n = 13), site clinic administrators (n = 13), and nurse supervisors (n = 10). METHODS Semi-structured interviews at 14 primary care practices within a large urban Federally Qualified Health Center (FQHC) delivery system to identify critical patient experience domains and mechanisms of change. Identified patient experience domains were compared with Consumer Assessment of Healthcare Providers and Systems (CAHPS) items. RESULTS We identified 28 patient experience domains improved by PCMH transformation, of which 22 are measured by CAHPS, and identified 24 mechanisms of change commonly reported by practice leaders during PCMH transformation. CONCLUSIONS PCMH practice transformation can improve patient experience. Most patient experience domains reported as improved during PCMH efforts are measured by CAHPS items. Practices would benefit from collecting specific information on staff behaviors related to teamwork, team-based communication, scheduling, emergency and inpatient follow-up, and referrals. All 3 types of practice leaders reported 4 main mechanisms of PCMH change that improved patient experience. Our findings provide guidance for practice leaders on which strategies of PCMH practice transformation lead to specific improvements in patient experience measures. Further research is needed on the relationship between PCMH changes and changes in CAHPS patient experience scores.
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25
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Islam NS, Wyatt LC, Taher M, Riley L, Tandon SD, Tanner M, Mukherji BR, Trinh-Shevrin C. A Culturally Tailored Community Health Worker Intervention Leads to Improvement in Patient-Centered Outcomes for Immigrant Patients With Type 2 Diabetes. Clin Diabetes 2018; 36:100-111. [PMID: 29686448 PMCID: PMC5898170 DOI: 10.2337/cd17-0068] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
IN BRIEF This article reports results from a patient-centered intervention to improve management of type 2 diabetes in the New York City Bangladeshi community. The DREAM (Diabetes Research, Education, and Action for Minorities) intervention is a randomized trial among Bangladeshi immigrants with type 2 diabetes comparing those enrolled in a community health worker (CHW) intervention to those in usual care. Participants in the intervention group received five group-based educational sessions and two one-on-one visits delivered by a trained CHW, whereas those in the control group received only the first group educational session. Main outcomes include changes in A1C, systolic and diastolic blood pressure, cholesterol, triglycerides, weight, BMI, and patient-centered outcomes such as knowledge and behavior related to type 2 diabetes management.
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Affiliation(s)
- Nadia S. Islam
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Laura C. Wyatt
- Department of Population Health, New York University School of Medicine, New York, NY
| | - M.D. Taher
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Lindsey Riley
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY
| | - S. Darius Tandon
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael Tanner
- Department of Medicine, New York University School of Medicine, New York, NY
| | - B. Runi Mukherji
- Department of Psychology, State University of New York at Old Westbury, Old Westbury, NY
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University School of Medicine, New York, NY
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26
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Islam N, Shapiro E, Wyatt L, Riley L, Zanowiak J, Ursua R, Trinh-Shevrin C. Evaluating community health workers' attributes, roles, and pathways of action in immigrant communities. Prev Med 2017; 103:1-7. [PMID: 28735724 PMCID: PMC6354577 DOI: 10.1016/j.ypmed.2017.07.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/28/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
Abstract
Community health workers (CHWs) are uniquely positioned to improve health outcomes in immigrant communities; however, research on appropriate metrics for evaluating CHW attributes and mechanisms of effectiveness are limited. The objective of this paper is to characterize CHW attributes and pathways of action using adapted measures, develop a scale using these measures, and explore how findings can inform future CHW research and practice. The study analyzed pre- and post-intervention group data from one quasi-experimental and three randomized controlled-design parent trials assessing the impact of CHW-led group and individual health coaching on various health outcomes in four New York City immigrant communities. We conducted descriptive, bi-variate and principal components analysis to develop a 13-item scale assessing CHW attributes, roles, and pathways of action. The sample included 437 individuals completing the intervention arm of a CHW study. We found CHWs were reported to affect change through a number of mechanisms and participants expressed substantial communal concordance with the CHWs in terms of country of birth, language, and culture. Principal components analysis with promax rotation identified 13 items with three factors and high Cronbach's alphas: 1) valued interpersonal attributes of the CHW (alpha=0.784); 2) CHW as a bridge to health and non-health resources (alpha=0.857); and 3) providing accessibility beyond health providers (alpha=0.904). Socio-demographic characteristics and differences in CHW pathways of action were identified by community. Study findings can guide improved selection and training of CHWs. Further, measures identified in the principal components analysis can be used to guide future CHW evaluation efforts.
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Affiliation(s)
- Nadia Islam
- New York University School of Medicine, Department of Population Health, United States.
| | | | - Laura Wyatt
- New York University School of Medicine, Department of Population Health, United States
| | - Lindsey Riley
- Michael J. Fox Foundation for Parkinson's Research, United States
| | - Jennifer Zanowiak
- New York University School of Medicine, Department of Population Health, United States
| | - Rhodora Ursua
- Asian Pacific Partnerships for Empowerment, Advocacy, and Leadership, United States
| | - Chau Trinh-Shevrin
- New York University School of Medicine, Department of Population Health, United States
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27
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King C, Goldman A, Gampa V, Smith C, Muskett O, Brown C, Malone J, Sehn H, Curley C, Begay MG, Nelson AK, Shin SS. Strengthening the role of Community Health Representatives in the Navajo Nation. BMC Public Health 2017; 17:348. [PMID: 28431541 PMCID: PMC5399395 DOI: 10.1186/s12889-017-4263-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 04/12/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Caroline King
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Community Outreach and Patient Empowerment (COPE), Gallup, NM, USA
| | - Alex Goldman
- Tufts University School of Medicine, Boston, MA, USA
| | - Vikas Gampa
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, USA.,Harvard Medical School, Boston, MA, USA
| | - Casey Smith
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Community Outreach and Patient Empowerment (COPE), Gallup, NM, USA
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Community Outreach and Patient Empowerment (COPE), Gallup, NM, USA
| | - Christian Brown
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Community Outreach and Patient Empowerment (COPE), Gallup, NM, USA
| | - Jamy Malone
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, USA.,Partners In Health, Boston, MA, USA
| | - Hannah Sehn
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, USA.,Partners In Health, Boston, MA, USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Community Outreach and Patient Empowerment (COPE), Gallup, NM, USA
| | - Mae-Gilene Begay
- Navajo Nation Community Health Representative Outreach Program, Window Rock, AZ, USA.,Navajo Nation Department of Health, Window Rock, AZ, USA
| | | | - Sonya Sunhi Shin
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Community Outreach and Patient Empowerment (COPE), Gallup, NM, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
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28
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Niemelä M, Marshall CA, Kroll T, Curran M, Koerner SS, Räsänen S, García F. Family-Focused Preventive Interventions With Cancer Cosurvivors: A Call to Action. Am J Public Health 2016; 106:1381-7. [PMID: 27196647 DOI: 10.2105/ajph.2016.303178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Health promotion and preventive action in the context of public health interventions for highly prevalent, long-term conditions such as cancer are rarely geared toward the family as a whole. Yet family members, as cancer cosurvivors, must manage their own substantial stress and multiple caregiving responsibilities and often constitute a critical nexus between individual patients and clinicians. We drew on 2 examples of cancer cosurvivorship from 2 different health service contexts, the United States and Finland. A systemic approach in public health is needed to support family members who not only have to confront the meaning of long-term conditions such as cancer but also may have to manage concurrent social life challenges and stressors such as economic hardship.
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Affiliation(s)
- Mika Niemelä
- Mika Niemelä is with the Child and Adolescent Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland. Catherine A. Marshall is with the Department of Disability and Psychoeducational Studies, University of Arizona, Tucson. Thilo Kroll is with the Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, Scotland, UK. Melissa Curran is with the Norton School of Family and Consumer Sciences, University of Arizona, Tucson. Susan Silverberg Koerner is with the Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign. Sami Räsänen is with the Department of Psychiatry, Oulu University Hospital, Oulu, Finland. Francisco García is with the Pima County Health Department, Tucson, AZ. All authors are affiliated with the FRED (Family-Focused Research, Education and Development) network
| | - Catherine A Marshall
- Mika Niemelä is with the Child and Adolescent Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland. Catherine A. Marshall is with the Department of Disability and Psychoeducational Studies, University of Arizona, Tucson. Thilo Kroll is with the Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, Scotland, UK. Melissa Curran is with the Norton School of Family and Consumer Sciences, University of Arizona, Tucson. Susan Silverberg Koerner is with the Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign. Sami Räsänen is with the Department of Psychiatry, Oulu University Hospital, Oulu, Finland. Francisco García is with the Pima County Health Department, Tucson, AZ. All authors are affiliated with the FRED (Family-Focused Research, Education and Development) network
| | - Thilo Kroll
- Mika Niemelä is with the Child and Adolescent Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland. Catherine A. Marshall is with the Department of Disability and Psychoeducational Studies, University of Arizona, Tucson. Thilo Kroll is with the Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, Scotland, UK. Melissa Curran is with the Norton School of Family and Consumer Sciences, University of Arizona, Tucson. Susan Silverberg Koerner is with the Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign. Sami Räsänen is with the Department of Psychiatry, Oulu University Hospital, Oulu, Finland. Francisco García is with the Pima County Health Department, Tucson, AZ. All authors are affiliated with the FRED (Family-Focused Research, Education and Development) network
| | - Melissa Curran
- Mika Niemelä is with the Child and Adolescent Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland. Catherine A. Marshall is with the Department of Disability and Psychoeducational Studies, University of Arizona, Tucson. Thilo Kroll is with the Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, Scotland, UK. Melissa Curran is with the Norton School of Family and Consumer Sciences, University of Arizona, Tucson. Susan Silverberg Koerner is with the Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign. Sami Räsänen is with the Department of Psychiatry, Oulu University Hospital, Oulu, Finland. Francisco García is with the Pima County Health Department, Tucson, AZ. All authors are affiliated with the FRED (Family-Focused Research, Education and Development) network
| | - Susan Silverberg Koerner
- Mika Niemelä is with the Child and Adolescent Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland. Catherine A. Marshall is with the Department of Disability and Psychoeducational Studies, University of Arizona, Tucson. Thilo Kroll is with the Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, Scotland, UK. Melissa Curran is with the Norton School of Family and Consumer Sciences, University of Arizona, Tucson. Susan Silverberg Koerner is with the Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign. Sami Räsänen is with the Department of Psychiatry, Oulu University Hospital, Oulu, Finland. Francisco García is with the Pima County Health Department, Tucson, AZ. All authors are affiliated with the FRED (Family-Focused Research, Education and Development) network
| | - Sami Räsänen
- Mika Niemelä is with the Child and Adolescent Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland. Catherine A. Marshall is with the Department of Disability and Psychoeducational Studies, University of Arizona, Tucson. Thilo Kroll is with the Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, Scotland, UK. Melissa Curran is with the Norton School of Family and Consumer Sciences, University of Arizona, Tucson. Susan Silverberg Koerner is with the Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign. Sami Räsänen is with the Department of Psychiatry, Oulu University Hospital, Oulu, Finland. Francisco García is with the Pima County Health Department, Tucson, AZ. All authors are affiliated with the FRED (Family-Focused Research, Education and Development) network
| | - Francisco García
- Mika Niemelä is with the Child and Adolescent Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland. Catherine A. Marshall is with the Department of Disability and Psychoeducational Studies, University of Arizona, Tucson. Thilo Kroll is with the Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, Scotland, UK. Melissa Curran is with the Norton School of Family and Consumer Sciences, University of Arizona, Tucson. Susan Silverberg Koerner is with the Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign. Sami Räsänen is with the Department of Psychiatry, Oulu University Hospital, Oulu, Finland. Francisco García is with the Pima County Health Department, Tucson, AZ. All authors are affiliated with the FRED (Family-Focused Research, Education and Development) network
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29
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Abstract
Peer supporters are recognized by various designations-community health workers, promotores de salud, lay health advisers-and are community members who work for pay or as volunteers in association with health care systems or nonprofit community organizations and often share ethnicity, language, and socioeconomic status with the mentees that they serve. Although emerging evidence demonstrates the efficacy of peer support at the community level, the adoption and implementation of this resource into patient-centered medical homes (PCMHs) is still under development. To accelerate that integration, this article addresses three major elements of peer support interventions: the functions and features of peer support, a framework and programmatic strategies for implementation, and fiscal models that would support the sustained viability of peer support programs within PCMHs. Key functions of peer support include assistance in daily management of health-related behaviors, social and emotional support, linkage to clinical care, and longitudinal or ongoing support. An organizational model of innovation implementation provides a useful framework for determining how to implement and evaluate peer support programs in PCMHs. Programmatic strategies that can be useful in developing peer support programs within PCMHs include peer coaching or mentoring, group self-management training, and programs designed around the telephone and information technology. Fiscal models for peer support programs include linkages with hospital or health care systems, service- or community-based nonprofit organizations, and partnerships between health care systems and community groups. Peer support promises to enrich PCMHs by activating patients in their self-care, providing culturally sensitive outreach, and opening the way for partnerships with community-based organizations.
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Affiliation(s)
- Timothy P Daaleman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation, Leawood, Kansas Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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30
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Franklin CM, Bernhardt JM, Lopez RP, Long-Middleton ER, Davis S. Interprofessional Teamwork and Collaboration Between Community Health Workers and Healthcare Teams: An Integrative Review. Health Serv Res Manag Epidemiol 2015; 2:2333392815573312. [PMID: 28462254 PMCID: PMC5266454 DOI: 10.1177/2333392815573312] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Community Health Workers (CHWs) serve as a means of improving outcomes for underserved populations. However, their relationship within health care teams is not well studied. The purpose of this integrative review was to examine published research reports that demonstrated positive health outcomes as a result of CHW intervention to identify interprofessional teamwork and collaboration between CHWs and health care teams. METHODS A total of 47 studies spanning 33 years were reviewed using an integrative literature review methodology for evidence to support the following assumptions of effective interprofessional teamwork between CHWs and health care teams: (1) shared understanding of roles, norms, values, and goals of the team; (2) egalitarianism; (3) cooperation; (4) interdependence; and(5) synergy. RESULTS Of the 47 studies, 12 reported at least one assumption of effective interprofessional teamwork. Four studies demonstrated all 5 assumptions of interprofessional teamwork. CONCLUSIONS Four studies identified in this integrative review serve as exemplars for effective interprofessional teamwork between CHWs and health care teams. Further study is needed to describe the nature of interprofessional teamwork and collaboration in relation to patient health outcomes.
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Affiliation(s)
- Catherine M. Franklin
- Department of Family Medicine, East Boston Neighborhood Health Center, East Boston, MA, USA
| | - Jean M. Bernhardt
- School of Nursing, MGH Institute of Health Professions, Boston, MA, USA
| | - Ruth Palan Lopez
- School of Nursing, MGH Institute of Health Professions, Boston, MA, USA
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