A mixed methods evaluation of the feasibility, acceptability, and impact of a pilot project ECHO for community health workers (CHWs)

Abstract

Background Despite the positive effects of community health workers (CHWs) on addressing social determinants of health, improving patient health outcomes, and decreasing overall healthcare costs, there is a lack of standardization in training and certifying this workforce, resulting in different approaches to integrating this role into medical home models. The purpose of the current study is to evaluate the application of Project ECHO (Extension for Community Healthcare Outcomes) in enhancing CHWs’ capacity to address health and social issues of vulnerable populations. Methods An explanatory sequential mixed methods design was applied in which all participants (N = 49) completed pre (January 2019) and post (July 2019) quantitative online surveys measuring changes in self-efficacy, behavior change intent, and knowledge. Virtual focus groups were conducted with a subset of participants (n = 20) in July 2019 to assess the feasibility, acceptability, and impact of Project ECHO. Results There was a statistically significant difference of + 0.453 in the composite self-efficacy mean score pre- to post-series. For every 1 additional Project ECHO CHW session attended, there was a .05 improvement in participants’ self-efficacy to perform CHW-related job duties and address social determinants of health (SDOH). Four major themes emerged from the qualitative focus group data: value in learning from other participants’ caseloads, CHW-care team integration, availability of training and resources, and shared decision-making with patients. Conclusions This evaluation suggests that ECHO is a viable means of increasing access to training resources for CHWs. Future studies on the ECHO model as a means of educating and broadening implementation of CHWs are warranted. Programs such as Project ECHO can support CHWs by providing continuing education opportunities, as well as standardizing training content across large geographic areas.

Reflections on project ECHO: qualitative findings from five different ECHO programs

“…Consistent with prior work, our findings suggest that ECHO participants are motivated by and receive quality continuing education [ 31 , 32 , 34 , 35 , 37 , 38 ] and report changes to their own practice [ 31 , 33 , 35 , 38 ]. Indeed, these outcomes often have been foci of quantitative studies collected by systematic reviews [ 13 , 15 ], but the strength of evidence should be increased.…”

“…Many practitioners joined and valued ECHO because of the networking that it offered; this was not just a matter of accessing expert opinion but was seen, sometimes, as a replacement for traditional gathering places and a means to reduce practitioner isolation. This finding mirrors qualitative ECHO studies emphasizing community of practice and practitioner isolation [31][32][33][34][35]. It also reflects prior work on andragogical spaces for medical professional identity [36].…”

Feasibility, acceptability, and sustainability of Project ECHO to expand capacity for pediatricians in Vietnam

“…The success of an ECHO program critically depended on the acceptability from both the healthcare providers and hospital leaders. Before this study, Damian et al evaluated the level of satisfaction through the survey with participants as a tool to measure the program acceptability [ 20 ]. However, the satisfaction was not persuasive enough to reflect the acceptability.…”

“…Thus, as the Project ECHO has to run by its resource in the future, it is essential to examine the factors that impact the program’s sustainability. Although previous studies have mentioned the feasibility and acceptability of Project ECHO [ 6 , 14 , 15 , 20 ], few researchers have studied the sustainability of the program [ 7 , 39 ]. To ensure the sustainability of Project ECHO, the financial issue is crucial because the project has to invest in human resources, devices and the online network [ 39 , 40 ].…”

“…Several studies have evaluated the feasibility and acceptability of Project ECHO implementation in some countries [ 6 , 20 ]. However, no studies have yet investigated the feasibility, acceptability, and sustainability of Project ECHO for pediatricians.…”