Cardiovascular Disease and Stroke-Focused Competency Assessment Tools for Community Health Workers in the United States: A Scoping Review

Abstract

Cardiovascular disease (CVD) and stroke are major contributors to chronic disease burden in the United States. Despite the high prevalence of stroke, 90% of all stroke events are preventable and can be attributed to seven key modifiable risk factors (MRFs)—high blood pressure (BP), high cholesterol, diabetes mellitus (DM), smoking, obesity, unhealthy diet, and physical inactivity. In the United States, stroke prevention interventions led by community health workers (CHWs) have been proven to be highly effective in preventing the onset of MRFs. We conducted a scoping review of the competency assessment methods used in CVD and stroke-focused CHW training programs. We searched six online databases: PubMed, Cochrane, CINAHL, Embase, Web of Science, and HaPI, from all available years until January 2021. Of the 1,774 initial articles found, we identified 30 eligible articles to be included in the review. Nine of these studies used previously validated instruments, whereas the remaining 21 studies used tools from the training curriculum or independently developed instruments. Only five of these validated tools reported psychometric properties; none of them were designed for the CHW population. Our scoping review of literature revealed that CHW-specific competency assessment methods were limited, with few or no domain-referenced tools on CVD or stroke risk factors that complied with established measurement standards. We conclude that there is an urgent need for the development of a comprehensive and valid assessment instrument in CVD and stroke prevention to evaluate CHW performance and optimize their credibility, representing important first steps toward integrating CHWs into health care systems.

Evaluation of a clinically-integrated community health worker program to support adults with cardiovascular conditions: guided by the PRISM framework

“…Additionally, although some studies explored patient perceptions in coordination and quality of care, studies did not evaluate the contextual influence of cCHW support quality on intervention outcomes. Current literature recognizes the limitations in the training and evaluation of cCHWs, including a lack of cCHW-specific competency and performance assessment methods and limited use of validated tools cCHW competencies [68]. And with some studies reporting a low proportion of those who actually received the full intervention versus the control in addition to integrated cCHWs roles varying and undefined at times, quality of cCHW support in intervention can become a notable contextual factor with significant influence over cCHW reach and effectiveness, and outcomes overall.…”