Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature

Abstract

BackgroundHealth services in high-income countries increasingly recognise the challenge of effectively serving and engaging with marginalised people. Effective engagement with marginalised people is essential to reduce health disparities these populations face. One solution is by tapping into the phenomenon of boundary-spanning people in the community—those who facilitate the flow of ideas, information, activities and relationships across organisation and socio-cultural boundaries.MethodsA scoping review methodology was applied to peer-reviewed articles to answer the question: “How do health services identify, recruit and use boundary spanners and what are the outcomes?” The review was conducted in seven databases with search terms based on community-based boundary spanning, marginalised people and health services.FindingsWe identified 422 articles with the screening process resulting in a final set of 30 articles. We identified five types of community-based boundary spanning: navigators, community health workers, lay workers, peer supporters and community entities. These range from strong alignment to the organisation through to those embedded in the community. We found success in four domains for the organisation, the boundary spanner, the marginalised individuals and the broader community. Quantifiable outcomes related to cost-savings, improved disease management and high levels of clinical care. Outcomes for marginalised individuals related to improved health knowledge and behaviours, improved health, social benefits, reduced barriers to accessing services and increased participation in services. We identified potential organisational barriers to using boundary spanners based on organisational culture and staff beliefs.ConclusionsCommunity boundary spanners are a valuable adjunct to the health workforce. They enable access to hard to reach populations with beneficial health outcomes.Maintaining the balance of organisational and community alignment is key to ongoing success and diffusion of this approach.

Collaboration with community connectors to improve primary care access for hardly reached people: a case comparison of rural Ireland and Australia

“…[insert Figure 1] Connectors were sought who were acting in a voluntary capacity, to explore the extent to which boundary spanning community members assisting with access to health, naturally occurs. The connectors fulfilled many of the functions of CTC workers, and as expected, this resembled CTC roles most strongly aligned with the community rather than the organisation, namely peer supporter, lay helper or health champion [43]. The fact that several connectors clearly articulated the difference between their community expertise and the health expertise of staff indicated appreciation that their roles differed to staff roles.…”

“…Data from the case studies were imported into NVIVO software and coding was undertaken by CW, with samples reviewed by JF and AM for verification. Codes were compared with existing evidence [59,60] from a prior scoping review [43] and codes relating to the benefits of boundary spanning were added.…”

“…Future research beyond the "rural locale" [13] (p 499) would provide further insights on the extent to which these elements vary in response to urban socio-cultural and policy contexts, as would studies in other high income countries. Additionally, research on the impacts of connectors for hardly reached groups, connectors, organisations and the community [43] will build the evidence base required for health services to determine the value of enabling staff collaborations with connectors.…”

Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

“…(21,29,33,44,(46)(47)(48)(49) Health system navigability is enhanced through having coordinated and co-located care, (7,29,33,34,47,(50)(51)(52) through having clear and intuitive patient pathways managed by staff and providers who bring patients along to the next step, (14,33,47,53,54) and through accompanying patients either by link workers or peer advocates. (21,33,(54)(55)(56)(57)(58) Having this kind of support helps patients by providing extra motivation and con dence in seeking health services when needed and navigating institutional locations such as hospitals and clinics, and negotiating patient pathways which may be complex. (33,35,47,54) Peer advocates have a unique understanding of the experience the patient is having and have the ability to meet patients where they are and provide emotional support.…”

“…(33,35,47,54) Peer advocates have a unique understanding of the experience the patient is having and have the ability to meet patients where they are and provide emotional support. (33,38,52,(55)(56)(57) When care is organised around the person it is inherently respectful of other demands on their time and their particular goals (or lack thereof) for their own health. For example, as many services are carried out in one clinical encounter as possible and through shared and transparent decision making.…”