Community Health Workers, Access to Care, and Service Utilization Among Florida Latinos: A Randomized Controlled Trial

Chang, Aileen Y.; Patberg, Elizabeth; Cueto, Victor; Li, Hua; Singh, Bhavana; Kenya, Sonjia; Alonzo, Yisel; Carrasquillo, Olveen

doi:10.2105/ajph.2018.304542

Cited by 12 publications

(10 citation statements)

References 10 publications

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“…Despite variations in the study settings, methods, and program durations of the identified papers in this review, the findings indicated that Chinese CHWs provided certain types of community-based preventive services on major chronic diseases. These were generally aligned with the results of other international reviews [ 35 , 36 , 37 , 38 ]. However, limited studies in this review focused on NCD risk factors management among general populations, except one sodium reduction program conducted by Li et al [ 34 ].…”

Section: Discussionsupporting

confidence: 89%

Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006–2016)

Long

Huang

Zheng

et al. 2018

IJERPH

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Background: Non-communicable diseases (NCDs) have become a dominant disease burden in China. Although China has a prevention-centered NCD strategy, the implementation effect in the community has been subjected to manpower and financial difficulties. Engaging community health workers (CHWs) in community-based interventions may be a cost-effective approach to relieve the resource shortage and improve health. This review aimed to synthesize evidence on types of NCD-related care that was provided by CHWs in China, and to identify relevant barriers and facilitators. Methods: A literature search was conducted in Medline, PubMed, ProQuest, and Google Scholar databases for English-written, peer-reviewed articles published from 1996 to 2016 that reported findings from NCD-related interventions delivered by CHWs in China. Each article was extracted independently by two researchers. Results: Twenty distinct studies met the inclusion criteria. The two most common types of CHW-led NCD-related care were diabetes and hypertension management (n = 7) and mental health care (n = 7). Thirteen studies discussed the barriers and 16 studies reported facilitators. The most common barriers included lack of support (n = 6), lack of resources (n = 4), and heavy reliance on technology (n = 4). The common facilitators included an integrated health system (n = 9), community and patient trust (n = 5), high quality training (n = 5), and CHWs’ capacity (n = 5). Fourteen studies mentioned training content, while only eight described detailed procedures and duration. Conclusions: This review suggests that trained and supervised Chinese CHWs had the capacity to provide grassroots NCDs preventive interventions. In order to increase the generalizability and sustainability of such programs, studies with robust designs are needed to explore the effectiveness of CHW-led programs, and the intervention strategies to improve the practice of CHWs in various settings.

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Section: Discussionsupporting

confidence: 89%

Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006–2016)

Long

Huang

Zheng

et al. 2018

IJERPH

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“…CHWs are frontline public health workers who are trusted members of or closely familiar with the community they serve. [8][9][10][11] CHWs with appropriate training can serve as effective peer coaches by providing culturally congruent counseling to promote healthy behaviors and motivate patients to engage in proven disease prevention strategies. [12][13][14][15][16][17] CHWs integrated into PC teams can improve care for patients with chronic disease at modest cost, improve preventive care, and address social determinants of health.…”

Section: Introductionmentioning

confidence: 99%

Integrating Community Health Workers into Safety-Net Primary Care for Diabetes Prevention: Qualitative Analysis of Clinicians’ Perspectives

et al. 2019

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BACKGROUND: Evidence shows community health workers (CHWs) can effectively deliver proven behaviorchange strategies to prevent type 2 diabetes mellitus (diabetes) and enhance preventive care efforts in primary care for minority and low-income populations. However, operational details to integrate CHWs into primary care practice remain less well known. OBJECTIVE: To examine clinicians' perceptions about working with CHWs for diabetes prevention in safety-net primary care. SETTING: Clinicians are primary care physicians and nurses at two New York City safety-net hospitals participating in CHORD (Community Health Outreach to Reduce Diabetes). CHORD is a cluster-randomized trial testing a CHW intervention to prevent diabetes. DESIGN: Guided by the Consolidated Framework for Implementation Research, we studied how features of the CHW model and organizational context of the primary care practices influenced clinicians' perspectives about the acceptability, appropriateness, and feasibility of a diabetes-prevention CHW program. Data were collected pre-intervention using semi-structured interviews (n = 18) and a 20-item survey (n = 54). APPROACH: Both survey and interview questions covered clinicians' perspectives on diabetes prevention, attitudes and beliefs about CHWs' role, expectations in working with CHWs, and use of clinic-and community-based diabetes-prevention resources. Survey responses were descriptively analyzed. Interviews were coded using a mix of deductive and inductive approaches for thematic analysis. KEY RESULTS: Eighty-seven percent of survey respondents agreed CHWs could help in preventing diabetes; 83% reported interest in working with CHWs. Ninety-one percent were aware of clinic-based prevention resources; only 11% were aware of community resources. Clinicians supported CHWs' cultural competency and neighborhood reach, but expressed concerns about the adequacy of CHWs' training; public and professional emphasis on diabetes treatment over prevention; and added workload and communication with CHWs. CONCLUSIONS: Clinicians found CHWs appropriate for diabetes prevention in safety-net settings. However, disseminating high-quality evidence about CHWs' effectiveness and operations is needed to overcome concerns about integrating CHWs in primary care.

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“…Nevertheless, the results of this study have the potential to influence current and future policy regarding the need for additional interventions for retention, adherence, and continuity of care to improve treatment adherence and viral load suppression in MDC. If in fact, communities high in Factor 1 (lowest SES, lowest education, and least access to health insurance) are most likely to have high rates of uncontrolled HIV, then we would propose that effective HIV healthcare delivery may need to involve community-based participatory approaches to become more comprehensive with wrap around services from patient navigators to culturally diverse community health workers to medical-legal partnerships, for those of low SES, low education, and low access to health insurance, specifically for Black/African Americans and Hispanic/Latinx in MDC [ 33 – 36 , 38 , 39 , 41 – 50 ].…”

Section: Discussionmentioning

confidence: 99%

“…To achieve favorable results in HIV control, new interventions that address barriers to improving healthcare access and insurance coverage, as per the health and healthcare determinant of the SDOH, should be implemented. Chronic disease research has shown that interventions utilizing community health workers in underserved populations, particularly racial/ethnic minorities, have had positive effects on health outcomes in terms of prevention and reduced disease progression [33][34][35][36][37]. For both Black/African Americans and Hispanic/Latinx, the use of patient navigators has been shown to be a successful intervention that has had significant effects on improving timely linkage to care, retention in care, and preventing declines in viral suppression [38][39][40][41].…”

Section: Discussionmentioning

confidence: 99%

The Association Between the Social Determinants of Health and HIV Control in Miami-Dade County ZIP Codes, 2017

Rojas

Melo

Moise

et al. 2020

J. Racial and Ethnic Health Disparities

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Background There were 28,055 people living with HIV (PLWH) in Miami-Dade County (MDC) in 2017; 40.1% was either out of care or was not virally suppressed (uncontrolled HIV). The purpose of this study was to determine the association between the social determinants of health (SDOH) and the number of persons with uncontrolled HIV in MDC. Setting This cross-sectional study included PLWH 15 and older with uncontrolled HIV in MDC, 2017. Data on PLWH’s viral load, age, gender, mode of HIV transmission, and race/ethnicity were aggregated to the ZIP code level. All five SDOH per HealthyPeople 2020 were represented: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment. Methods Descriptive analyses on all study variables and a principal component analysis on the SDOH variables were performed. To account for overdispersion, multivariate negative binomial regressions were run while controlling for confounders and testing for significant interactions. Results The results of the regression analysis indicated that an increase in Factor 1 (economic stability, education, and health and healthcare determinants) was associated with a statistically significant increase in the number of PLWH with uncontrolled HIV. Additionally, we found a significant interaction between Factor 1 and White race. Among persons of low socioeconomic status, White race is associated with a reduction in PLWH with uncontrolled HIV. Conclusions These results suggest that reducing poverty and increasing education and rates of health insurance should result in significant reductions in PLWH with uncontrolled HIV. These results have the potential to influence future policy, interventions for retention, adherence, and continuity of care to improve suppression rates in MDC.

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Community Health Workers, Access to Care, and Service Utilization Among Florida Latinos: A Randomized Controlled Trial

Abstract: Among Latinos with poorly controlled diabetes, a 1-year community health worker intervention was associated with improvements in self-reported access to care but not service utilization.

Cited by 12 publications

References 10 publications

Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006–2016)

Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006–2016)

Integrating Community Health Workers into Safety-Net Primary Care for Diabetes Prevention: Qualitative Analysis of Clinicians’ Perspectives

The Association Between the Social Determinants of Health and HIV Control in Miami-Dade County ZIP Codes, 2017

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