Do Community Health Worker Interventions Improve Rates of Screening Mammography in the United States? A Systematic Review

Abstract

Background Community health workers (CHWs) are lay individuals who are trained to serve as liaisons between members of their communities and healthcare providers and services. Methods A systematic review was conducted to synthesize evidence from all prospective controlled studies on effectiveness of CHW programs in improving screening mammography rates. Studies reported in English and conducted in the United States were included if they: (1) evaluated a CHW intervention designed to increase screening mammography rates in women 40 years of age or older without a history of breast cancer; (2) were a randomized controlled trial (RCT), case-controlled study, or quasi-experimental study; and (3) evaluated a CHW intervention outside of a hospital setting. Results Participation in a CHW intervention was associated with a statistically significant increase in receipt of screening mammography [Risk Ratio (RR):1.06 (favoring intervention); 95% Confidence Interval (CI:1.02, 1.11),p=0.003]. The effect remained when pooled data from only RCTs were included in meta-analysis (RR:1.07,95% CI:1.03,1.12,p=0.0005), but was not present using pooled data from only quasi-experimental studies (RR:1.03,95% CI:0.89,1.18,p=0.71). In RCTs, participants recruited from medical settings (RR:1.41,95% CI:1.09,1.82,p=0.008), programs conducted in urban settings (RR:1.23,95% CI:1.09,1.39,p=0.001), and programs where CHWs were matched to intervention participants on race or ethnicity (RR:1.58, 95%CI:1.29,1.93,p=0.0001) demonstrated stronger effects on increasing mammography screening rates. Conclusions CHW interventions are effective for increasing screening mammography in certain settings and populations. Impact CHW interventions are especially associated with improvements in rate of screening mammography in medical settings, urban settings, and in participants who are racially or ethnically concordant with the CHW.

Outreach programmes for health improvement of Traveller Communities: a synthesis of evidence

“…144,145 There is also evidence to show that they are effective in promoting mammography, although effectiveness is modest. 145,146 There is less evidence of effectiveness in promoting access to antenatal care and smoking cessation. 144 There is some evidence that CHWs are more effective when they share the ethnicity of the recipients.…”

“…144 There is some evidence that CHWs are more effective when they share the ethnicity of the recipients. 146 The benefit from attendance at mammographic screening is small and unlikely to justify a programme to encourage attendance at screening. 107,147 The benefits of boosting vaccination rates are less well defined.…”

Redesigning Cancer Care Delivery: Views From Patients and Caregivers

“…Our findings reveal opportunities for improving cancer care from patient and caregiver perspectives and suggest that incorporating nonphysician health personnel into cancer care delivery is not only acceptable but also a patient-preferred solution. Although studies have examined the quality of care provided by lay health community workers in preventive cancer care delivery, 31,32 no current studies have shown the benefit of these care providers in assisting with serious illness conversations or symptom assessment techniques. Research is needed to determine the effectiveness of these nonphysician personnel in these aspects of care delivery.…”

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

“…Typically grant funded and not reimbursed through fee for service, they focus on health education, prevention, or chronic disease management for vulnerable and minority populations. [1][2][3] As value-based payment models expand, providers will have more flexibility to fund CHWs with global budgets, or payers may elect to reimburse for CHW services. [4][5][6] The emerging evidence base on CHW programs 7 for the prevention and management of chronic diseases includes systematic reviews concluding that CHW interventions can improve overall health outcomes 8 and outcomes for patients with heart disease, stroke, 9 type II diabetes, [10][11][12] HIV, 13 and asthma 2,14 and for vulnerable patients with or at risk for a variety of chronic diseases or cancer.…”