Patients' Perspectives on the Feasibility, Acceptability, and Impact of a Community Health Worker Program: A Qualitative Study

Chang, Wei; Oo, May May; Rojas, Adriana; Damian, April Joy

doi:10.1089/heq.2020.0159

Cited by 6 publications

(23 citation statements)

References 12 publications

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“…Related to this, CHWP training varied from a brief induction delivered by research staff ( 58 ) to an in-depth training programme with regular updates delivered by local health care providers ( 61 ). In studies the training regime was often poorly described or inconsistent making it difficult to evaluate the resulting impact on intervention quality ( 49 , 52 , 55 , 56 , 60 , 63 ).…”

Section: Resultsmentioning

confidence: 99%

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Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review

Grant,

Litchfield

2024

Front. Clin. Diabetes Healthc.

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ObjectiveEthnic minority groups in high income countries in North America, Europe, and elsewhere are disproportionately affected by T2DM with a higher risk of mortality and morbidity. The use of community health workers and peer supporters offer a way of ensuring the benefits of self-management support observed in the general population are shared by those in minoritized communities.Materials and methodsThe major databases were searched for existing qualitative evidence of participants’ experiences and perspectives of self-management support for type 2 diabetes delivered by community health workers and peer supporters (CHWPs) in ethnically minoritized populations. The data were analysed using Sekhon’s Theoretical Framework of Acceptability.ResultsThe results are described within five domains of the framework of acceptability collapsed from seven for reasons of clarity and concision: Affective attitude described participants’ satisfaction with CHWPs delivering the intervention including the open, trusting relationships that developed in contrast to those with clinical providers. In considering Burden and Opportunity Costs, participants reflected on the impact of health, transport, and the responsibilities of work and childcare on their attendance, alongside a lack of resources necessary to maintain healthy diets and active lifestyles. In relation to Cultural Sensitivity participants appreciated the greater understanding of the specific cultural needs and challenges exhibited by CHWPs. The evidence related to Intervention Coherence indicated that participants responded positively to the practical and applied content, the range of teaching materials, and interactive practical sessions. Finally, in examining the impact of Effectiveness and Self-efficacy participants described how they changed a range of health-related behaviours, had more confidence in dealing with their condition and interacting with senior clinicians and benefitted from the social support of fellow participants and CHWPs.ConclusionMany of the same barriers around attendance and engagement with usual self-management support interventions delivered to general populations were observed, including lack of time and resource. However, the insight of CHWPs, their culturally-sensitive and specific strategies for self-management and their development of trusting relationships presented considerable advantages.

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Section: Resultsmentioning

confidence: 99%

“…The physical and mental health of participants related to T2DM severity affected ability to attend sessions in two studies set in Latino populations ( 49 , 51 ). As one participant from a Latino population in Connecticut, USA explained:…”

Section: Resultsmentioning

confidence: 99%

Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review

Grant,

Litchfield

2024

Front. Clin. Diabetes Healthc.

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“…As described by Boyd et al , this trust-based relationship was perceived by patients as being influential to the improvement in emotional well-being and health behaviours 24. Chang et al reported that in a CHW intervention focused on HbA1c outcomes, patients acknowledged how CHWs increased their skills and confidence to modify behaviours and achieve their goals 25. Another CHW quality that contributes to the SyV intervention is their ability to communicate complex information in a low-literacy manner, enhancing their communication with participants 26 27.…”

Section: Discussionmentioning

confidence: 96%

“… 24 Chang et al reported that in a CHW intervention focused on HbA1c outcomes, patients acknowledged how CHWs increased their skills and confidence to modify behaviours and achieve their goals. 25 Another CHW quality that contributes to the SyV intervention is their ability to communicate complex information in a low-literacy manner, enhancing their communication with participants. 26 27 One example of a curriculum designed for lower health literacy populations is the DEEP curriculum.…”

Section: Discussionmentioning

confidence: 99%

Participant engagement in a community health worker-delivered intervention and type 2 diabetes clinical outcomes: a quasiexperimental study in MexicanAmericans

et al. 2022

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ObjectivesThis study helps to fill the existing research gap related to participant engagement in behavioural interventions and diabetes management. We examined type 2 diabetes control over time among Mexican Americans by level of engagement in a chronic care management (CCM) program that included community health worker (CHW)-delivered multilevel interventions. The programme complemented clinical care and promoted behaviour changes to improve diabetes self-management.DesignQuasiexperimental study.SettingThe study was implemented in the Rio Grande Valley region in the USA. Recruitment was conducted in clinics and community events. All other visits were provided in participant homes and community locations.Participants5649 adults (aged ≥18 years) with poorly controlled type 2 diabetes who enrolled in a community-delivered CCM programme between September 2013 and 2018.InterventionsThe intervention comprised two components: CHW home visits conducted every 3 months and diabetes self-management education (DSME) classes provided in community locations.Primary outcome measuresThe primary outcome was haemoglobin A1c (HbA1c) measured at baseline every 3 months for up to 24 months. We first examined changes in HbA1c levels over time. The number of completed CHW and DSME encounters was used to classify participants into engagement groups—high engagement defined as ≥10 encounters (n=2952); low engagement defined as 1–9 encounters (n=2697). We used univariable and multivariable longitudinal linear regression models with a generalised estimating equation method. We tested interactions between engagement groups and time.ResultsParticipants’ mean HbA1c decreased from 10.20% at baseline to 8.93% (p<0.0001) at 3 months, remaining stable thereafter. Changes in HbA1c were statistically different between the engagement groups. High engagement participants had lower HbA1c levels over the first 15 months of the follow-up period compared with low engagement participants, as compared at 3 months (−0.44%, 95% CI −0.57% to –0.31%; p<0.0001), 6 months (−0.31%, 95% CI −0.43% to –0.14%; p<0.0001), 9 months (−0.27%, 95% CI −0.42% to –0.13%; p=0.0001), 12 months (−0.23%, 95% CI −0.37% to –0.08%; p=0.0025) and 15 months (−0.32%, 95% CI −0.54% to –0.10%; p=0.0040). At months 18, 21 and 24, the HbA1c differences were not statistically significant (18 months: −0.34%, 95% CI −0.77% to 0.08%; p=0.1086; 21 months: −0.22%, 95% CI −1.00% to 0.56%; p=0.5721; 24 months: −0.42%, 95% CI −1.38% to 0.55%; p=0.3966).ConclusionsHigher engagement in the CCM programme delivered by CHWs and coordinated with clinical care was associated with beneficial improvements in type 2 diabetes control, but both engagement groups showed strong improvements.

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“…As found in other studies, CHWs tend to be accepted by their neighbors as they are commonly selected by communities they live among [49,62], which further increases the likelihood of outcomes including acceptability, feasibility, and equity. Implementation of this program mainly requires leadership follow-up and use of small budget, which helps with feasibility of its rollout [63,64]. In addition, sustainability of EBIs such as pneumococcal conjugate vaccine and rotavirus vaccination was mainly dependent on funding availability from both partners and governments.…”

Section: Discussionmentioning

confidence: 99%

Cross-country analysis of contextual factors and implementation strategies in under-5 mortality reduction in six low- and middle-income countries 2000–2015

Binagwaho,

VanderZanden,

Garcia

et al. 2024

BMC Pediatr

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Background The Exemplars in Under-5 Mortality (U5M) was a multiple cases study of how six low- and middle-income countries (LMICs), Bangladesh, Ethiopia, Nepal, Peru, Rwanda, and Senegal, implemented health system-delivered evidence-based interventions (EBIs) to reduce U5M between 2000 and 2015 more effectively than others in their regions or with similar economic growth. Using implementation research, we conducted a cross-country analysis to compare decision-making pathways for how these countries chose, implemented, and adapted strategies for health system-delivered EBIs that mitigated or leveraged contextual factors to improve implementation outcomes in reducing amenable U5M. Methods The cross-country analysis was based on the hybrid mixed methods implementation research framework used to inform the country case studies. The framework included a common pathway of Exploration, Preparation, Implementation, Adaptation, and Sustainment (EPIAS). From the existing case studies, we extracted contextual factors which were barriers, facilitators, or determinants of strategic decisions; strategies to implement EBIs; and implementation outcomes including acceptability and coverage. We identified common factors and strategies shared by countries, and individual approaches used by countries reflecting differences in contextual factors and goals. Results We found the six countries implemented many of the same EBIs, often using similar strategies with adaptations to local context and disease burden. Common implementation strategies included use of data by decision-makers to identify problems and prioritize EBIs, determine implementation strategies and their adaptation, and measure outcomes; leveraging existing primary healthcare systems; and community and stakeholder engagement. We also found common facilitators included culture of donor and partner coordination and culture and capacity of data use, while common barriers included geography and culture and beliefs. We found evidence for achieving implementation outcomes in many countries and EBIs including acceptability, coverage, equity, and sustainability. Discussion We found all six countries used a common pathway to implementation with a number of strategies common across EBIs and countries which contributed to progress, either despite contextual barriers or by leveraging facilitators. The transferable knowledge from this cross-country study can be used by other countries to more effectively implement EBIs known to reduce amenable U5M and contribute to strengthening health system delivery now and in the future.

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Patients' Perspectives on the Feasibility, Acceptability, and Impact of a Community Health Worker Program: A Qualitative Study

Cited by 6 publications

References 12 publications

Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review

Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review

Participant engagement in a community health worker-delivered intervention and type 2 diabetes clinical outcomes: a quasiexperimental study in MexicanAmericans

Cross-country analysis of contextual factors and implementation strategies in under-5 mortality reduction in six low- and middle-income countries 2000–2015

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