Tales from the Miami Healthy Heart Initiative: The Experiences of Two Community Health Workers

Abstract

Community health workers (CHWs) have been bridging the gap between under-served populations and health care systems for centuries; however, their experiences are rarely recounted. The Miami Healthy Heart Initiative is a randomized control trial designed to examine the effectiveness of CHWs on reducing the risk for cardiovascular disease among Hispanics with poorly controlled diabetes in South Florida. This manuscript, told from the perspective of CHWs, is a summary of cases that were successful and some that did not achieve optimal outcomes. These case summaries include anecdotal data and clinical variables that demonstrate each patient's progress during the intervention.

Effect of a Community Health Worker Intervention Among Latinos With Poorly Controlled Type 2 Diabetes

“…Abbreviations: CHW, community health worker; EUC, enhanced usual care; HbA 1c , hemoglobin A 1c ; LDLC, low-density lipoprotein cholesterol.SI conversion factors: To convert HbA 1c to a proportion of total hemoglobin, multiply by 0.01; LDLC to millimoles per liter, multiply by 0.0259. a Includes 215 participants with 12-month follow-up data. b The 95% CIs for these measures do not include zero. c Adjusted for age, body mass index, sex, comorbidity, educational attainment, and depression …”

“…In addition, 212 participants, or 70.7% of our population, had positive findings on screening for depression. Helping a predominantly uninsured population find high-quality culturally acceptable behavioral and mental health services was a major challenge . The CHWs were trained to screen for depression by using standardized instruments and on the processes and procedures to link patients with the mental health resources that exist in the community.…”

“…Dissemination of CHW programs is also a challenge. To this end, we have published an implementation guide that includes more detail on specific components of the intervention and case studies by CHWs as examples of ways that they helped address many of the social and health systems barriers encountered . Lack of reimbursement is also a major barrier to CHW uptake.…”

“…The CHW services included health education, patient navigation (help obtaining appointments, appointment reminders, appointment preparation checklists, medication refills, assistance with behavioral health linkages, communication with the clinician about patient care issues, and ≥1 clinic visit with the patient), and health coaching (helping patients to prioritize concerns before clinician visits, bringing all their medications, and ensuring they informed clinicians during the visit about elevated home blood pressure or glucose level readings). For long-term disease management, CHWs used culturally relevant resources, manuals, and tool kits . In addition, based on a framework of social determinants of health, CHWs assisted with nonmedical services, such as housing, employment, legal and financial assistance, food resources, and, when needed, linkages to existing community social service providers.…”

Hispanic Secondary Stroke Prevention Initiative Design: Study Protocol and Rationale for a Randomized Controlled Trial

“…This 4-part learning program gives CHWs health training on reaching vulnerable, low-income, and underserved members of Latino and Hispanic populations. For the cardiovascular disease-specific training, we use CHW training materials from the Centers for Disease Control and Prevention and National Heart, Lung, and Blood Institute as well as our own CHW training material [ 40 - 42 ]. Additional training on stroke and stroke prevention is also provided by the stroke neurologist on our team (JGR).…”