Transforming the Delivery of Care in the Post–Health Reform Era: What Role Will Community Health Workers Play?

Martinez, Jacqueline; Ro, Marguerite; Villa, Normandy; Powell, Wayne; Knickman, James R.

doi:10.2105/ajph.2011.300335

Cited by 85 publications

(75 citation statements)

References 29 publications

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“…Efforts to clarify the role that CHWs will have in the delivery of health care services, including legislative and policy efforts for CHW certification, continue to be debated [26]. Team climate can act as a mediator on patient care outcomes [27], and it may impact the innovativeness and ability of health care teams and organizations to adopt new ways of delivering health care [28].…”

Section: Discussionmentioning

confidence: 99%

“…Previous research on team climate has shown it is affected by a variety of internal and external factors not assessed in this study including: leadership, electronic health record capability, organizational culture, organizational tenure, support from new roles, and professional role conflicts [31][32]. In addition, the survey questions did not address potential mediating and moderating variables including: payment options available for CHW services [26], team training, and organizational resources available for innovation and adoption of new models of health care delivery.…”

Section: Limitationsmentioning

confidence: 94%

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The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

Siemon

2014

J Community Health

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This is an author-produced, peer-reviewed version of this article. The final, definitive version of this document can be found online at Journal of Community Health, published by Springer. The final publication is available at link.springer.com. Copyright restrictions may apply. doi: 10.1007/ s10900-014-9919-6 AbstractA number of states have adopted certification programs for community health workers (CHWs) to improve recognition of CHWs as members of health care teams, increase oversight, and to provide sustainable funding. There has been little research into the impact of state CHW certification on the diffusion and adoption of CHWs into existing health care systems. This study examined the impact of state CHW certification on the perceptions of team climate among registered nurses (RNs) who work with CHWs in states with and without CHW certification programs. The study recruited RNs using a purposeful sampling method and used an online survey, which included the Team Climate Inventory (TCI), and compared the perceptions of team climate between the two groups. The study found no significant differences in the overall mean TCI score or TCI subscale scores between RNs who work in states with CHW certification programs (n = 81) and those who work in states without CHW certification programs (n = 115). There was a statistically significant difference on one survey question regarding whether RNs believe state certification of CHWs improved the ability of their health care team to deliver quality care. More research is needed to assess impact of state certification of CHWs and other factors that influence the diffusion and adoption of CHWs into the current health care system.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 94%

The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

Siemon

2014

J Community Health

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“…21,24,44,45 Finally, because of the focus of CHW interventions on primary health care, health promotion and disease prevention, these interventions have demonstrated both actual and potential control of high costs of medical services and inappropriate use of emergency services when and if CHWs and their interventions are integrated into health care systems. [46][47][48] …”

Section: Evaluation Studiesmentioning

confidence: 99%

Community health workers in Canada and other high-income countries: A scoping review and research gaps

Najafizada

Bourgeault

Labonté

et al. 2015

Can J Public Health

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OBJECTIVES: Community health workers (CHWs) have been deployed to provide health-related services to their fellow community members and to guide them through often complex health systems. They help address concerns about how marginalized populations in many countries experience health inequities that are due, in part, to lack of appropriate primary health care services, possibly resulting in inappropriate use of higher-cost health services or facilities. This paper reviews studies on CHW interventions in a number of high-income countries, including Canada, to identify research gaps on CHW roles. METHODS:A scoping review using 68 sources of interventions involving CHWs was undertaken. The five-step Arksey and O'Malley model guided this review with the aim of summarizing research findings and identifying research gaps in the existing literature on CHWs in Canada (23 sources). A standardized extraction tool was employed to synthesize the literature. SYNTHESIS:We found that CHWs provide a wide range of health-related services but in a manner that, in Canada, is unrecognized and unregulated. In highincome countries, CHW interventions have contributed to health-related issues in communities and demonstrated potential to both reduce health inequity in marginalized populations and reduce the cost of medical services. CONCLUSION:CHWs are an under-recognized, and therefore underutilized, public health workforce, which has a promising capacity to reduce health inequities in marginalized populations in Canada. There is growing support to suggest that CHW roles need to be better integrated within the broader health and social services systems to enable their full potential to be realized.KEY WORDS: Community health workers; human resources; Canada La traduction du résumé se trouve à la fin de l'article.Can J Public Health 2015;106(3):e157-e164 doi: 10.17269/CJPH.106.4747C ommunity health workers (CHWs) have been deployed in most countries (whether low-, middle-or highincome) to provide health-related services to their fellow community members and to guide them through often complex health systems. They help to address concerns about how marginalized populations and communities in many countries experience health inequities that are due, in part, to lack of appropriate primary health care services, possibly resulting in inappropriate use of higher-cost health services or facilities. [1][2][3][4] The World Health Organization (WHO) defines CHWs as "members of communities where they work, selected by and answerable to the communities for their activities, supported by the health system but not necessarily a part of its organization, and have shorter training than professional workers." 5 The 2006 World Health Report identified the use of CHWs as an important strategy to address the growing shortage of health workers, particularly in low-resource settings, as well as to achieve the health-related Millennium Development Goals. 6 The key research priorities related to CHWs in these settings are to know more about their re...

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“…The health insurance mandate under the Affordable Care Act introduces opportunities for currently uninsured hypertensive individuals to afford and enroll in health insurance. 38 Additionally, the American Heart Association recommends that states and certain localities develop surveillance capacity that would include direct the assessment of "awareness, detection, treatment, and control of obesity, hypertension, dyslipidemia, and diabetes." 29 Although requiring extensive efforts, community organizing is one type of approach to reach a large community-based population in order to provide mechanisms for individuals to access necessary healthcare resources for hypertension management.…”

Section: Controlmentioning

confidence: 99%

Awareness, Treatment and Control of Hypertension Among Filipino Immigrants

et al. 2013

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BACKGROUND: Filipino Americans have high rates of hypertension, yet little research has examined hypertension awareness, treatment, and control in this group. OBJECTIVE: In a community-based sample of hypertensive Filipino American immigrants, we identify 1) rates of hypertension awareness, treatment, and control; and 2) factors associated with awareness, treatment, and control. DESIGN: Cross-sectional analysis of survey data from health screenings collected from 2006 to 2010. PARTICIPANTS: A total of 566 hypertensive Filipino immigrants in New York City, New York and Jersey City, New Jersey. MAIN MEASURES: Hypertension awareness, treatment, and control. Participants were included in analysis if they were hypertensive, based on: a past physician diagnosis, antihypertensive medication use, and/or high blood pressure (BP) screening measurements. Demographic variables included sex, age, time in the United States, location of residence, and English spoken language fluency. Health-related variables included self-reported health, insurance status, diabetes diagnosis, high cholesterol diagnosis, clinical measures (body mass index [BMI], glucose, and cholesterol), exercise frequency, smoking status, cardiac event history, family history of cardiac event, and family history of hypertension. RESULTS: Among the hypertensive individuals, awareness, treatment, and control rates were suboptimal; 72.1 % were aware of their status, 56.5 % were on medication, and only 21.7 % had controlled BP. Factors related to awareness included older age, worse selfreported health, family history of hypertension, and a diagnosis of high cholesterol or diabetes; factors related to treatment included older age, longer time lived in the United States, and being a non-smoker; having health insurance was found to be the main predictor of hypertension control. Many individuals had other cardiovascular disease (CVD) risk factors; 60.4 % had a BMI ≥25, 12.0 % had at-risk glucose measurements and 12.8 % had cholesterol ≥ 240.CONCLUSIONS: Hypertensive Filipinos exhibit poor hypertension management, warranting increased efforts to improve awareness, treatment and control. Culturally tailored public health strategies must be prioritized to reduce CVD risk factors among at-risk minority populations.KEY WORDS: hypertension; community based participatory research; immigrant health; cardiovascular disease; race & ethnicity.

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Transforming the Delivery of Care in the Post–Health Reform Era: What Role Will Community Health Workers Play?

Cited by 85 publications

References 29 publications

The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

Community health workers in Canada and other high-income countries: A scoping review and research gaps

Awareness, Treatment and Control of Hypertension Among Filipino Immigrants

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