Community Health Workers: Social Justice and Policy Advocates for Community Health and Well-Being

Community health workers improve health and well-being through, most notably, health education, advocacy, and building individual and community capacity. In spite of these contributions to the health care landscape, these workers are not well integrated within the professional workforce throughout much of the United States. Building on the lens of medical citizenship, I introduce the concept of professional citizenship, which elucidates the belongingness of a group within a professional workforce. Drawing on this framing, I detail the lack of professional belongingness among community health workers in Indiana and the emergent issues that arose via professionalization including: the potential creation of a hierarchy, changes to core roles, and the (in)accessibility of the position due to the requirements for the community health worker certification course. Additionally, I situate these issues within race, ethnicity, gender, and class in examining their effects on the professionalization of these workers. The findings presented in this article can be utilized by policymakers, public health programs, and other employing organizations as community health workers undergo professionalization. Given the poor health outcomes in Indiana, these workers are poised to make significant contributions to the health of their communities—with careful consideration for potential ramifications via professionalization.

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Community Health Workers’ Perspectives on Their Contribution to Rural Health and Well-Being in Iran

American Journal of Public Health ◽

10.2105/ajph.2011.300355 ◽

2011 ◽

Vol 101 (12) ◽

pp. 2287-2292 ◽

Cited By ~ 29

Author(s):

Sara Javanparast ◽

Fran Baum ◽

Ronald Labonte ◽

David Sanders

Keyword(s):

Community Health ◽

Rural Health ◽

Community Health Workers ◽

Health Workers ◽

Well Being ◽

Health And Well Being

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Community Health Workers (CHWs) as Innovators

International Journal of Healthcare Information Systems and Informatics ◽

10.4018/ijhisi.2018010102 ◽

2018 ◽

Vol 13 (1) ◽

pp. 15-28

Author(s):

Tyler Prentiss ◽

John Zervos ◽

Mohan Tanniru ◽

Joseph Tan

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Underserved Populations ◽

Low Cost ◽

Cost Effective ◽

Well Being ◽

Grant Writing ◽

Multiple Sources ◽

Context Of Learning

Community health workers (CHWs) have a longstanding role in improving the health and well-being of underserved populations in resource-limited settings. CHWs are trusted in the communities they serve and are often able to see through solutions on community challenges that outside persons cannot. Notwithstanding, such solutions often must be low-cost, easily implementable, and permit knowledge gaps among CHWs to be filled via appropriate training. In this sense, use of cost-effective information technology (IT) solutions can be key to increasing access to knowledge for these community agents. This paper highlights insights gleaned from a pilot study performed in Detroit, Michigan with a group of CHWs in basic grant-writing training via an e-platform, the Community Health Innovator Program (CHIP). The results are discussed within the context of learning theory. It is concluded that e-platforms are necessary for CHWs to leverage knowledge from multiple sources in an adaptive environment towards addressing ever-evolving global health challenges.

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Promotoras Voice Their Challenges in Fulfilling Their Role as Community Health Workers

Health Promotion Practice ◽

10.1177/1524839920921189 ◽

2020 ◽

pp. 152483992092118

Author(s):

Pamela Orpinas ◽

Rebecca A. Matthew ◽

Luis R. Alvarez-Hernandez ◽

Alejandra Calva ◽

J. Maria Bermúdez

Keyword(s):

Community Health ◽

Community Health Workers ◽

Participatory Research ◽

English Language ◽

Health Workers ◽

Cultural Beliefs ◽

Community Based Participatory Research ◽

Well Being ◽

Emotional Impact ◽

Community Based

Promotoras de salud (Spanish for female community health workers) are integral to efforts to enhance the health and well-being of Latinx individuals, families, and communities. The purpose of this study was to describe the challenges that promotoras face and the proposed solutions from the perspective of the promotoras themselves. Five promotoras who worked for a year as volunteers in a community-based participatory research study, Lazos Hispanos, participated in two group interviews. Eight challenges emerged—balancing their new work with their family commitments, handling their perceived imbalance of power with men, managing the emotional impact of hearing participants’ problems, facing and handling the barriers imposed by having limited English language skills, feeling discouraged by the perception of ethnocentric beliefs and discrimination from some providers, feeling disheartened by the cultural beliefs of some Latinx participants, handling the lack of transportation for themselves and for the participants, and managing the burden of data collection for the research aspect of the program. The explanation of these challenges and the practical solutions they proposed are embedded in their intersecting identities. The solutions are a valuable addition to the practice of health promotion and community-based participatory research, particularly within Latinx communities.

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Community health workers for pandemic response: a rapid evidence synthesis

BMJ Global Health ◽

10.1136/bmjgh-2020-002769 ◽

2020 ◽

Vol 5 (6) ◽

pp. e002769 ◽

Cited By ~ 7

Author(s):

Soumyadeep Bhaumik ◽

Sandeep Moola ◽

Jyoti Tyagi ◽

Devaki Nambiar ◽

Misimi Kakoti

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Evidence Synthesis ◽

Critical Role ◽

Well Being ◽

Contact Tracing ◽

Housing Allowance ◽

Role Clarity ◽

Pandemic Response

IntroductionCoronavirus disease (COVID-19), affects 213 countries or territories globally. We received a request from National Health Systems Resource Centre, a public agency in India, to conduct rapid evidence synthesis (RES) on community health workers (CHWs) for COVID-19 prevention and control in 3 days.MethodsWe searched PubMed, websites of ministries (n=3), public agencies (n=6), multilateral institutions (n=3), COVID-19 resource aggregators (n=5) and preprints (n=1) (without language restrictions) for articles on CHWs in pandemics. Two reviewers screened the records independently with a third reviewer resolving disagreements. One reviewer extracted data with another reviewer cross-checking it. A framework on CHW performance in primary healthcare not specific to pandemic was used to guide data extraction and narrative analysis.ResultsWe retrieved 211 records and finally included 36 articles. Most of the evidence was from low-and middle-income countries with well-established CHW programmes. Evidence from CHW programmes initiated during pandemics and for CHW involvement in pandemic response in high-income countries was scant. CHW roles and tasks change substantially during pandemics. Clear guidance, training for changed roles and definition of what constitutes essential activities (ie, those that must to be sustained) is required. Most common additional activities during pandemics were community awareness, engagement and sensitisation (including for countering stigma) and contact tracing. CHWs were reported to be involved in all aspects of contact tracing - this was reported to affect routine service delivery. CHWs have often been stigmatised or been socially ostracised during pandemics. Providing PPE, housing allowance, equal training opportunities, transportation allowance, improving salaries (paid on time and for a broad range of services) and awards in high-profile public events contributed to better recruitment and retention. We also created inventories of resources with guiding notes on guidelines for health workers (n=24), self-isolation in the community (n=10) and information, education and counselling materials on COVID-19 (n=16).ConclusionsCHWs play a critical role in pandemics. It is important to ensure role clarity, training, supportive supervision, as well as their work satisfaction, health and well-being. More implementation research on CHWs in pandemics is required.

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Association between Japanese community health workers’ willingness to continue service and two categories of motives: altruistic and self-oriented

10.1101/703322 ◽

2019 ◽

Author(s):

Atsuko Taguchi ◽

Hiroshi Murayama ◽

Keiko Ono

Keyword(s):

Confidence Interval ◽

Community Health ◽

Community Health Workers ◽

Response Rate ◽

Health Workers ◽

Practical Implication ◽

Final Analysis ◽

Well Being ◽

Individual Responsibility ◽

Effective Response

AbstractBackgroundAs population aging progresses, volunteers in health field are expected to play a key role in health promotion and disease prevention, which may improve community residents’ health and well-being and at the same time help curve healthcare cost. The objective of this study is to examine the effects of self-oriented motives and altruistic motives as explanatory factors for Japanese Community Health Workers (CHWs)’ desire to continue their service. Unraveling the relative effects of these two types of motivation on CHW retention may lead to policy and practical implications for recruiting, training, and supporting CHWs in Japan. Haddad (2007) observed that citizens in Japan generally have a sense of governmental and individual responsibility for dealing with social problems. Applying these insights to CHWs, we hypothesize that altruistic motives have more potent influence on volunteers’ willingness to continue to serve than self-oriented motives.MethodsThree cities in Shiga prefecture, Japan agreed to participate in the study. Anonymous, self-administered questionnaire was mailed to all CHWs who work in the three communities. The survey data were collected in March and April, 2013. A total of 417 questionnaires were mailed to CHWs, of which 346 were completed and returned (response rate 83.0%). Nine questionnaires missing response to the question concerning willingness to continue serving were removed from the analysis. The final analysis used 337 questionnaires (effective response rate 80.8%).ResultsOne hundred ninety-nine (59.1%) of the respondents answered the question about willingness to continue CHW affirmatively, and 138 (40.9%) negatively. Controlling for other relevant factors, those with self-oriented motives in serving as CHWs were more likely to state they are willing to continue to serve (OR:1.54, confidence interval 1.00-2.37) than those without such motives. Contrary to our hypothesis, the effect of altruistic motives on respondents’ willingness to continue serving as CHWs was slightly larger than that of self-oriented motives; the odds ratio was 1.56(confidence interval 1.08-2.27).ConclusionOne practical implication of the research is that learning more about the twin motives, self-oriented and altruistic, of volunteers and tailoring the content of CHW training to address those motives may be beneficial.

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Emerging from the Shadows: Intrinsic and Extrinsic Factors Facing Community Health Workers in Western Cape, South Africa

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17093199 ◽

2020 ◽

Vol 17 (9) ◽

pp. 3199

Author(s):

Wilson Majee ◽

Laura Schopp ◽

Levona Johnson ◽

Adaobi Anakwe ◽

Anthea Rhoda ◽

...

Keyword(s):

South Africa ◽

Rural Communities ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Patient Adherence ◽

Well Being ◽

Western Cape ◽

Extrinsic Factors ◽

Intrinsic And Extrinsic Factors

Community health workers (CHWs) have been identified as a key component of the health workforce in South Africa. However, the efficacy of CHW programs continues to be limited by a poor understanding of facilitators and barriers to CHW engagement. This study explores intrinsic and extrinsic factors that CHWs face. We conducted in-depth interviews with 20 CHWs in order to understand the challenges they may face as they implement their duties linked to the primary health care strategy in the Western Cape, South Africa. All interviews were audiotaped, transcribed verbatim, coded and analyzed using NVivo 12. Drawing on narratives of CHWs, we illustrate the complex issues surrounding CHW outreach in poor rural communities. The CHWs identified five key areas of challenges with respect to personal health, gender issues, poor community understanding of CHWs roles, environmental challenges and lack of patient adherence. These all hinder the ability of CHWs to meet their personal and familial needs, as well as those of the community members they support. There is a need to address the intrinsic needs of CHWs in order to ensure their emotional and physical well-being, as well as a need to create an awareness of the roles of CHWs.

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A Self-Management Training Intervention: Perceptions and Practices of Community Health Workers in South Africa

Health Promotion Practice ◽

10.1177/1524839918820038 ◽

2019 ◽

Vol 21 (6) ◽

pp. 983-992 ◽

Cited By ~ 1

Author(s):

Wilson Majee ◽

Adaobi Anakwe ◽

Levona Johnson ◽

Anthea Rhoda ◽

Jose Frantz ◽

...

Keyword(s):

South Africa ◽

Health Behavior ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Action Planning ◽

Management Training ◽

Well Being ◽

Health Behavior Change ◽

Self Management

Background. While community health workers (CHWs) are increasingly being used as a strategy for increasing health care access, particularly in rural communities, interventions are needed to improve their skill sets in inspiring health behavior change, both for themselves and among their community clients. Self-management (SM) education interventions have shown to improve health behaviors and well-being. Purpose. This article reports on systematic, in-depth interviews conducted with rural CHWs in South Africa to understand (1) their motivation for participating in SM training, (2) skills gained from training and (3) perceived impact of training on CHW health behavior, both personally and as health professionals. Method. Nineteen rural CHWs who completed an SM training participated in face-to-face semistructured interviews. Transcripts were independently coded by two researchers using the thematic framework approach. Findings. CHWs felt empowered to change their health behavior by skills such as goal setting and action planning, and by growth in self-awareness and confidence. They expressed that their desire to help others motivated them to participate in SM training. Conclusion. SM training programs that address practice skill gaps hold promise in producing health behavior changes for rural CHWs and their clients.

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Association between Japanese community health workers’ willingness to continue service and two categories of motives: Altruistic and self-oriented

PLoS ONE ◽

10.1371/journal.pone.0220277 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0220277

Author(s):

Atsuko Taguchi ◽

Hiroshi Murayama ◽

Keiko Ono

Keyword(s):

Confidence Interval ◽

Community Health ◽

Community Health Workers ◽

Response Rate ◽

Health Workers ◽

Practical Implication ◽

Final Analysis ◽

Well Being ◽

Individual Responsibility ◽

Effective Response

Background As population aging progresses, volunteers in health field are expected to play a key role in health promotion and disease prevention, which may improve community residents’ health and well-being and at the same time help slow the growth of healthcare cost. The objective of this study is to examine the effects of self-oriented motives and altruistic motives as explanatory factors for Japanese Community Health Workers (CHWs)’ desire to continue their service. Unraveling the relative effects of these two types of motivation on CHW retention may lead to policy and practical implications for recruiting, training, and supporting CHWs in Japan. Haddad (2007) observed that citizens in Japan generally have a sense of governmental and individual responsibility for dealing with social problems. Applying these insights to CHWs, we hypothesize that altruistic motives have more potent influence on volunteers’ willingness to continue to serve than self-oriented motives. Methods Three cities in Shiga prefecture, Japan agreed to participate in the study. Anonymous, self-administered questionnaire was mailed to all CHWs who work in the three communities. The survey data were collected in March and April, 2013. A total of 417 questionnaires were mailed to CHWs, of which 346 were completed and returned (response rate 83.0%). Nine questionnaires missing response to the question concerning willingness to continue serving were removed from the analysis. The final analysis used 337 questionnaires (effective response rate 80.8%). Results One hundred ninety-nine (59.1%) of the respondents answered the question about willingness to continue CHW affirmatively, and 138 (40.9%) negatively. Controlling for other relevant factors, those with self-oriented motives in serving as CHWs were more likely to state they are willing to continue to serve (OR:1.54, confidence interval 1.00–2.37) than those without such motives. Those with altruistic motives were also more likely to say they want to continue their service (OR 1.56, confidence interval 1.08–2.27) than those without such motives. Contrary to our hypothesis, the two motives, altruistic and self-oriented, were shown to have nearly equal degree of influence on respondents’ willingness to continue serving as CHWs. Conclusion One practical implication of the research is that learning more about the twin motives, self-oriented and altruistic, of volunteers and tailoring the content of CHW training by municipal health professionals to address those motives may be beneficial.

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Recruitment, Training, and Roles of the Bilingual, Bicultural Navegantes: Developing a Specialized Workforce of Community Health Workers to Serve a Low-Income, Spanish-Speaking Population in Rhode Island

Frontiers in Public Health ◽

10.3389/fpubh.2021.666566 ◽

2021 ◽

Vol 9 ◽

Author(s):

Meghan McCarthy ◽

Katherine Barry ◽

Cindy Estrada ◽

Brenda Veliz ◽

Damaris Rosales ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Rhode Island ◽

Low Income ◽

Health Workers ◽

Low Cost ◽

Large Population ◽

Well Being ◽

Healthcare Sector ◽

Spanish Speaking

Clínica Esperanza/Hope Clinic (CEHC) employs Navegantes, who are specially-trained bilingual Community Health Workers (CHW), as key team members who improve the ability of the clinic to provide care for and improve the health status of a large population of uninsured Spanish-speaking patients in Providence, Rhode Island. Given the growing demand for CHWs at the clinic and in the broader healthcare sector in the state, CEHC developed the Advanced Navegante Training Program (ANTP). The ANTP prepares community members to become certified CHWs who are equipped to provide patient navigation and lifestyle coaching as well as professional medical interpretation services. The ANTP is developed and taught by CEHC Navegantes who themselves are bilingual and bicultural peers of trainees as well as the population that CEHC serves. Upon graduation, ANTP trainees have been able to attain higher-paying and fulfilling careers in a range of healthcare and other community settings. The ANTP offers a low-cost, community-based model for training CHWs who are uniquely prepared to promote health and well-being among medically underserved patients.

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