Community Health Workers Leading the Charge on Workforce Development: Lessons from New Orleans

Academic institutions and community organizations engaged community health workers (CHWs) in creating a community-appropriate CHW workforce capacity-building program in an area without a previously established CHW professional group. From 2009 to 2010, we solicited New Orleans-based CHWs’ opinions about CHW professional development through a survey, a community conference, and workgroup meetings. Throughout 2011 and 2012, we created and implemented a responsive 80-h workforce development program that used popular education techniques. We interviewed CHWs 6 months post-training to assess impressions of the course and application of skills and knowledge to practice. CHWs requested training to develop nationally-recognized core competencies including community advocacy, addresses issues unique to New Orleans, and mitigate common professional challenges. Thirty-five people completed the course. Among 25 interviewees, common themes included positive impressions of the course, application of skills and community-specific information to practice, understanding of CHWs’ historical roles as community advocates, and ongoing professional challenges. Engaging CHW participation in workforce development programs is possible in areas lacking organized CHW groups. CHW insight supports development of training that addresses unique local concerns. Trained CHWs require ongoing professional support.     

Assessing Maternal Risk for Fetal-Infant Mortality: A Population-Based Study to Prioritize Risk Reduction in a Healthy Start Community

Study goals were to distinguish between maternal risk factors for fetal versus infant mortality, and to identify which maternal characteristics contributed the greatest risk of mortality overall. This case–control retrospective study abstracted data on more than forty maternal characteristics from 261 prenatal and delivery records: all 26 fetal deaths, all 40 infant deaths and 195 randomly selected surviving births in a high-mortality Healthy Start community. Bivariate and multivariate analyses were conducted. The fetal-mortality population was significantly more likely than the infant-mortality population to have no insurance (P = .047), inadequate prenatal care (P = .039) and previous fetal death (P = .021). Comparing the combined mortality population with the surviving sample, two tiers of risk emerged: Rare-but-lethal risks, including no prenatal care (P < .001) and Child-Protective-Service involvement (P = .001), and common-and-dangerous risks, including inadequate maternal weight gain (OR = 13.55), drug or alcohol abuse (OR = 8.67), obesity (OR = 2.77) and anemia (OR = 3.61). Both fetal and infant mortality groups must be considered when identifying maternal risks. Inadequate prenatal weight gain, obesity and anemia contribute as much to feto-infant mortality as substance abuse. Public health efforts to improve maternal nutrition and healthy weight should be redoubled.     

Partners in Health: A Conceptual Framework for the Role of Community Health Workers in Facilitating Patients' Adoption of Healthy Behaviors

We formulated a conceptual framework that begins to answer the national call to improve health care access, delivery, and quality by explaining the processes through which community health workers (CHWs) facilitate patients’ adoption of healthy behaviors. In September 2011 to January 2012, we conducted a qualitative study that triangulated multiple data sources: 26 in-depth interviews, training documents, and patient charts. CHWs served as partners in health to immigrant Filipinos with hypertension, leveraging their cultural congruence with intervention participants, employing interpersonal communication techniques to build trust and rapport, providing social support, and assisting with health behavior change. To drive the field forward, this work can be expanded with framework testing that may influence future CHW training and interventions.Community health workers (CHWs) are laypeople from within the communities where they work, who share common characteristics with their patients (e.g., ethnicity, culture, race, and language).1–4 CHWs have demonstrated effectiveness in an array of conditions, ranging from maternal and child health to chronic disease management.4–12 A systematic review of randomized controlled trials on CHW effectiveness determined that CHWs address health issues among various ethnic and racial groups, help improve use of early intervention services for children at risk for developmental delay, improve screening for breast and cervical cancer, and aid in improving dietary behaviors and blood pressure control.10CHWs have specific training in providing basic nutrition and health promotion services; they aim to improve health care access through a set of core skills,13,14 advocacy, outreach, and education.2,15,16 They function in multiple roles: bridging communication between patients and providers, providing health education and counseling, and monitoring health status.7,12 Thus, CHWs have a tremendous potential to influence and improve health outcomes.Although CHWs play integral roles in supporting patients’ individual health behaviors,17–23 the processes through which they are influential are poorly understood.21 Increasing use of this model in the United States, and recommendations in the Patient Protection and Affordable Care Act to integrate CHWs as part of health care teams,24 underscore the need to advance the knowledge base surrounding CHWs and to better understand mechanisms of this role. We developed a conceptual framework to explicate the processes through which CHWs facilitate the adoption of healthy behaviors among their patients.     

Evaluation of Training Program for the Maternal and Child Health Workforce at Tulane University

Objectives Despite significant investments in Maternal and Child Health (MCH), the United States still lags behind other countries in key MCH indicators. A well-trained workforce is needed to improve MCH. The Division of MCH Workforce Development of HRSA’s Maternal and Child Health Bureau provides funding to schools of Public Health to support Centers of Excellence in MCH, which is focused on preparing the next generation of MCH leaders through specialized training and mentorship. One such center, the Tulane Center of Excellence in MCH (CEMCH), is housed at the Tulane University School of Public Health and Tropical Medicine. This study evaluated the perceived effectiveness and acceptability of the CEMCH leadership training program. Methods A mixed-methods approach was used, consisting of semi-structured interviews and quantitative surveys which were analyzed through inductive methods based in grounded theory and non-parametric methods respectively. Results Results indicated an overall high level of program satisfaction by all stakeholders. Mentorship and personal attention emerged as an important benefit for both former and current Scholars. The opportunity to gain real-world understanding of MCH work through program activities was an added benefit, although these activities also presented the most challenges. Community stakeholders generally did not view the program as providing immediate organizational benefit, but recognized the distal benefit of contributing to a well-trained MCH workforce. Conclusions for Practice These results will be used to inform other MCH training programs and strengthen Tulane’s CEMCH. A well-trained MCH workforce is essential to improving MCH, and high-quality training its foundation.     

Defining the Role of the Community Health Worker within a Federal Healthy Start Care Coordination Team

Introduction Federal and state policies often require utilization of evidence-based home visiting programs. Measurement of specified interventions is important for tracking program implementation and achieving program outcomes. Thus, the Strong Beginnings program worked to define community health worker (CHW) interventions, a core service of the program to improve maternal and child health. Methods A workgroup consisting of CHWs, supervisors and other program staff was created in order to develop and define specific CHW interventions within a nurse or social worker care team. Basic interventions were first compared to the nurse or social worker care coordinator home visiting interventions by risk topic. The evaluator then grouped each CHW intervention into categories per risk domain using thematic analysis and assigned a CHW core function or role based on literature review findings. The workgroup confirmed the results. The workgroup then continued discussions to further enhance CHW interventions per risk domain once the general structure was created. Results The workgroup identified seven core functions and 28 maternal and child health risk topics to be addressed by the CHW. The process resulted in a detailed document of program interventions that the CHWs use to guide care. Conclusions The process helped CHWs feel more valued with their role in team care. The specified interventions will help others understand the CHW role within the care team, ensure consistent interventions are delivered across program partners, provide a foundation to better understand how specific CHW contributions are related to health outcomes, and support program sustainability.     

Community Health Worker Employer Survey: Perspectives on CHW Workforce Development in the Midwest

A statewide Community Health Worker Employer Survey was administered to various clinical, community, and faith-based organizations (n?=?240) across a range of rural and urban settings in the Midwest. At least 80% of participants agreed or strongly agreed that items characterized as supervisory support were present in their work environment. Thirty-six percent of respondents currently employed CHWs, over half (51%) of survey respondents reported seeing the need to hire/work with more CHWs, and 44% saw the need for CHWs increasing in the future. Regarding CHW support, a majority of respondents indicated networking opportunities (63%), paid time for networking (80%), adequate time for supervision (75%), orientation training (78%), mandatory training (78%), ongoing training (79%), and paid time for training (82%). Open-ended responses to the question "In your organization, what needs could CHWs meet?" resulted in the largest number of respondents reporting mental health issues as a priority, followed by connecting people with services or resources, educating the public on preventive health, family support, and home care/visitations. Our findings suggest that respondents, who largely have supervisory or managerial roles, view workplace environments in Nebraska favorably, despite the fact that nearly two-thirds of respondents typically work well over 40 h per week. In addition, CHWs could help address mental and physical health needs in a variety of community and clinical settings through primary and secondary prevention activities, such as provision of health screenings, health and nutrition education, connecting people to resources and empowering community members through these activities and more.     

Impact of a Federal Healthy Start Program on Feto-infant Morbidity Associated with Absent Fathers: A Quasi-experimental Study

The absence of fathers during pregnancy increases the risk of feto-infant morbidities, including low birth weight (LBW), preterm birth (PTB), and small-for-gestational age. Previous research has shown that the Central Hillsborough Healthy Start project (CHHS)—a federally funded initiative in Tampa, Florida—has improved birth outcomes. This study explores the effectiveness of the CHHS project in ameliorating the adverse effects of fathers’ absence during pregnancy. This retrospective cohort study used CHHS records linked to vital statistics and hospital discharge data (1998–2007). The study population consisted of women who had a singleton birth with an absent father during pregnancy. Women were categorized based on residence in the CHHS service area. Propensity score matching was used to match cases (CHHS) to controls (rest of Florida). Conditional logistic regression was employed to generate odds ratios (OR) and 95 % confidence intervals (CI) for matched observations. Women residing in the CHHS service area were more likely to be high school graduates, black, younger (<35 years), and to have adequate prenatal care compared to controls (p < 0.01). These differences disappeared after propensity score matching. Mothers with absent fathers in the CHHS service area had a reduced likelihood of LBW (OR 0.76, 95 % CI 0.65–0.89), PTB (OR 0.72, 95 % CI 0.62–0.84), very low birth weight (OR 0.50, 95 % CI 0.35–0.72) and very preterm birth (OR 0.48, 95 % CI 0.34–0.69) compared to their counterparts in the rest of the state. This study demonstrates that a Federal Healthy Start project contributed to a significant reduction in adverse fetal birth outcomes in families with absent fathers.     

Training Community Health Workers to be Advocates for Health Promotion: Efforts Taken by a Community-Based Organization to Reduce Health Disparities in Cardiovascular Disease

Compared to white adults, blacks are less likely to be aware of their cardiovascular risk factors and are less likely to respond appropriately to signs and symptoms of a myocardial infarction or stroke. This fact highlights the need for better dissemination of health information about cardiovascular disease among communities of color. Community health workers (CHWs) are important resources for disseminating health information. Recognizing this important role of CHWs, the Greater Southern Brooklyn Health Coalition and its community and academic partners developed a workshop designed to educate CHWs about the risk factors, signs and symptoms of cardiovascular disease. The purpose of this workshop was to educate CHWs so that they themselves could be better informed and thus, be in a better position to educate their respective clients. The resulting workshop, Taking Action Against Cardiovascular Disease in Our Communities: A Training for Service Providers, was a half-day workshop attended by 70 CHWs from various community service organizations. Approximately 97% of attendees said that the workshop met their expectations. More than half said they learned the signs and symptoms of cardiovascular disease and about 90% said that they received clear and concrete information that they could use with their clients. These evaluations also provided critiques regarding aspects of the workshop that could be improved upon and other information which will be used as a formative tool in developing future educational initiatives. In conclusion, this workshop demonstrated that it was feasible to develop effective community programs targeted at educating CHWs about cardiovascular disease.     

A Methodological Approach for Evaluating the Enterprise Community Healthy Start Program in Rural Georgia: An Analysis Using Linked PRAMS,Birth Records and Program Data

Maternal and Child Health Journal - Community Healthy Start program evaluations are often limited by a lack of robust data and rigorous study designs. This study describes an enhanced...     

加强人才培养 促进卫生事业全面发展

当前卫生改革已进入攻坚阶段 ,卫生事业的发展又面临着一个关键时期 ,既面临难得的机遇 ,又面临严峻的挑战。我们要抓住发展机遇 ,解放思想、更新观念 ,以改革的精神正确对待当前面临的困难和任务 ,加大人才培养的力度 ,全面提高医疗护理水平 ,促进卫生事业的全面发展。1　人才培养是医疗卫生单位在改革大潮和激烈的医疗市场竞争中立于不败之地的保证 ,也是一项带根本性的、战略性的任务人才是医疗卫生单位发展中的重要关键因素 ,人才是科学知识的生产者、宣传者和使用者。卫生局和各医疗卫生单位党政领导 ,要按照德、智、体、能的要求 ,大…     

Marriageable Women: A Focus on Participants in a Community Healthy Marriage Program

Although disadvantaged women are the targets of marriage programs, little attention has been paid to women's marriage constraints and their views of marriage. Drawing on an exchange framework and using qualitative data collected from single women participating in a marriage initiative, we introduce the concept of marriageable women—the notion that certain limitations may make women poor marriage partners. Like their male counterparts, we find women also possess qualities that are not considered assets in the marriage market, such as economic constraints, mental and physical health issues, substance use, multiple partner fertility, and gender distrust. We also consider how women participating in a marriage program frame their marriage options, whereas a few opt out of the marriage market altogether.     

社区卫生工作者营养标签识读能力及其影响因素研究——以中国五城市为例

目的了解社区卫生工作者营养标签识读能力和传播情况,探索如何通过社区卫生工作者开展有实效而广泛的居民营养标签教育。方法采用两阶段整群抽样对社区卫生工作者进行问卷调查,对数据进行描述性分析。结果社区卫生工作者营养标签识读能力测验及格的有109人(58.3%)。经常阅读营养标签的有35人(19.9%),阅读者中有92人(54.1%)只能读懂"部分内容"。给居民开展过营养知识讲座的人数为61人(33.2%),接受过营养知识培训的有73人(40.8%)。营养标签识读能力的影响因素分别为文化程度、是否参与过营养知识培训、对开展健康教育工作必要性的认识以及是否愿意承担健康教育工作(P<0.05)四项。结论社区医生工作者营养标签识读能力有待进一步提高,阅读营养标签行为有待进一步改善。通过提高文化程度,开展有针对性的营养知识培训,对基层医疗机构工作人员开展健康教育工作重要性和必要性的宣传等措施可以提高营养标签认知水平。