NAU publications by CHER
Faculty & staff publications
NAU faculty and staff have the opportunity to publish their findings and knowledge as authors. CHER has many researchers that have been cited multiple times in major publications for their great work. The Center for Health Equity Research has accumulated all faculty publications into one, easy to navigate database.
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Samantha Sabo Louisa O'Meara, Janet Yellowhair Joyce Hamilton JT Nashio Brook Bender Fernando Flores Jr Marianne Bennett Rema Metts Isabella Denton Kim Russell Frontiers in Public Health, 11 , 2023. @article{Sabo2023b, title = {Community Health Representative Workforce: Integration across systems and teams to address the social determinants of indigenous health and wellbeing}, author = {Samantha Sabo, Louisa O'Meara, Janet Yellowhair, Joyce Hamilton, JT Nashio, Brook Bender, Fernando Flores Jr, Marianne Bennett, Rema Metts, Isabella Denton, Kim Russell}, editor = {Lily K. Lee}, url = {https://doi.org/10.3389/fpubh.2023.1047152}, doi = {10.3389/fpubh.2023.1047152}, year = {2023}, date = {2023-03-15}, journal = {Frontiers in Public Health}, volume = {11}, abstract = {Tribally employed, Community Health Representatives (CHRs) serving Indigenous and American Indian and Alaskan Native (AIAN) peoples are culturally and linguistically embedded community leaders, with the unique ability to serve as the link and intermediary between community members and systems. Unique to the CHR workforce scope of practice is the expectation for high level integration within the medical and social service care team. This explicit role outlined in the scope of work sets an expectation for both CHR and care teams to deliver integrated patient, family, and systems level care coordination and case management. This paper aims to build from our previous manuscript published in Volume 1 of the special issue Community Health Workers Practice from Recruitment to Integration. In that Volume, we explored through a Community Case Study CHR Managers’ perspectives on the challenges and opportunities for full CHR integration into health systems and teams serving AIAN. In this paper, we offer new information about the current CHR and CHR Managers’ involvements and perceived level of integration within health care teams and the broader public health systems addressing the social and structural determinants of health. We approach this topic considering the COVID-19 pandemic and how CHRs and CHR Programs were included and not included in tribal pandemic response efforts.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Tribally employed, Community Health Representatives (CHRs) serving Indigenous and American Indian and Alaskan Native (AIAN) peoples are culturally and linguistically embedded community leaders, with the unique ability to serve as the link and intermediary between community members and systems. Unique to the CHR workforce scope of practice is the expectation for high level integration within the medical and social service care team. This explicit role outlined in the scope of work sets an expectation for both CHR and care teams to deliver integrated patient, family, and systems level care coordination and case management. This paper aims to build from our previous manuscript published in Volume 1 of the special issue Community Health Workers Practice from Recruitment to Integration. In that Volume, we explored through a Community Case Study CHR Managers’ perspectives on the challenges and opportunities for full CHR integration into health systems and teams serving AIAN. In this paper, we offer new information about the current CHR and CHR Managers’ involvements and perceived level of integration within health care teams and the broader public health systems addressing the social and structural determinants of health. We approach this topic considering the COVID-19 pandemic and how CHRs and CHR Programs were included and not included in tribal pandemic response efforts. |
McCue, Kelly; Sabo, Samantha; Wightman, Patrick; Butler, Matthew; Pilling, Vern; Jiménez, Dulce; Annorbah, Rebecca; Rumann, Sara Maternal and Child Health Journal, 26 , pp. 2485–2495, 2022. @article{McCue2022, title = {Impact of a Community Health Worker (CHW) Home Visiting Intervention on Any and Adequate Prenatal Care Among Ethno-Racially Diverse Pregnant Women of the US Southwest}, author = {Kelly McCue and Samantha Sabo and Patrick Wightman and Matthew Butler and Vern Pilling and Dulce Jiménez and Rebecca Annorbah and Sara Rumann}, url = { https://doi.org/10.1007/s10995-022-03506-2}, doi = {10.1007/s10995-022-03506-2}, year = {2022}, date = {2022-10-21}, journal = {Maternal and Child Health Journal}, volume = {26}, pages = {2485–2495}, abstract = {Social and structural barriers drive disparities in prenatal care utilization among minoritized women in the United States. This study examined the impact of Arizona’s Health Start Program, a community health worker (CHW) home visiting intervention, on prenatal care utilization among an ethno-racially and geographically diverse cohort of women. A CHW-led perinatal home visiting intervention operated through a state health department can improve prenatal care utilization among demographically and socioeconomically disadvantaged women and reduce maternal and child health inequity.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Social and structural barriers drive disparities in prenatal care utilization among minoritized women in the United States. This study examined the impact of Arizona’s Health Start Program, a community health worker (CHW) home visiting intervention, on prenatal care utilization among an ethno-racially and geographically diverse cohort of women. A CHW-led perinatal home visiting intervention operated through a state health department can improve prenatal care utilization among demographically and socioeconomically disadvantaged women and reduce maternal and child health inequity. |
Wightman, Patrick; McCue, Kelly; Sabo, Samantha; Annorbah, Rebecca; Jiménez, Dulce; Pilling, Vern; Butler, Matthew; Celaya, Martín F; Rumann, Sara Community Health Worker Intervention Improves Early Childhood Vaccination Rates: Results from a Propensity-score Matching Evaluation Journal Article BMC Public Health, 22 (1), pp. 1854, 2022. @article{Wightman2022, title = {Community Health Worker Intervention Improves Early Childhood Vaccination Rates: Results from a Propensity-score Matching Evaluation}, author = {Patrick Wightman and Kelly McCue and Samantha Sabo and Rebecca Annorbah and Dulce Jiménez and Vern Pilling and Matthew Butler and Martín F Celaya and Sara Rumann}, url = {https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14239-w}, doi = {10.1186/s12889-022-14239-w}, year = {2022}, date = {2022-10-04}, journal = {BMC Public Health}, volume = {22}, number = {1}, pages = {1854}, abstract = {Arizona’s Health Start Program is a statewide community health worker (CHW) maternal and child health home visiting intervention. The objective of this study was to test if participation in Health Start during 2006–2016 improved early childhood vaccination completion rates. Methods This retrospective study used 11 years of administrative, birth certificate, and immunization records. Propensity score matching was used to identify control groups, based on demographic, socioeconomic, and geographic characteristics. Results are reported by historically disadvantaged subgroups and/or with a history of low vaccine uptake, including Hispanic/Latinx and American Indian children, and children of low socioeconomic status and from rural areas, children with teen mothers and first-born children. The average treatment-on-the-treated (ATT) effect estimated the impact of Health Start on timely completion of seven early childhood vaccine series: diphtheria/tetanus toxoids and acellular/whole-cell pertussis (DTaP/DTP), Haemophilus influenzae type b (Hib), hepatitis B (Hep. B), measles-mumps-rubella (MMR), pneumococcal conjugate vaccine (PCV13), poliovirus, and varicella. Results Vaccination completion rates (by age five) were 5.0% points higher for Health Start children as a group, and on average 5.0% points higher for several subgroups of mothers: women from rural border counties (ATT 5.8), Hispanic/Latinx women (ATT 4.8), American Indian women (ATT 4.8), women with less than high school education (ATT 5.0), teen mothers (ATT 6.1), and primipara women (ATT 4.5), compared to matched control groups (p-value ≤ 0.05). Time-to-event analyses show Health Start children complete vaccination sooner, with a hazard rate for full vaccination 13% higher than their matches. Conclusion A state-operated home visiting intervention with CHWs as the primary interventionist can effectively promote early childhood vaccine completion, which may reduce the incidence of preventable diseases and subsequently improve children’s health. Effects of CHW interventions on vaccination uptake is particularly relevant given the rise in vaccine-preventable diseases in the US and globally.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Arizona’s Health Start Program is a statewide community health worker (CHW) maternal and child health home visiting intervention. The objective of this study was to test if participation in Health Start during 2006–2016 improved early childhood vaccination completion rates. Methods This retrospective study used 11 years of administrative, birth certificate, and immunization records. Propensity score matching was used to identify control groups, based on demographic, socioeconomic, and geographic characteristics. Results are reported by historically disadvantaged subgroups and/or with a history of low vaccine uptake, including Hispanic/Latinx and American Indian children, and children of low socioeconomic status and from rural areas, children with teen mothers and first-born children. The average treatment-on-the-treated (ATT) effect estimated the impact of Health Start on timely completion of seven early childhood vaccine series: diphtheria/tetanus toxoids and acellular/whole-cell pertussis (DTaP/DTP), Haemophilus influenzae type b (Hib), hepatitis B (Hep. B), measles-mumps-rubella (MMR), pneumococcal conjugate vaccine (PCV13), poliovirus, and varicella. Results Vaccination completion rates (by age five) were 5.0% points higher for Health Start children as a group, and on average 5.0% points higher for several subgroups of mothers: women from rural border counties (ATT 5.8), Hispanic/Latinx women (ATT 4.8), American Indian women (ATT 4.8), women with less than high school education (ATT 5.0), teen mothers (ATT 6.1), and primipara women (ATT 4.5), compared to matched control groups (p-value ≤ 0.05). Time-to-event analyses show Health Start children complete vaccination sooner, with a hazard rate for full vaccination 13% higher than their matches. Conclusion A state-operated home visiting intervention with CHWs as the primary interventionist can effectively promote early childhood vaccine completion, which may reduce the incidence of preventable diseases and subsequently improve children’s health. Effects of CHW interventions on vaccination uptake is particularly relevant given the rise in vaccine-preventable diseases in the US and globally. |
Sabo, Samantha; O'Meara, Louisa; Russell, Kim; Hemstreet, Corey; Nashio, J T; Bender, Brook; Hamilton, Joyce; Begay, Mae-Gilene Community Health Representative Workforce: Meeting the Moment in American Indian Health Equity Journal Article Frontiers in Public Health, 9 , 2021. @article{Sabo2021, title = {Community Health Representative Workforce: Meeting the Moment in American Indian Health Equity}, author = {Samantha Sabo and Louisa O'Meara and Kim Russell and Corey Hemstreet and J. T. Nashio and Brook Bender and Joyce Hamilton and Mae-Gilene Begay}, url = {https://doi.org/10.3389/fpubh.2021.667926}, doi = {10.3389/fpubh.2021.667926}, year = {2021}, date = {2021-07-21}, journal = {Frontiers in Public Health}, volume = {9}, abstract = {In 2018, the Community Health Representative (CHR) workforce celebrated their 50th year and serve as the oldest and only federally funded Community Health Worker (CHW) workforce in the United States. CHRs are a highly trained, well-established standardized workforce serving the medical and social needs of American Indian communities. Nationally, the CHR workforce consists of ~1,700 CHRs, representing 264 Tribes. Of the 22 Tribes of Arizona, 19 Tribes operate a CHR Program and employ ~250 CHRs, equivalent to ~30% of the total CHW workforce in the state. Since 2015, Tribal CHR Programs of Arizona have come together for annual CHR Policy Summits to dialogue and plan for the unique issues and opportunities facing CHR workforce sustainability and advancement. Overtime, the Policy Summits have resulted in the Arizona CHR Workforce Movement, which advocates for inclusion of CHRs in state and national level dialogue regarding workforce standardization, certification, training, supervision, and financing. This community case study describes the impetus, collaborative process, and selected results of a 2019–2020 multi-phase CHR workforce assessment. Specifically, we highlight CHR core roles and competencies, contributions to the social determinant of health and well-being and the level to which CHRs are integrated within systems and teams. We offer recommendations for strengthening the workforce, increasing awareness of CHR roles and competencies, integrating CHRs within teams and systems, and mechanism for sustainability. }, keywords = {}, pubstate = {published}, tppubtype = {article} } In 2018, the Community Health Representative (CHR) workforce celebrated their 50th year and serve as the oldest and only federally funded Community Health Worker (CHW) workforce in the United States. CHRs are a highly trained, well-established standardized workforce serving the medical and social needs of American Indian communities. Nationally, the CHR workforce consists of ~1,700 CHRs, representing 264 Tribes. Of the 22 Tribes of Arizona, 19 Tribes operate a CHR Program and employ ~250 CHRs, equivalent to ~30% of the total CHW workforce in the state. Since 2015, Tribal CHR Programs of Arizona have come together for annual CHR Policy Summits to dialogue and plan for the unique issues and opportunities facing CHR workforce sustainability and advancement. Overtime, the Policy Summits have resulted in the Arizona CHR Workforce Movement, which advocates for inclusion of CHRs in state and national level dialogue regarding workforce standardization, certification, training, supervision, and financing. This community case study describes the impetus, collaborative process, and selected results of a 2019–2020 multi-phase CHR workforce assessment. Specifically, we highlight CHR core roles and competencies, contributions to the social determinant of health and well-being and the level to which CHRs are integrated within systems and teams. We offer recommendations for strengthening the workforce, increasing awareness of CHR roles and competencies, integrating CHRs within teams and systems, and mechanism for sustainability. |
Ingram, Maia; Sabo, Samantha; Redondo, Floribella; Soto, Yanitza; Russell, Kim; Carter, Heather; Bender, Brook; de Zapien, Jill Guernsey Establishing voluntary certification of community health workers in Arizona: a policy case study of building a unified workforce Journal Article Human Resources for Health, 18 (46), 2020. @article{Ingram2020, title = {Establishing voluntary certification of community health workers in Arizona: a policy case study of building a unified workforce}, author = {Maia Ingram and Samantha Sabo and Floribella Redondo and Yanitza Soto and Kim Russell and Heather Carter and Brook Bender and Jill Guernsey de Zapien }, url = {https://doi.org/10.1186/s12960-020-00487-7}, doi = {10.1186/s12960-020-00487-7}, year = {2020}, date = {2020-06-26}, journal = {Human Resources for Health}, volume = {18}, number = {46}, abstract = {Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort. |
Sabo, Samantha; Flores, Melissa; Wennerström, Ashley; Bell, Melanie L; Verdugo, Lorena; Carvajal, Scott; Ingram, Maia Community health workers promote civic engagement and organizational capacity to impact policy Journal Article Journal of Community Health, 42 (6), pp. 1197-1203, 2017. @article{Sabo2017b, title = {Community health workers promote civic engagement and organizational capacity to impact policy}, author = {Samantha Sabo and Melissa Flores and Ashley Wennerström and Melanie L Bell and Lorena Verdugo and Scott Carvajal and Maia Ingram}, url = {https://link.springer.com/article/10.1007/s10900-017-0370-3}, year = {2017}, date = {2017-06-06}, journal = {Journal of Community Health}, volume = {42}, number = {6}, pages = {1197-1203}, abstract = {Community health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N = 1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted R 2 statistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N = 1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted R 2 statistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change. |
Ingram, Maia; Sabo, Samantha; Rothers, Janet; Wennerstrom, Ashley; de Zapien, Jill Guernsey Community Health Workers and community advocacy: addressing health disparities Journal Article Journal of Community Health, 33 (6), pp. 417-424, 2008. @article{Ingram2008, title = {Community Health Workers and community advocacy: addressing health disparities}, author = {Maia Ingram and Samantha Sabo and Janet Rothers and Ashley Wennerstrom and Jill Guernsey de Zapien}, url = {https://www.ncbi.nlm.nih.gov/pubmed/18584315}, doi = {10.1007/s10900-008-9111-y}, year = {2008}, date = {2008-12-01}, journal = {Journal of Community Health}, volume = {33}, number = {6}, pages = {417-424}, abstract = {The Community Health Worker model is recognized nationally as a means to address glaring inequities in the burden of adverse health conditions that exist among specific population groups in the United States. This study explored Arizona CHW involvement in advocacy beyond the individual patient level into the realm of advocating for community level change as a mechanism to reduce the structural underpinnings of health disparities. A survey of CHWs in Arizona found that CHWs advocate at local, state and federal political levels as well as within health and social service agencies and business. Characteristics significantly associated with advocacy include employment in a not for profit organization, previous leadership training, and a work environment that allows flexible work hours and the autonomy to start new projects at work. Intrinsic characteristics of CHWs associated with advocacy include their belief that they can influence community decisions, self perception that they are leaders in the community, and knowledge of who to talk to in their community to make change. Community-level advocacy has been identified as a core CHW function and has the potential to address structural issues such as poverty, employment, housing, and discrimination. Agencies utilizing the CHW model could encourage community advocacy by providing a flexible working environment, ongoing leadership training, and opportunities to collaborate with both veteran CHWs and local community leaders. Further research is needed to understand the nature and impact of CHW community advocacy activities on both systems change and health outcomes.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The Community Health Worker model is recognized nationally as a means to address glaring inequities in the burden of adverse health conditions that exist among specific population groups in the United States. This study explored Arizona CHW involvement in advocacy beyond the individual patient level into the realm of advocating for community level change as a mechanism to reduce the structural underpinnings of health disparities. A survey of CHWs in Arizona found that CHWs advocate at local, state and federal political levels as well as within health and social service agencies and business. Characteristics significantly associated with advocacy include employment in a not for profit organization, previous leadership training, and a work environment that allows flexible work hours and the autonomy to start new projects at work. Intrinsic characteristics of CHWs associated with advocacy include their belief that they can influence community decisions, self perception that they are leaders in the community, and knowledge of who to talk to in their community to make change. Community-level advocacy has been identified as a core CHW function and has the potential to address structural issues such as poverty, employment, housing, and discrimination. Agencies utilizing the CHW model could encourage community advocacy by providing a flexible working environment, ongoing leadership training, and opportunities to collaborate with both veteran CHWs and local community leaders. Further research is needed to understand the nature and impact of CHW community advocacy activities on both systems change and health outcomes. |
2023 |
Samantha Sabo Louisa O'Meara, Janet Yellowhair Joyce Hamilton JT Nashio Brook Bender Fernando Flores Jr Marianne Bennett Rema Metts Isabella Denton Kim Russell Frontiers in Public Health, 11 , 2023. @article{Sabo2023b, title = {Community Health Representative Workforce: Integration across systems and teams to address the social determinants of indigenous health and wellbeing}, author = {Samantha Sabo, Louisa O'Meara, Janet Yellowhair, Joyce Hamilton, JT Nashio, Brook Bender, Fernando Flores Jr, Marianne Bennett, Rema Metts, Isabella Denton, Kim Russell}, editor = {Lily K. Lee}, url = {https://doi.org/10.3389/fpubh.2023.1047152}, doi = {10.3389/fpubh.2023.1047152}, year = {2023}, date = {2023-03-15}, journal = {Frontiers in Public Health}, volume = {11}, abstract = {Tribally employed, Community Health Representatives (CHRs) serving Indigenous and American Indian and Alaskan Native (AIAN) peoples are culturally and linguistically embedded community leaders, with the unique ability to serve as the link and intermediary between community members and systems. Unique to the CHR workforce scope of practice is the expectation for high level integration within the medical and social service care team. This explicit role outlined in the scope of work sets an expectation for both CHR and care teams to deliver integrated patient, family, and systems level care coordination and case management. This paper aims to build from our previous manuscript published in Volume 1 of the special issue Community Health Workers Practice from Recruitment to Integration. In that Volume, we explored through a Community Case Study CHR Managers’ perspectives on the challenges and opportunities for full CHR integration into health systems and teams serving AIAN. In this paper, we offer new information about the current CHR and CHR Managers’ involvements and perceived level of integration within health care teams and the broader public health systems addressing the social and structural determinants of health. We approach this topic considering the COVID-19 pandemic and how CHRs and CHR Programs were included and not included in tribal pandemic response efforts.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Tribally employed, Community Health Representatives (CHRs) serving Indigenous and American Indian and Alaskan Native (AIAN) peoples are culturally and linguistically embedded community leaders, with the unique ability to serve as the link and intermediary between community members and systems. Unique to the CHR workforce scope of practice is the expectation for high level integration within the medical and social service care team. This explicit role outlined in the scope of work sets an expectation for both CHR and care teams to deliver integrated patient, family, and systems level care coordination and case management. This paper aims to build from our previous manuscript published in Volume 1 of the special issue Community Health Workers Practice from Recruitment to Integration. In that Volume, we explored through a Community Case Study CHR Managers’ perspectives on the challenges and opportunities for full CHR integration into health systems and teams serving AIAN. In this paper, we offer new information about the current CHR and CHR Managers’ involvements and perceived level of integration within health care teams and the broader public health systems addressing the social and structural determinants of health. We approach this topic considering the COVID-19 pandemic and how CHRs and CHR Programs were included and not included in tribal pandemic response efforts. |
2022 |
McCue, Kelly; Sabo, Samantha; Wightman, Patrick; Butler, Matthew; Pilling, Vern; Jiménez, Dulce; Annorbah, Rebecca; Rumann, Sara Maternal and Child Health Journal, 26 , pp. 2485–2495, 2022. @article{McCue2022, title = {Impact of a Community Health Worker (CHW) Home Visiting Intervention on Any and Adequate Prenatal Care Among Ethno-Racially Diverse Pregnant Women of the US Southwest}, author = {Kelly McCue and Samantha Sabo and Patrick Wightman and Matthew Butler and Vern Pilling and Dulce Jiménez and Rebecca Annorbah and Sara Rumann}, url = { https://doi.org/10.1007/s10995-022-03506-2}, doi = {10.1007/s10995-022-03506-2}, year = {2022}, date = {2022-10-21}, journal = {Maternal and Child Health Journal}, volume = {26}, pages = {2485–2495}, abstract = {Social and structural barriers drive disparities in prenatal care utilization among minoritized women in the United States. This study examined the impact of Arizona’s Health Start Program, a community health worker (CHW) home visiting intervention, on prenatal care utilization among an ethno-racially and geographically diverse cohort of women. A CHW-led perinatal home visiting intervention operated through a state health department can improve prenatal care utilization among demographically and socioeconomically disadvantaged women and reduce maternal and child health inequity.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Social and structural barriers drive disparities in prenatal care utilization among minoritized women in the United States. This study examined the impact of Arizona’s Health Start Program, a community health worker (CHW) home visiting intervention, on prenatal care utilization among an ethno-racially and geographically diverse cohort of women. A CHW-led perinatal home visiting intervention operated through a state health department can improve prenatal care utilization among demographically and socioeconomically disadvantaged women and reduce maternal and child health inequity. |
Wightman, Patrick; McCue, Kelly; Sabo, Samantha; Annorbah, Rebecca; Jiménez, Dulce; Pilling, Vern; Butler, Matthew; Celaya, Martín F; Rumann, Sara Community Health Worker Intervention Improves Early Childhood Vaccination Rates: Results from a Propensity-score Matching Evaluation Journal Article BMC Public Health, 22 (1), pp. 1854, 2022. @article{Wightman2022, title = {Community Health Worker Intervention Improves Early Childhood Vaccination Rates: Results from a Propensity-score Matching Evaluation}, author = {Patrick Wightman and Kelly McCue and Samantha Sabo and Rebecca Annorbah and Dulce Jiménez and Vern Pilling and Matthew Butler and Martín F Celaya and Sara Rumann}, url = {https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14239-w}, doi = {10.1186/s12889-022-14239-w}, year = {2022}, date = {2022-10-04}, journal = {BMC Public Health}, volume = {22}, number = {1}, pages = {1854}, abstract = {Arizona’s Health Start Program is a statewide community health worker (CHW) maternal and child health home visiting intervention. The objective of this study was to test if participation in Health Start during 2006–2016 improved early childhood vaccination completion rates. Methods This retrospective study used 11 years of administrative, birth certificate, and immunization records. Propensity score matching was used to identify control groups, based on demographic, socioeconomic, and geographic characteristics. Results are reported by historically disadvantaged subgroups and/or with a history of low vaccine uptake, including Hispanic/Latinx and American Indian children, and children of low socioeconomic status and from rural areas, children with teen mothers and first-born children. The average treatment-on-the-treated (ATT) effect estimated the impact of Health Start on timely completion of seven early childhood vaccine series: diphtheria/tetanus toxoids and acellular/whole-cell pertussis (DTaP/DTP), Haemophilus influenzae type b (Hib), hepatitis B (Hep. B), measles-mumps-rubella (MMR), pneumococcal conjugate vaccine (PCV13), poliovirus, and varicella. Results Vaccination completion rates (by age five) were 5.0% points higher for Health Start children as a group, and on average 5.0% points higher for several subgroups of mothers: women from rural border counties (ATT 5.8), Hispanic/Latinx women (ATT 4.8), American Indian women (ATT 4.8), women with less than high school education (ATT 5.0), teen mothers (ATT 6.1), and primipara women (ATT 4.5), compared to matched control groups (p-value ≤ 0.05). Time-to-event analyses show Health Start children complete vaccination sooner, with a hazard rate for full vaccination 13% higher than their matches. Conclusion A state-operated home visiting intervention with CHWs as the primary interventionist can effectively promote early childhood vaccine completion, which may reduce the incidence of preventable diseases and subsequently improve children’s health. Effects of CHW interventions on vaccination uptake is particularly relevant given the rise in vaccine-preventable diseases in the US and globally.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Arizona’s Health Start Program is a statewide community health worker (CHW) maternal and child health home visiting intervention. The objective of this study was to test if participation in Health Start during 2006–2016 improved early childhood vaccination completion rates. Methods This retrospective study used 11 years of administrative, birth certificate, and immunization records. Propensity score matching was used to identify control groups, based on demographic, socioeconomic, and geographic characteristics. Results are reported by historically disadvantaged subgroups and/or with a history of low vaccine uptake, including Hispanic/Latinx and American Indian children, and children of low socioeconomic status and from rural areas, children with teen mothers and first-born children. The average treatment-on-the-treated (ATT) effect estimated the impact of Health Start on timely completion of seven early childhood vaccine series: diphtheria/tetanus toxoids and acellular/whole-cell pertussis (DTaP/DTP), Haemophilus influenzae type b (Hib), hepatitis B (Hep. B), measles-mumps-rubella (MMR), pneumococcal conjugate vaccine (PCV13), poliovirus, and varicella. Results Vaccination completion rates (by age five) were 5.0% points higher for Health Start children as a group, and on average 5.0% points higher for several subgroups of mothers: women from rural border counties (ATT 5.8), Hispanic/Latinx women (ATT 4.8), American Indian women (ATT 4.8), women with less than high school education (ATT 5.0), teen mothers (ATT 6.1), and primipara women (ATT 4.5), compared to matched control groups (p-value ≤ 0.05). Time-to-event analyses show Health Start children complete vaccination sooner, with a hazard rate for full vaccination 13% higher than their matches. Conclusion A state-operated home visiting intervention with CHWs as the primary interventionist can effectively promote early childhood vaccine completion, which may reduce the incidence of preventable diseases and subsequently improve children’s health. Effects of CHW interventions on vaccination uptake is particularly relevant given the rise in vaccine-preventable diseases in the US and globally. |
2021 |
Sabo, Samantha; O'Meara, Louisa; Russell, Kim; Hemstreet, Corey; Nashio, J T; Bender, Brook; Hamilton, Joyce; Begay, Mae-Gilene Community Health Representative Workforce: Meeting the Moment in American Indian Health Equity Journal Article Frontiers in Public Health, 9 , 2021. @article{Sabo2021, title = {Community Health Representative Workforce: Meeting the Moment in American Indian Health Equity}, author = {Samantha Sabo and Louisa O'Meara and Kim Russell and Corey Hemstreet and J. T. Nashio and Brook Bender and Joyce Hamilton and Mae-Gilene Begay}, url = {https://doi.org/10.3389/fpubh.2021.667926}, doi = {10.3389/fpubh.2021.667926}, year = {2021}, date = {2021-07-21}, journal = {Frontiers in Public Health}, volume = {9}, abstract = {In 2018, the Community Health Representative (CHR) workforce celebrated their 50th year and serve as the oldest and only federally funded Community Health Worker (CHW) workforce in the United States. CHRs are a highly trained, well-established standardized workforce serving the medical and social needs of American Indian communities. Nationally, the CHR workforce consists of ~1,700 CHRs, representing 264 Tribes. Of the 22 Tribes of Arizona, 19 Tribes operate a CHR Program and employ ~250 CHRs, equivalent to ~30% of the total CHW workforce in the state. Since 2015, Tribal CHR Programs of Arizona have come together for annual CHR Policy Summits to dialogue and plan for the unique issues and opportunities facing CHR workforce sustainability and advancement. Overtime, the Policy Summits have resulted in the Arizona CHR Workforce Movement, which advocates for inclusion of CHRs in state and national level dialogue regarding workforce standardization, certification, training, supervision, and financing. This community case study describes the impetus, collaborative process, and selected results of a 2019–2020 multi-phase CHR workforce assessment. Specifically, we highlight CHR core roles and competencies, contributions to the social determinant of health and well-being and the level to which CHRs are integrated within systems and teams. We offer recommendations for strengthening the workforce, increasing awareness of CHR roles and competencies, integrating CHRs within teams and systems, and mechanism for sustainability. }, keywords = {}, pubstate = {published}, tppubtype = {article} } In 2018, the Community Health Representative (CHR) workforce celebrated their 50th year and serve as the oldest and only federally funded Community Health Worker (CHW) workforce in the United States. CHRs are a highly trained, well-established standardized workforce serving the medical and social needs of American Indian communities. Nationally, the CHR workforce consists of ~1,700 CHRs, representing 264 Tribes. Of the 22 Tribes of Arizona, 19 Tribes operate a CHR Program and employ ~250 CHRs, equivalent to ~30% of the total CHW workforce in the state. Since 2015, Tribal CHR Programs of Arizona have come together for annual CHR Policy Summits to dialogue and plan for the unique issues and opportunities facing CHR workforce sustainability and advancement. Overtime, the Policy Summits have resulted in the Arizona CHR Workforce Movement, which advocates for inclusion of CHRs in state and national level dialogue regarding workforce standardization, certification, training, supervision, and financing. This community case study describes the impetus, collaborative process, and selected results of a 2019–2020 multi-phase CHR workforce assessment. Specifically, we highlight CHR core roles and competencies, contributions to the social determinant of health and well-being and the level to which CHRs are integrated within systems and teams. We offer recommendations for strengthening the workforce, increasing awareness of CHR roles and competencies, integrating CHRs within teams and systems, and mechanism for sustainability. |
2020 |
Ingram, Maia; Sabo, Samantha; Redondo, Floribella; Soto, Yanitza; Russell, Kim; Carter, Heather; Bender, Brook; de Zapien, Jill Guernsey Establishing voluntary certification of community health workers in Arizona: a policy case study of building a unified workforce Journal Article Human Resources for Health, 18 (46), 2020. @article{Ingram2020, title = {Establishing voluntary certification of community health workers in Arizona: a policy case study of building a unified workforce}, author = {Maia Ingram and Samantha Sabo and Floribella Redondo and Yanitza Soto and Kim Russell and Heather Carter and Brook Bender and Jill Guernsey de Zapien }, url = {https://doi.org/10.1186/s12960-020-00487-7}, doi = {10.1186/s12960-020-00487-7}, year = {2020}, date = {2020-06-26}, journal = {Human Resources for Health}, volume = {18}, number = {46}, abstract = {Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort. |
2017 |
Sabo, Samantha; Flores, Melissa; Wennerström, Ashley; Bell, Melanie L; Verdugo, Lorena; Carvajal, Scott; Ingram, Maia Community health workers promote civic engagement and organizational capacity to impact policy Journal Article Journal of Community Health, 42 (6), pp. 1197-1203, 2017. @article{Sabo2017b, title = {Community health workers promote civic engagement and organizational capacity to impact policy}, author = {Samantha Sabo and Melissa Flores and Ashley Wennerström and Melanie L Bell and Lorena Verdugo and Scott Carvajal and Maia Ingram}, url = {https://link.springer.com/article/10.1007/s10900-017-0370-3}, year = {2017}, date = {2017-06-06}, journal = {Journal of Community Health}, volume = {42}, number = {6}, pages = {1197-1203}, abstract = {Community health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N = 1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted R 2 statistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N = 1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted R 2 statistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change. |
2008 |
Ingram, Maia; Sabo, Samantha; Rothers, Janet; Wennerstrom, Ashley; de Zapien, Jill Guernsey Community Health Workers and community advocacy: addressing health disparities Journal Article Journal of Community Health, 33 (6), pp. 417-424, 2008. @article{Ingram2008, title = {Community Health Workers and community advocacy: addressing health disparities}, author = {Maia Ingram and Samantha Sabo and Janet Rothers and Ashley Wennerstrom and Jill Guernsey de Zapien}, url = {https://www.ncbi.nlm.nih.gov/pubmed/18584315}, doi = {10.1007/s10900-008-9111-y}, year = {2008}, date = {2008-12-01}, journal = {Journal of Community Health}, volume = {33}, number = {6}, pages = {417-424}, abstract = {The Community Health Worker model is recognized nationally as a means to address glaring inequities in the burden of adverse health conditions that exist among specific population groups in the United States. This study explored Arizona CHW involvement in advocacy beyond the individual patient level into the realm of advocating for community level change as a mechanism to reduce the structural underpinnings of health disparities. A survey of CHWs in Arizona found that CHWs advocate at local, state and federal political levels as well as within health and social service agencies and business. Characteristics significantly associated with advocacy include employment in a not for profit organization, previous leadership training, and a work environment that allows flexible work hours and the autonomy to start new projects at work. Intrinsic characteristics of CHWs associated with advocacy include their belief that they can influence community decisions, self perception that they are leaders in the community, and knowledge of who to talk to in their community to make change. Community-level advocacy has been identified as a core CHW function and has the potential to address structural issues such as poverty, employment, housing, and discrimination. Agencies utilizing the CHW model could encourage community advocacy by providing a flexible working environment, ongoing leadership training, and opportunities to collaborate with both veteran CHWs and local community leaders. Further research is needed to understand the nature and impact of CHW community advocacy activities on both systems change and health outcomes.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The Community Health Worker model is recognized nationally as a means to address glaring inequities in the burden of adverse health conditions that exist among specific population groups in the United States. This study explored Arizona CHW involvement in advocacy beyond the individual patient level into the realm of advocating for community level change as a mechanism to reduce the structural underpinnings of health disparities. A survey of CHWs in Arizona found that CHWs advocate at local, state and federal political levels as well as within health and social service agencies and business. Characteristics significantly associated with advocacy include employment in a not for profit organization, previous leadership training, and a work environment that allows flexible work hours and the autonomy to start new projects at work. Intrinsic characteristics of CHWs associated with advocacy include their belief that they can influence community decisions, self perception that they are leaders in the community, and knowledge of who to talk to in their community to make change. Community-level advocacy has been identified as a core CHW function and has the potential to address structural issues such as poverty, employment, housing, and discrimination. Agencies utilizing the CHW model could encourage community advocacy by providing a flexible working environment, ongoing leadership training, and opportunities to collaborate with both veteran CHWs and local community leaders. Further research is needed to understand the nature and impact of CHW community advocacy activities on both systems change and health outcomes. |