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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Reinschmidt, Kerstin M; Ingram, Maia; Morales, Stephanie; Sabo, Samantha; Blackburn, John; Murrieta, Lucy; David, Cassalyn; Carvajal, Scott C Documenting community health worker roles in primary care: Contributions to evidence-based integration into health care teams, 2015 Journal Article Journal of Ambulatory Care Management, 40 (4), pp. 305-315, 2017. @article{Reinschmidt2017, title = {Documenting community health worker roles in primary care: Contributions to evidence-based integration into health care teams, 2015}, author = {Kerstin M Reinschmidt and Maia Ingram and Stephanie Morales and Samantha Sabo and John Blackburn and Lucy Murrieta and Cassalyn David and Scott C Carvajal}, url = {https://journals.lww.com/ambulatorycaremanagement/Fulltext/2017/10000/Documenting_Community_Health_Worker_Roles_in.11.aspx}, doi = {10.1097/JAC.0000000000000178}, year = {2017}, date = {2017-10-01}, journal = {Journal of Ambulatory Care Management}, volume = {40}, number = {4}, pages = {305-315}, abstract = {The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements. |
Reinschmidt, Kerstin M; Ingram, Maia; Schachter, Kenneth; Sabo, Samantha; Verdugo, Lorena; Carvajal, Scott The Journal of Ambulatory Care Management, 38 (3), pp. 244-253, 2015. @article{Reinschmidt2015, title = {The Impact of Integrating Community Advocacy Into Community Health Worker Roles on Health-Focused Organizations and Community Health Workers in Southern Arizona}, author = {Kerstin M Reinschmidt and Maia Ingram and Kenneth Schachter and Samantha Sabo and Lorena Verdugo and Scott Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26049654}, doi = {10.1097/JAC.0000000000000092}, year = {2015}, date = {2015-08-01}, journal = {The Journal of Ambulatory Care Management}, volume = {38}, number = {3}, pages = {244-253}, abstract = {Organizational environments may encourage community health workers (CHWs) to engage community members in improving their communities. We conducted open-ended interviews and focus groups to explore how participation in the Acción intervention, which trained CHWs in community advocacy, affected organizational capacity to support their CHWs. Supervisors described improved organizational recognition and trust of CHWs. Organizational leaders reported organizational benefits and increased appreciation of CHW leadership. Both expressed increased interest in future advocacy trainings. Limiting factors included organizational mission, CHW position descriptions, and funding. Findings indicate that, with training and funding, CHW community advocacy can be integrated into organizations with congruent missions.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Organizational environments may encourage community health workers (CHWs) to engage community members in improving their communities. We conducted open-ended interviews and focus groups to explore how participation in the Acción intervention, which trained CHWs in community advocacy, affected organizational capacity to support their CHWs. Supervisors described improved organizational recognition and trust of CHWs. Organizational leaders reported organizational benefits and increased appreciation of CHW leadership. Both expressed increased interest in future advocacy trainings. Limiting factors included organizational mission, CHW position descriptions, and funding. Findings indicate that, with training and funding, CHW community advocacy can be integrated into organizations with congruent missions. |
Ingram, Maia; Sabo, Samantha; Gomez, Sofia; Piper, Rosalinda; de Zapien, Jill Guernsey; Reinschmidt, Kerstin M; Schachter, Ken A; Carvajal, Scott C Progress in Community Health Partnerships: Research, Education, and Action, 9 (1), pp. 49-56, 2015. @article{Ingram2015, title = {Taking a community-based participatory research approach in the development of methods to measure a community health worker community advocacy intervention}, author = {Maia Ingram and Samantha Sabo and Sofia Gomez and Rosalinda Piper and Jill Guernsey de Zapien and Kerstin M Reinschmidt and Ken A Schachter and Scott C Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/25981424}, doi = {10.1353/cpr.2015.0001}, year = {2015}, date = {2015-04-01}, journal = {Progress in Community Health Partnerships: Research, Education, and Action}, volume = {9}, number = {1}, pages = {49-56}, abstract = {BACKGROUND: Public health advocacy is by necessity responsive to shifting sociopolitical climates, and thus a challenge of advocacy research is that the intervention must by definition be adaptive. Moving beyond the classification of advocacy efforts to measurable indicators and outcomes of policy, therefore, requires a dynamic research approach. OBJECTIVES: The purposes of this article are to (1) describe use of the CBPR approach in the development and measurement of a community health worker (CHW) intervention designed to engage community members in public health advocacy and (2) provide a model for application of this approach in advocacy interventions addressing community-level systems and environmental change. METHODS: The Kingdon three streams model of policy change provided a theoretical framework for the intervention. Research and community partners collaboratively identified and documented intervention data. We describe five research methods used to monitor and measure CHW advocacy activities that both emerged from and influenced intervention activities. DISCUSSION: Encounter forms provided a longitudinal perspective of how CHWs engaged in advocacy activities in the three streams. Strategy maps defined desired advocacy outcomes and health benefits. Technical assistance notes identified and documented intermediate outcomes. Focus group and interview data reflected CHW efforts to engage community members in advocacy and the development of community leaders. APPLICATION OF LESSONS LEARNED: We provide a model for application of key principles of CPBR that are vital to effectively capturing the overarching and nuanced aspects of public health advocacy work in dynamic political and organizational environments.}, keywords = {}, pubstate = {published}, tppubtype = {article} } BACKGROUND: Public health advocacy is by necessity responsive to shifting sociopolitical climates, and thus a challenge of advocacy research is that the intervention must by definition be adaptive. Moving beyond the classification of advocacy efforts to measurable indicators and outcomes of policy, therefore, requires a dynamic research approach. OBJECTIVES: The purposes of this article are to (1) describe use of the CBPR approach in the development and measurement of a community health worker (CHW) intervention designed to engage community members in public health advocacy and (2) provide a model for application of this approach in advocacy interventions addressing community-level systems and environmental change. METHODS: The Kingdon three streams model of policy change provided a theoretical framework for the intervention. Research and community partners collaboratively identified and documented intervention data. We describe five research methods used to monitor and measure CHW advocacy activities that both emerged from and influenced intervention activities. DISCUSSION: Encounter forms provided a longitudinal perspective of how CHWs engaged in advocacy activities in the three streams. Strategy maps defined desired advocacy outcomes and health benefits. Technical assistance notes identified and documented intermediate outcomes. Focus group and interview data reflected CHW efforts to engage community members in advocacy and the development of community leaders. APPLICATION OF LESSONS LEARNED: We provide a model for application of key principles of CPBR that are vital to effectively capturing the overarching and nuanced aspects of public health advocacy work in dynamic political and organizational environments. |
Ingram, Maia; Schachter, Ken A; Sabo, Samantha; Reinschmidt, Kerstin M; Gomez, Sofia; Zapien, Jill Guernsey De; Carvajal, Scott C A community health worker intervention to address the social determinants of health through policy change Journal Article The Journal of primary Prevention, 35 (2), pp. 119-123, 2014. @article{Ingram2014, title = {A community health worker intervention to address the social determinants of health through policy change}, author = {Maia Ingram and Ken A Schachter and Samantha Sabo and Kerstin M Reinschmidt and Sofia Gomez and Jill Guernsey De Zapien and Scott C Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/24363179}, doi = {10.1007/s10935-013-0335-y}, year = {2014}, date = {2014-04-01}, journal = {The Journal of primary Prevention}, volume = {35}, number = {2}, pages = {119-123}, abstract = {Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services. |
Sabo, Samantha; Ingram, Maia; Reinschmidt, Kerstin M; Schachter, Kenneth; Jacobs, Laurel; de Zapien, Jill Guernsey; Robinson, Laurie; Carvajal, Scott Predictors and a framework for fostering community advocacy as a community health worker core function to eliminate health disparities Journal Article American Journal of Public health, 103 (7), pp. 67-73, 2013. @article{Sabo2013, title = {Predictors and a framework for fostering community advocacy as a community health worker core function to eliminate health disparities}, author = {Samantha Sabo and Maia Ingram and Kerstin M Reinschmidt and Kenneth Schachter and Laurel Jacobs and Jill Guernsey de Zapien and Laurie Robinson and Scott Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/23678904}, doi = {10.2105/AJPH.2012.301108}, year = {2013}, date = {2013-07-01}, journal = {American Journal of Public health}, volume = {103}, number = {7}, pages = {67-73}, abstract = {OBJECTIVES: Using a mixed-method, participatory research approach, we investigated factors related to community health worker (CHW) community advocacy that affect social determinants of health. METHODS: We used cross-sectional survey data for 371 CHWs to assess demographics, training, work environment, and leadership qualities on civic, political, and organizational advocacy. We present advocacy stories to further articulate CHW activities. The data reported are from the recently completed National Community Health Workers Advocacy Study. RESULTS: CHWs are involved in advocacy that is community-focused, although advocacy differs by intrinsic leadership, experience, training, and work environment. We propose a framework to conceptualize, support, and evaluate CHW advocacy and the iterative processes they engage in. These processes create opportunities for community voice and action to affect social and structural conditions that are known to have wide-ranging health effects on communities. CONCLUSIONS: The framework presented may have utility for CHWs, their training programs, and their employers as well as funders and policymakers aiming to promote health equity.}, keywords = {}, pubstate = {published}, tppubtype = {article} } OBJECTIVES: Using a mixed-method, participatory research approach, we investigated factors related to community health worker (CHW) community advocacy that affect social determinants of health. METHODS: We used cross-sectional survey data for 371 CHWs to assess demographics, training, work environment, and leadership qualities on civic, political, and organizational advocacy. We present advocacy stories to further articulate CHW activities. The data reported are from the recently completed National Community Health Workers Advocacy Study. RESULTS: CHWs are involved in advocacy that is community-focused, although advocacy differs by intrinsic leadership, experience, training, and work environment. We propose a framework to conceptualize, support, and evaluate CHW advocacy and the iterative processes they engage in. These processes create opportunities for community voice and action to affect social and structural conditions that are known to have wide-ranging health effects on communities. CONCLUSIONS: The framework presented may have utility for CHWs, their training programs, and their employers as well as funders and policymakers aiming to promote health equity. |
Ingram, Maia; Reinschmidt, Kerstin M; Schachter, Ken A; Davidson, Chris L; Sabo, Samantha; Zapien, Jill Guernsey De; Carvajal, Scott C Establishing a professional profile of community health workers: results from a national study of roles, activities and training Journal Article Journal of Community Health, 37 (2), pp. 529-537, 2012. @article{Ingram2012, title = {Establishing a professional profile of community health workers: results from a national study of roles, activities and training}, author = {Maia Ingram and Kerstin M Reinschmidt and Ken A Schachter and Chris L Davidson and Samantha Sabo and Jill Guernsey De Zapien and Scott C Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/21964912}, doi = {10.1007/s10900-011-9475-2}, year = {2012}, date = {2012-04-01}, journal = {Journal of Community Health}, volume = {37}, number = {2}, pages = {529-537}, abstract = {Community Health Workers (CHWs) have gained national recognition for their role in addressing health disparities and are increasingly integrated into the health care delivery system. There is a lack of consensus, however, regarding empirical evidence on the impact of CHW interventions on health outcomes. In this paper, we present results from the 2010 National Community Health Worker Advocacy Survey (NCHWAS) in an effort to strengthen a generalized understanding of the CHW profession that can be integrated into ongoing efforts to improve the health care delivery system. Results indicate that regardless of geographical location, work setting, and demographic characteristics, CHWs generally share similar professional characteristics, training preparation, and job activities. CHWs are likely to be female, representative of the community they serve, and to work in community health centers, clinics, community-based organizations, and health departments. The most common type of training is on-the-job and conference training. Most CHWs work with clients, groups, other CHWs and less frequently community leaders to address health issues, the most common of which are chronic disease, prevention and health care access. Descriptions of CHW activities documented in the survey demonstrate that CHWs apply core competencies in a synergistic manner in an effort to assure that their clients get the services they need. NCHWAS findings suggest that over the past 50 years, the CHW field has become standardized in response to the unmet needs of their communities. In research and practice, the field would benefit from being considered a health profession rather than an intervention.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community Health Workers (CHWs) have gained national recognition for their role in addressing health disparities and are increasingly integrated into the health care delivery system. There is a lack of consensus, however, regarding empirical evidence on the impact of CHW interventions on health outcomes. In this paper, we present results from the 2010 National Community Health Worker Advocacy Survey (NCHWAS) in an effort to strengthen a generalized understanding of the CHW profession that can be integrated into ongoing efforts to improve the health care delivery system. Results indicate that regardless of geographical location, work setting, and demographic characteristics, CHWs generally share similar professional characteristics, training preparation, and job activities. CHWs are likely to be female, representative of the community they serve, and to work in community health centers, clinics, community-based organizations, and health departments. The most common type of training is on-the-job and conference training. Most CHWs work with clients, groups, other CHWs and less frequently community leaders to address health issues, the most common of which are chronic disease, prevention and health care access. Descriptions of CHW activities documented in the survey demonstrate that CHWs apply core competencies in a synergistic manner in an effort to assure that their clients get the services they need. NCHWAS findings suggest that over the past 50 years, the CHW field has become standardized in response to the unmet needs of their communities. In research and practice, the field would benefit from being considered a health profession rather than an intervention. |
Reinschmidt, Kerstin M; Teufel-Shone, Nicolette; Bradford, Gail; Drummond, Rebecca L; Torres, Emma; Redondo, Floribella; Elenes, Jo Jean; Sanders, Alicia; Gastelum, Sylvia; Moore-Monroy, Martha; Barajas, Salvador; Fernandez, Lourdes; Alvidrez, Rosy; de Zapien, Jill Guernsey; Staten, Lisa K Taking a broad approach to public health program adaptation: adapting a family-based diabetes education program Journal Article The Journal of Primary Prevention, 31 (1-2), pp. 69-83, 2010. @article{Reinschmidt2010, title = {Taking a broad approach to public health program adaptation: adapting a family-based diabetes education program}, author = {Kerstin M Reinschmidt and Nicolette Teufel-Shone and Gail Bradford and Rebecca L Drummond and Emma Torres and Floribella Redondo and Jo Jean Elenes and Alicia Sanders and Sylvia Gastelum and Martha Moore-Monroy and Salvador Barajas and Lourdes Fernandez and Rosy Alvidrez and Jill Guernsey de Zapien and Lisa K Staten}, url = {https://www.ncbi.nlm.nih.gov/pubmed/20140646}, doi = {10.1007/s10935-010-0208-6}, year = {2010}, date = {2010-04-01}, journal = {The Journal of Primary Prevention}, volume = {31}, number = {1-2}, pages = {69-83}, abstract = {Diabetes health disparities among Hispanic populations have been countered with federally funded health promotion and disease prevention programs. Dissemination has focused on program adaptation to local cultural contexts for greater acceptability and sustainability. Taking a broader approach and drawing on our experience in Mexican American communities at the U.S.-Mexico Border, we demonstrate how interventions are adapted at the intersection of multiple cultural contexts: the populations targeted, the community- and university-based entities designing and implementing interventions, and the field team delivering the materials. Program adaptation involves negotiations between representatives of all contexts and is imperative in promoting local ownership and program sustainability.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Diabetes health disparities among Hispanic populations have been countered with federally funded health promotion and disease prevention programs. Dissemination has focused on program adaptation to local cultural contexts for greater acceptability and sustainability. Taking a broader approach and drawing on our experience in Mexican American communities at the U.S.-Mexico Border, we demonstrate how interventions are adapted at the intersection of multiple cultural contexts: the populations targeted, the community- and university-based entities designing and implementing interventions, and the field team delivering the materials. Program adaptation involves negotiations between representatives of all contexts and is imperative in promoting local ownership and program sustainability. |
2017 |
Reinschmidt, Kerstin M; Ingram, Maia; Morales, Stephanie; Sabo, Samantha; Blackburn, John; Murrieta, Lucy; David, Cassalyn; Carvajal, Scott C Documenting community health worker roles in primary care: Contributions to evidence-based integration into health care teams, 2015 Journal Article Journal of Ambulatory Care Management, 40 (4), pp. 305-315, 2017. @article{Reinschmidt2017, title = {Documenting community health worker roles in primary care: Contributions to evidence-based integration into health care teams, 2015}, author = {Kerstin M Reinschmidt and Maia Ingram and Stephanie Morales and Samantha Sabo and John Blackburn and Lucy Murrieta and Cassalyn David and Scott C Carvajal}, url = {https://journals.lww.com/ambulatorycaremanagement/Fulltext/2017/10000/Documenting_Community_Health_Worker_Roles_in.11.aspx}, doi = {10.1097/JAC.0000000000000178}, year = {2017}, date = {2017-10-01}, journal = {Journal of Ambulatory Care Management}, volume = {40}, number = {4}, pages = {305-315}, abstract = {The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements. |
2015 |
Reinschmidt, Kerstin M; Ingram, Maia; Schachter, Kenneth; Sabo, Samantha; Verdugo, Lorena; Carvajal, Scott The Journal of Ambulatory Care Management, 38 (3), pp. 244-253, 2015. @article{Reinschmidt2015, title = {The Impact of Integrating Community Advocacy Into Community Health Worker Roles on Health-Focused Organizations and Community Health Workers in Southern Arizona}, author = {Kerstin M Reinschmidt and Maia Ingram and Kenneth Schachter and Samantha Sabo and Lorena Verdugo and Scott Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26049654}, doi = {10.1097/JAC.0000000000000092}, year = {2015}, date = {2015-08-01}, journal = {The Journal of Ambulatory Care Management}, volume = {38}, number = {3}, pages = {244-253}, abstract = {Organizational environments may encourage community health workers (CHWs) to engage community members in improving their communities. We conducted open-ended interviews and focus groups to explore how participation in the Acción intervention, which trained CHWs in community advocacy, affected organizational capacity to support their CHWs. Supervisors described improved organizational recognition and trust of CHWs. Organizational leaders reported organizational benefits and increased appreciation of CHW leadership. Both expressed increased interest in future advocacy trainings. Limiting factors included organizational mission, CHW position descriptions, and funding. Findings indicate that, with training and funding, CHW community advocacy can be integrated into organizations with congruent missions.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Organizational environments may encourage community health workers (CHWs) to engage community members in improving their communities. We conducted open-ended interviews and focus groups to explore how participation in the Acción intervention, which trained CHWs in community advocacy, affected organizational capacity to support their CHWs. Supervisors described improved organizational recognition and trust of CHWs. Organizational leaders reported organizational benefits and increased appreciation of CHW leadership. Both expressed increased interest in future advocacy trainings. Limiting factors included organizational mission, CHW position descriptions, and funding. Findings indicate that, with training and funding, CHW community advocacy can be integrated into organizations with congruent missions. |
Ingram, Maia; Sabo, Samantha; Gomez, Sofia; Piper, Rosalinda; de Zapien, Jill Guernsey; Reinschmidt, Kerstin M; Schachter, Ken A; Carvajal, Scott C Progress in Community Health Partnerships: Research, Education, and Action, 9 (1), pp. 49-56, 2015. @article{Ingram2015, title = {Taking a community-based participatory research approach in the development of methods to measure a community health worker community advocacy intervention}, author = {Maia Ingram and Samantha Sabo and Sofia Gomez and Rosalinda Piper and Jill Guernsey de Zapien and Kerstin M Reinschmidt and Ken A Schachter and Scott C Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/25981424}, doi = {10.1353/cpr.2015.0001}, year = {2015}, date = {2015-04-01}, journal = {Progress in Community Health Partnerships: Research, Education, and Action}, volume = {9}, number = {1}, pages = {49-56}, abstract = {BACKGROUND: Public health advocacy is by necessity responsive to shifting sociopolitical climates, and thus a challenge of advocacy research is that the intervention must by definition be adaptive. Moving beyond the classification of advocacy efforts to measurable indicators and outcomes of policy, therefore, requires a dynamic research approach. OBJECTIVES: The purposes of this article are to (1) describe use of the CBPR approach in the development and measurement of a community health worker (CHW) intervention designed to engage community members in public health advocacy and (2) provide a model for application of this approach in advocacy interventions addressing community-level systems and environmental change. METHODS: The Kingdon three streams model of policy change provided a theoretical framework for the intervention. Research and community partners collaboratively identified and documented intervention data. We describe five research methods used to monitor and measure CHW advocacy activities that both emerged from and influenced intervention activities. DISCUSSION: Encounter forms provided a longitudinal perspective of how CHWs engaged in advocacy activities in the three streams. Strategy maps defined desired advocacy outcomes and health benefits. Technical assistance notes identified and documented intermediate outcomes. Focus group and interview data reflected CHW efforts to engage community members in advocacy and the development of community leaders. APPLICATION OF LESSONS LEARNED: We provide a model for application of key principles of CPBR that are vital to effectively capturing the overarching and nuanced aspects of public health advocacy work in dynamic political and organizational environments.}, keywords = {}, pubstate = {published}, tppubtype = {article} } BACKGROUND: Public health advocacy is by necessity responsive to shifting sociopolitical climates, and thus a challenge of advocacy research is that the intervention must by definition be adaptive. Moving beyond the classification of advocacy efforts to measurable indicators and outcomes of policy, therefore, requires a dynamic research approach. OBJECTIVES: The purposes of this article are to (1) describe use of the CBPR approach in the development and measurement of a community health worker (CHW) intervention designed to engage community members in public health advocacy and (2) provide a model for application of this approach in advocacy interventions addressing community-level systems and environmental change. METHODS: The Kingdon three streams model of policy change provided a theoretical framework for the intervention. Research and community partners collaboratively identified and documented intervention data. We describe five research methods used to monitor and measure CHW advocacy activities that both emerged from and influenced intervention activities. DISCUSSION: Encounter forms provided a longitudinal perspective of how CHWs engaged in advocacy activities in the three streams. Strategy maps defined desired advocacy outcomes and health benefits. Technical assistance notes identified and documented intermediate outcomes. Focus group and interview data reflected CHW efforts to engage community members in advocacy and the development of community leaders. APPLICATION OF LESSONS LEARNED: We provide a model for application of key principles of CPBR that are vital to effectively capturing the overarching and nuanced aspects of public health advocacy work in dynamic political and organizational environments. |
2014 |
Ingram, Maia; Schachter, Ken A; Sabo, Samantha; Reinschmidt, Kerstin M; Gomez, Sofia; Zapien, Jill Guernsey De; Carvajal, Scott C A community health worker intervention to address the social determinants of health through policy change Journal Article The Journal of primary Prevention, 35 (2), pp. 119-123, 2014. @article{Ingram2014, title = {A community health worker intervention to address the social determinants of health through policy change}, author = {Maia Ingram and Ken A Schachter and Samantha Sabo and Kerstin M Reinschmidt and Sofia Gomez and Jill Guernsey De Zapien and Scott C Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/24363179}, doi = {10.1007/s10935-013-0335-y}, year = {2014}, date = {2014-04-01}, journal = {The Journal of primary Prevention}, volume = {35}, number = {2}, pages = {119-123}, abstract = {Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services. |
2013 |
Sabo, Samantha; Ingram, Maia; Reinschmidt, Kerstin M; Schachter, Kenneth; Jacobs, Laurel; de Zapien, Jill Guernsey; Robinson, Laurie; Carvajal, Scott Predictors and a framework for fostering community advocacy as a community health worker core function to eliminate health disparities Journal Article American Journal of Public health, 103 (7), pp. 67-73, 2013. @article{Sabo2013, title = {Predictors and a framework for fostering community advocacy as a community health worker core function to eliminate health disparities}, author = {Samantha Sabo and Maia Ingram and Kerstin M Reinschmidt and Kenneth Schachter and Laurel Jacobs and Jill Guernsey de Zapien and Laurie Robinson and Scott Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/23678904}, doi = {10.2105/AJPH.2012.301108}, year = {2013}, date = {2013-07-01}, journal = {American Journal of Public health}, volume = {103}, number = {7}, pages = {67-73}, abstract = {OBJECTIVES: Using a mixed-method, participatory research approach, we investigated factors related to community health worker (CHW) community advocacy that affect social determinants of health. METHODS: We used cross-sectional survey data for 371 CHWs to assess demographics, training, work environment, and leadership qualities on civic, political, and organizational advocacy. We present advocacy stories to further articulate CHW activities. The data reported are from the recently completed National Community Health Workers Advocacy Study. RESULTS: CHWs are involved in advocacy that is community-focused, although advocacy differs by intrinsic leadership, experience, training, and work environment. We propose a framework to conceptualize, support, and evaluate CHW advocacy and the iterative processes they engage in. These processes create opportunities for community voice and action to affect social and structural conditions that are known to have wide-ranging health effects on communities. CONCLUSIONS: The framework presented may have utility for CHWs, their training programs, and their employers as well as funders and policymakers aiming to promote health equity.}, keywords = {}, pubstate = {published}, tppubtype = {article} } OBJECTIVES: Using a mixed-method, participatory research approach, we investigated factors related to community health worker (CHW) community advocacy that affect social determinants of health. METHODS: We used cross-sectional survey data for 371 CHWs to assess demographics, training, work environment, and leadership qualities on civic, political, and organizational advocacy. We present advocacy stories to further articulate CHW activities. The data reported are from the recently completed National Community Health Workers Advocacy Study. RESULTS: CHWs are involved in advocacy that is community-focused, although advocacy differs by intrinsic leadership, experience, training, and work environment. We propose a framework to conceptualize, support, and evaluate CHW advocacy and the iterative processes they engage in. These processes create opportunities for community voice and action to affect social and structural conditions that are known to have wide-ranging health effects on communities. CONCLUSIONS: The framework presented may have utility for CHWs, their training programs, and their employers as well as funders and policymakers aiming to promote health equity. |
2012 |
Ingram, Maia; Reinschmidt, Kerstin M; Schachter, Ken A; Davidson, Chris L; Sabo, Samantha; Zapien, Jill Guernsey De; Carvajal, Scott C Establishing a professional profile of community health workers: results from a national study of roles, activities and training Journal Article Journal of Community Health, 37 (2), pp. 529-537, 2012. @article{Ingram2012, title = {Establishing a professional profile of community health workers: results from a national study of roles, activities and training}, author = {Maia Ingram and Kerstin M Reinschmidt and Ken A Schachter and Chris L Davidson and Samantha Sabo and Jill Guernsey De Zapien and Scott C Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/21964912}, doi = {10.1007/s10900-011-9475-2}, year = {2012}, date = {2012-04-01}, journal = {Journal of Community Health}, volume = {37}, number = {2}, pages = {529-537}, abstract = {Community Health Workers (CHWs) have gained national recognition for their role in addressing health disparities and are increasingly integrated into the health care delivery system. There is a lack of consensus, however, regarding empirical evidence on the impact of CHW interventions on health outcomes. In this paper, we present results from the 2010 National Community Health Worker Advocacy Survey (NCHWAS) in an effort to strengthen a generalized understanding of the CHW profession that can be integrated into ongoing efforts to improve the health care delivery system. Results indicate that regardless of geographical location, work setting, and demographic characteristics, CHWs generally share similar professional characteristics, training preparation, and job activities. CHWs are likely to be female, representative of the community they serve, and to work in community health centers, clinics, community-based organizations, and health departments. The most common type of training is on-the-job and conference training. Most CHWs work with clients, groups, other CHWs and less frequently community leaders to address health issues, the most common of which are chronic disease, prevention and health care access. Descriptions of CHW activities documented in the survey demonstrate that CHWs apply core competencies in a synergistic manner in an effort to assure that their clients get the services they need. NCHWAS findings suggest that over the past 50 years, the CHW field has become standardized in response to the unmet needs of their communities. In research and practice, the field would benefit from being considered a health profession rather than an intervention.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community Health Workers (CHWs) have gained national recognition for their role in addressing health disparities and are increasingly integrated into the health care delivery system. There is a lack of consensus, however, regarding empirical evidence on the impact of CHW interventions on health outcomes. In this paper, we present results from the 2010 National Community Health Worker Advocacy Survey (NCHWAS) in an effort to strengthen a generalized understanding of the CHW profession that can be integrated into ongoing efforts to improve the health care delivery system. Results indicate that regardless of geographical location, work setting, and demographic characteristics, CHWs generally share similar professional characteristics, training preparation, and job activities. CHWs are likely to be female, representative of the community they serve, and to work in community health centers, clinics, community-based organizations, and health departments. The most common type of training is on-the-job and conference training. Most CHWs work with clients, groups, other CHWs and less frequently community leaders to address health issues, the most common of which are chronic disease, prevention and health care access. Descriptions of CHW activities documented in the survey demonstrate that CHWs apply core competencies in a synergistic manner in an effort to assure that their clients get the services they need. NCHWAS findings suggest that over the past 50 years, the CHW field has become standardized in response to the unmet needs of their communities. In research and practice, the field would benefit from being considered a health profession rather than an intervention. |
2010 |
Reinschmidt, Kerstin M; Teufel-Shone, Nicolette; Bradford, Gail; Drummond, Rebecca L; Torres, Emma; Redondo, Floribella; Elenes, Jo Jean; Sanders, Alicia; Gastelum, Sylvia; Moore-Monroy, Martha; Barajas, Salvador; Fernandez, Lourdes; Alvidrez, Rosy; de Zapien, Jill Guernsey; Staten, Lisa K Taking a broad approach to public health program adaptation: adapting a family-based diabetes education program Journal Article The Journal of Primary Prevention, 31 (1-2), pp. 69-83, 2010. @article{Reinschmidt2010, title = {Taking a broad approach to public health program adaptation: adapting a family-based diabetes education program}, author = {Kerstin M Reinschmidt and Nicolette Teufel-Shone and Gail Bradford and Rebecca L Drummond and Emma Torres and Floribella Redondo and Jo Jean Elenes and Alicia Sanders and Sylvia Gastelum and Martha Moore-Monroy and Salvador Barajas and Lourdes Fernandez and Rosy Alvidrez and Jill Guernsey de Zapien and Lisa K Staten}, url = {https://www.ncbi.nlm.nih.gov/pubmed/20140646}, doi = {10.1007/s10935-010-0208-6}, year = {2010}, date = {2010-04-01}, journal = {The Journal of Primary Prevention}, volume = {31}, number = {1-2}, pages = {69-83}, abstract = {Diabetes health disparities among Hispanic populations have been countered with federally funded health promotion and disease prevention programs. Dissemination has focused on program adaptation to local cultural contexts for greater acceptability and sustainability. Taking a broader approach and drawing on our experience in Mexican American communities at the U.S.-Mexico Border, we demonstrate how interventions are adapted at the intersection of multiple cultural contexts: the populations targeted, the community- and university-based entities designing and implementing interventions, and the field team delivering the materials. Program adaptation involves negotiations between representatives of all contexts and is imperative in promoting local ownership and program sustainability.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Diabetes health disparities among Hispanic populations have been countered with federally funded health promotion and disease prevention programs. Dissemination has focused on program adaptation to local cultural contexts for greater acceptability and sustainability. Taking a broader approach and drawing on our experience in Mexican American communities at the U.S.-Mexico Border, we demonstrate how interventions are adapted at the intersection of multiple cultural contexts: the populations targeted, the community- and university-based entities designing and implementing interventions, and the field team delivering the materials. Program adaptation involves negotiations between representatives of all contexts and is imperative in promoting local ownership and program sustainability. |