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. |
Sabo, Samantha; Wexler, Nancy; O'Meara, Louisa; Dreifuss, Heather; Soto, Yanitza; Redondo, Floribella; Carter, Heather; de Zapien, Jill Guernsey; Ingram, Maia Frontiers in Public Health, 9 , 2021. @article{Sabo2021b, title = {Organizational Readiness for Community Health Worker Workforce Integration Among Medicaid Contracted Health Plans and Provider Networks: An Arizona Case Study}, author = {Samantha Sabo and Nancy Wexler and Louisa O'Meara and Heather Dreifuss and Yanitza Soto and Floribella Redondo and Heather Carter and Jill Guernsey de Zapien and Maia Ingram}, url = {https://www.frontiersin.org/articles/10.3389/fpubh.2021.601908/full}, doi = {10.3389/fpubh.2021.601908}, year = {2021}, date = {2021-06-07}, journal = {Frontiers in Public Health}, volume = {9}, abstract = {Understanding and building organizational capacity for system change and the integration of the Community Health Worker (CHW) workforce within the health scare sector requires a supportive organizational culture among sector leaders and providers. The aim of this mixed-methods study was to assess organizational readiness for CHW workforce integration into Arizona Medicaid health systems and care teams. This collaborative effort was in direct response to emergent state and national CHW workforce policy opportunities, and the shifting health care landscape in Arizona – which merged behavior and physical health. Specifically, and in collaboration with a broad-based, statewide CHW workforce coalition, led by the CHW professional association, we assessed 245 licensed health care professionals with experience working with CHWs and 16 Medicaid-contracted health plan leadership. Our goal was to generate a baseline understanding of the knowledge, attitudes and beliefs these stakeholders held about the integration of CHWs into systems and teams. Our findings demonstrate a high level of organizational readiness and action toward integration of CHWs within the Arizona health care system and care teams. CHWs have emerged as a health care workforce able to enhance the patient experience of care, improve population health, reduce cost of care, and improve the experience of providing care among clinicians and staff.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Understanding and building organizational capacity for system change and the integration of the Community Health Worker (CHW) workforce within the health scare sector requires a supportive organizational culture among sector leaders and providers. The aim of this mixed-methods study was to assess organizational readiness for CHW workforce integration into Arizona Medicaid health systems and care teams. This collaborative effort was in direct response to emergent state and national CHW workforce policy opportunities, and the shifting health care landscape in Arizona – which merged behavior and physical health. Specifically, and in collaboration with a broad-based, statewide CHW workforce coalition, led by the CHW professional association, we assessed 245 licensed health care professionals with experience working with CHWs and 16 Medicaid-contracted health plan leadership. Our goal was to generate a baseline understanding of the knowledge, attitudes and beliefs these stakeholders held about the integration of CHWs into systems and teams. Our findings demonstrate a high level of organizational readiness and action toward integration of CHWs within the Arizona health care system and care teams. CHWs have emerged as a health care workforce able to enhance the patient experience of care, improve population health, reduce cost of care, and improve the experience of providing care among clinicians and staff. |
Sabo, Samantha; Wightman, Patrick; McCue, Kelly; Butler, Matthew; Pilling, Vern; andMartín Celaya, Dulce Jimenez J; Rumann, Sara BMJ Open, 11 (6), 2021. @article{Sabo2021d, title = {Addressing maternal and child health equity through a community health worker home visiting intervention to reduce low birth weight: retrospective quasi-experimental study of the Arizona Health Start Programme}, author = {Samantha Sabo and Patrick Wightman and Kelly McCue and Matthew Butler and Vern Pilling and Dulce J Jimenez andMartín Celaya and Sara Rumann}, url = {http://dx.doi.org/10.1136/bmjopen-2020-045014}, doi = {10.1136/bmjopen-2020-045014}, year = {2021}, date = {2021-05-01}, journal = {BMJ Open}, volume = {11}, number = {6}, abstract = {To test if participation in the Health Start Programme, an Arizona statewide Community Health Worker (CHW) maternal and child health (MCH) home visiting programme, reduced rates of low birth weight (LBW), very LBW (VLBW), extremely LBW (ELBW) and preterm birth (PTB).}, keywords = {}, pubstate = {published}, tppubtype = {article} } To test if participation in the Health Start Programme, an Arizona statewide Community Health Worker (CHW) maternal and child health (MCH) home visiting programme, reduced rates of low birth weight (LBW), very LBW (VLBW), extremely LBW (ELBW) and preterm birth (PTB). |
Lockhart, Elizabeth; Turner, DeAnne; Martinez-Tyson, Dinorah; Baldwin, Julie A; Marhefka, Stephanie L Opportunities for and Perceptions of Integrating Community Health Workers Via the Affordable Care Act: Medicaid Health Homes Journal Article Journal of Public Health Management and Practice, 27 (01), pp. 193-200, 2021. @article{Lockhart2021, title = {Opportunities for and Perceptions of Integrating Community Health Workers Via the Affordable Care Act: Medicaid Health Homes}, author = {Elizabeth Lockhart and DeAnne Turner and Dinorah Martinez-Tyson and Julie A Baldwin and Stephanie L Marhefka}, url = {https://journals.lww.com/jphmp/Fulltext/2021/03000/Opportunities_for_and_Perceptions_of_Integrating.14.aspx}, doi = {10.1097/PHH.0000000000001118}, year = {2021}, date = {2021-03-01}, journal = {Journal of Public Health Management and Practice}, volume = {27}, number = {01}, pages = {193-200}, abstract = {The Affordable Care Act created opportunities for innovative, cost-saving measures to improve health care access. Community health workers (CHWs) are frontline public health workers who have a close understanding of the communities they serve. States that expanded Medicaid coverage could also create Medicaid Health Homes (MHHs)-virtual health care networks-to coordinate care for people with chronic conditions. New York was the second state to implement MHHs and gave the option to include CHWs as part of the health care team.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The Affordable Care Act created opportunities for innovative, cost-saving measures to improve health care access. Community health workers (CHWs) are frontline public health workers who have a close understanding of the communities they serve. States that expanded Medicaid coverage could also create Medicaid Health Homes (MHHs)-virtual health care networks-to coordinate care for people with chronic conditions. New York was the second state to implement MHHs and gave the option to include CHWs as part of the health care team. |
Valdez, Elizabeth Salerno; Sabo, Samantha; Butler, Matthew; Camplain, Ricky; Simpson, Rosi; Castro, Yara Perinatal Depression Symptom Prevalence on the U.S.–Mexico Border Journal Article Journal of Rural Mental Health, 43 (1), pp. 38-44, 2019. @article{Valdez2019, title = {Perinatal Depression Symptom Prevalence on the U.S.–Mexico Border}, author = {Elizabeth Salerno Valdez and Samantha Sabo and Matthew Butler and Ricky Camplain and Rosi Simpson and Yara Castro}, editor = {PhD James L. Werth}, url = {https://psycnet.apa.org/record/2019-06780-004?doi=1}, year = {2019}, date = {2019-01-01}, journal = {Journal of Rural Mental Health}, volume = {43}, number = {1}, pages = {38-44}, abstract = {At the U.S.–Mexico border, immigration policies have been documented to exacerbate health inequities among immigrant communities. We examined the prevalence of perinatal depressive symptomatology among Mexican-origin mothers living on the U.S.–Mexico border. Data for 1,629 pre- and postnatal women were drawn from a Community Health Worker Home Visiting Program from 2008 to 2016. Participants were screened for perinatal depressive symptomatology using the Edinburgh Postnatal Depression Scale (EPDS). Prevalence and associated 95% confidence intervals for prenatal and postnatal depression scores were estimated among women with prenatal depression scores only, postnatal depression scores only, and among women with both prenatal and postnatal scores by year and by participant characteristics. Participants were predominantly Mexican, Spanish-speaking, unmarried, with less than high school education, and with an annual income of less than $15,000. Prenatal and postnatal EPDS scores indicating low risk for depression (i.e., 0–5) ranged from 59.4% to 64.8% and 62.2% to 71.9%, respectively. Moderate risk prenatal and postnatal EPDS scores (i.e., 6–12) ranged from 28.6% to 32.1% and 22.8% to 25.6%, respectively. High-risk prenatal and postnatal EPDS scores (i.e., ≥13) ranged from 6.6% to 8.5% and 5.3% to 12.3%, respectively. In the context of a proliferation of anti-immigrant policies that jeopardize social determinants of maternal well-being, we observed a sustained upward trend in mean EPDS scores. U.S.–Mexico border women may be at particular risk for discrimination, stress, and victimization because of U.S. immigration and border security policies. This brief report generates a baseline prevalence of perinatal depressive symptomatology among women of Mexican origin and offers public health research explanations for maternal mental well-being at the U.S.–Mexico border. (PsycINFO Database Record (c) 2019 APA, all rights reserved)}, keywords = {}, pubstate = {published}, tppubtype = {article} } At the U.S.–Mexico border, immigration policies have been documented to exacerbate health inequities among immigrant communities. We examined the prevalence of perinatal depressive symptomatology among Mexican-origin mothers living on the U.S.–Mexico border. Data for 1,629 pre- and postnatal women were drawn from a Community Health Worker Home Visiting Program from 2008 to 2016. Participants were screened for perinatal depressive symptomatology using the Edinburgh Postnatal Depression Scale (EPDS). Prevalence and associated 95% confidence intervals for prenatal and postnatal depression scores were estimated among women with prenatal depression scores only, postnatal depression scores only, and among women with both prenatal and postnatal scores by year and by participant characteristics. Participants were predominantly Mexican, Spanish-speaking, unmarried, with less than high school education, and with an annual income of less than $15,000. Prenatal and postnatal EPDS scores indicating low risk for depression (i.e., 0–5) ranged from 59.4% to 64.8% and 62.2% to 71.9%, respectively. Moderate risk prenatal and postnatal EPDS scores (i.e., 6–12) ranged from 28.6% to 32.1% and 22.8% to 25.6%, respectively. High-risk prenatal and postnatal EPDS scores (i.e., ≥13) ranged from 6.6% to 8.5% and 5.3% to 12.3%, respectively. In the context of a proliferation of anti-immigrant policies that jeopardize social determinants of maternal well-being, we observed a sustained upward trend in mean EPDS scores. U.S.–Mexico border women may be at particular risk for discrimination, stress, and victimization because of U.S. immigration and border security policies. This brief report generates a baseline prevalence of perinatal depressive symptomatology among women of Mexican origin and offers public health research explanations for maternal mental well-being at the U.S.–Mexico border. (PsycINFO Database Record (c) 2019 APA, all rights reserved) |
Sabo, Samantha; Allen, Caitlin G; Sutkowi, Katherine; Wennerstrom, Ashley Community health workers in the United States: Challenges in identifying, surveying, and supporting the workforce Journal Article American Journal of Public Health, 107 (12), pp. 1964-1969, 2017. @article{Sabo2017, title = {Community health workers in the United States: Challenges in identifying, surveying, and supporting the workforce}, author = {Samantha Sabo and Caitlin G Allen and Katherine Sutkowi and Ashley Wennerstrom}, url = {https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304096}, year = {2017}, date = {2017-11-08}, journal = {American Journal of Public Health}, volume = {107}, number = {12}, pages = {1964-1969}, abstract = {Community health workers (CHWs) are members of a growing profession in the United States. Studying this dynamic labor force is challenging, in part because its members have more than 100 different job titles. The demand for timely, accurate information about CHWs is increasing as the profession gains recognition for its ability to improve health outcomes and reduce costs. Although numerous surveys of CHWs have been conducted, the field lacks well-delineated methods for gaining access to this hard-to-identify workforce. We outline methods for surveying CHWs and promising approaches to engage the workforce and other stakeholders in conducting local, state, and national studies. We also highlight successful strategies to overcome challenges in CHW surveys and future directions for surveying the field.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community health workers (CHWs) are members of a growing profession in the United States. Studying this dynamic labor force is challenging, in part because its members have more than 100 different job titles. The demand for timely, accurate information about CHWs is increasing as the profession gains recognition for its ability to improve health outcomes and reduce costs. Although numerous surveys of CHWs have been conducted, the field lacks well-delineated methods for gaining access to this hard-to-identify workforce. We outline methods for surveying CHWs and promising approaches to engage the workforce and other stakeholders in conducting local, state, and national studies. We also highlight successful strategies to overcome challenges in CHW surveys and future directions for surveying the field. |
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. |
Ingram, Maia; Doubleday, Kevin; Bell, Melanie L; Lohr, Abby; Murrieta, Lucy; Velasco, Maria; Blackburn, John; Sabo, Samantha; de Zapien, Jill Guernsey; Carvajal, Scott C Community health worker impact on chronic disease outcomes within primary care examined using electronic health records Journal Article American Journal of Public health, 107 (10), pp. 1668-1674, 2017. @article{Ingram2017b, title = {Community health worker impact on chronic disease outcomes within primary care examined using electronic health records}, author = {Maia Ingram and Kevin Doubleday and Melanie L Bell and Abby Lohr and Lucy Murrieta and Maria Velasco and John Blackburn and Samantha Sabo and Jill Guernsey de Zapien and Scott C Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/28817321}, doi = {10.2105/AJPH.2017.303934}, year = {2017}, date = {2017-09-13}, journal = {American Journal of Public health}, volume = {107}, number = {10}, pages = {1668-1674}, abstract = {Objectives. To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). Methods. We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. Results. Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = −0.24, −0.06), body mass index decreased 0.29 kilograms per meter squared (CI = –0.39, −0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = −13.5, −10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = –0.7, −0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = −0.14, −0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = −39.0, −6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = −6.6, −0.6) in health center 1 was the only improvement tied to CHW contact. Conclusions. Although patients’ chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs’ evolution may elucidate CHW contributions moving forward.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objectives. To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). Methods. We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. Results. Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = −0.24, −0.06), body mass index decreased 0.29 kilograms per meter squared (CI = –0.39, −0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = −13.5, −10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = –0.7, −0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = −0.14, −0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = −39.0, −6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = −6.6, −0.6) in health center 1 was the only improvement tied to CHW contact. Conclusions. Although patients’ chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs’ evolution may elucidate CHW contributions moving forward. |
Sabo, Samantha; Wennerstrom, Ashley; Phillips, David; Haywoord, Catherine; Redondo, Floribella; Bell, Melanie L; Ingram, Maia Community Health Worker Professional Advocacy: Voices of Action from the 2014 National Community Health Worker Advocacy Survey Journal Article The Journal of Ambulatory Care Management, 38 (2), pp. 225-235, 2015. @article{Sabo2015, title = {Community Health Worker Professional Advocacy: Voices of Action from the 2014 National Community Health Worker Advocacy Survey}, author = {Samantha Sabo and Ashley Wennerstrom and David Phillips and Catherine Haywoord and Floribella Redondo and Melanie L Bell and Maia Ingram}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26049652}, doi = {10.1097/JAC.0000000000000089}, year = {2015}, date = {2015-08-01}, journal = {The Journal of Ambulatory Care Management}, volume = {38}, number = {2}, pages = {225-235}, abstract = {This mixed-methods study explores community health worker (CHW) engagement in professional advocacy. Data from the National Community Health Worker Advocacy Survey (n = 1661) assessed the relationship between CHW professional advocacy and CHW demographics, and work characteristics. Qualitative data articulated the quality of professional advocacy efforts. Approximately, 30% of CHW respondents advocated for professional advancement or collaborated with other CHWs to advance the workforce. Advocacy was more prevalent among CHWs affiliated with a professional network. CHW advocacy targeted recognition of the field, appropriate training and compensation, and sustainable funding. CHW professional advocacy is imperative to advancement of the field.}, keywords = {}, pubstate = {published}, tppubtype = {article} } This mixed-methods study explores community health worker (CHW) engagement in professional advocacy. Data from the National Community Health Worker Advocacy Survey (n = 1661) assessed the relationship between CHW professional advocacy and CHW demographics, and work characteristics. Qualitative data articulated the quality of professional advocacy efforts. Approximately, 30% of CHW respondents advocated for professional advancement or collaborated with other CHWs to advance the workforce. Advocacy was more prevalent among CHWs affiliated with a professional network. CHW advocacy targeted recognition of the field, appropriate training and compensation, and sustainable funding. CHW professional advocacy is imperative to advancement of the field. |
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. |
Gwede, Clement K; Ashley, Atalie A; McGinnis, Kara; Montiel-Ishino, Alejandro F; Standifer, Maisha; Baldwin, Julie A; Williams, Coni; Sneed, Kevin B; Wathington, Deanna; Dash-Pitts, Lolita; Green, Lee B Designing a community-based lay health advisor training curriculum to address cancer health disparities Journal Article Health Promotion Practice, 14 (3), pp. 415-424, 2013. @article{Gwede2013, title = {Designing a community-based lay health advisor training curriculum to address cancer health disparities}, author = {Clement K Gwede and Atalie A Ashley and Kara McGinnis and Alejandro F Montiel-Ishino and Maisha Standifer and Julie A Baldwin and Coni Williams and Kevin B Sneed and Deanna Wathington and Lolita Dash-Pitts and Lee B Green}, url = {https://www.ncbi.nlm.nih.gov/pubmed/22982709}, doi = {10.1177/1524839912458675}, year = {2013}, date = {2013-05-01}, journal = {Health Promotion Practice}, volume = {14}, number = {3}, pages = {415-424}, abstract = {INTRODUCTION: Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. DISCUSSION AND CONCLUSIONS: Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.}, keywords = {}, pubstate = {published}, tppubtype = {article} } INTRODUCTION: Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. DISCUSSION AND CONCLUSIONS: Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research. |
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. |
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. |
2021 |
Sabo, Samantha; Wexler, Nancy; O'Meara, Louisa; Dreifuss, Heather; Soto, Yanitza; Redondo, Floribella; Carter, Heather; de Zapien, Jill Guernsey; Ingram, Maia Frontiers in Public Health, 9 , 2021. @article{Sabo2021b, title = {Organizational Readiness for Community Health Worker Workforce Integration Among Medicaid Contracted Health Plans and Provider Networks: An Arizona Case Study}, author = {Samantha Sabo and Nancy Wexler and Louisa O'Meara and Heather Dreifuss and Yanitza Soto and Floribella Redondo and Heather Carter and Jill Guernsey de Zapien and Maia Ingram}, url = {https://www.frontiersin.org/articles/10.3389/fpubh.2021.601908/full}, doi = {10.3389/fpubh.2021.601908}, year = {2021}, date = {2021-06-07}, journal = {Frontiers in Public Health}, volume = {9}, abstract = {Understanding and building organizational capacity for system change and the integration of the Community Health Worker (CHW) workforce within the health scare sector requires a supportive organizational culture among sector leaders and providers. The aim of this mixed-methods study was to assess organizational readiness for CHW workforce integration into Arizona Medicaid health systems and care teams. This collaborative effort was in direct response to emergent state and national CHW workforce policy opportunities, and the shifting health care landscape in Arizona – which merged behavior and physical health. Specifically, and in collaboration with a broad-based, statewide CHW workforce coalition, led by the CHW professional association, we assessed 245 licensed health care professionals with experience working with CHWs and 16 Medicaid-contracted health plan leadership. Our goal was to generate a baseline understanding of the knowledge, attitudes and beliefs these stakeholders held about the integration of CHWs into systems and teams. Our findings demonstrate a high level of organizational readiness and action toward integration of CHWs within the Arizona health care system and care teams. CHWs have emerged as a health care workforce able to enhance the patient experience of care, improve population health, reduce cost of care, and improve the experience of providing care among clinicians and staff.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Understanding and building organizational capacity for system change and the integration of the Community Health Worker (CHW) workforce within the health scare sector requires a supportive organizational culture among sector leaders and providers. The aim of this mixed-methods study was to assess organizational readiness for CHW workforce integration into Arizona Medicaid health systems and care teams. This collaborative effort was in direct response to emergent state and national CHW workforce policy opportunities, and the shifting health care landscape in Arizona – which merged behavior and physical health. Specifically, and in collaboration with a broad-based, statewide CHW workforce coalition, led by the CHW professional association, we assessed 245 licensed health care professionals with experience working with CHWs and 16 Medicaid-contracted health plan leadership. Our goal was to generate a baseline understanding of the knowledge, attitudes and beliefs these stakeholders held about the integration of CHWs into systems and teams. Our findings demonstrate a high level of organizational readiness and action toward integration of CHWs within the Arizona health care system and care teams. CHWs have emerged as a health care workforce able to enhance the patient experience of care, improve population health, reduce cost of care, and improve the experience of providing care among clinicians and staff. |
Sabo, Samantha; Wightman, Patrick; McCue, Kelly; Butler, Matthew; Pilling, Vern; andMartín Celaya, Dulce Jimenez J; Rumann, Sara BMJ Open, 11 (6), 2021. @article{Sabo2021d, title = {Addressing maternal and child health equity through a community health worker home visiting intervention to reduce low birth weight: retrospective quasi-experimental study of the Arizona Health Start Programme}, author = {Samantha Sabo and Patrick Wightman and Kelly McCue and Matthew Butler and Vern Pilling and Dulce J Jimenez andMartín Celaya and Sara Rumann}, url = {http://dx.doi.org/10.1136/bmjopen-2020-045014}, doi = {10.1136/bmjopen-2020-045014}, year = {2021}, date = {2021-05-01}, journal = {BMJ Open}, volume = {11}, number = {6}, abstract = {To test if participation in the Health Start Programme, an Arizona statewide Community Health Worker (CHW) maternal and child health (MCH) home visiting programme, reduced rates of low birth weight (LBW), very LBW (VLBW), extremely LBW (ELBW) and preterm birth (PTB).}, keywords = {}, pubstate = {published}, tppubtype = {article} } To test if participation in the Health Start Programme, an Arizona statewide Community Health Worker (CHW) maternal and child health (MCH) home visiting programme, reduced rates of low birth weight (LBW), very LBW (VLBW), extremely LBW (ELBW) and preterm birth (PTB). |
Lockhart, Elizabeth; Turner, DeAnne; Martinez-Tyson, Dinorah; Baldwin, Julie A; Marhefka, Stephanie L Opportunities for and Perceptions of Integrating Community Health Workers Via the Affordable Care Act: Medicaid Health Homes Journal Article Journal of Public Health Management and Practice, 27 (01), pp. 193-200, 2021. @article{Lockhart2021, title = {Opportunities for and Perceptions of Integrating Community Health Workers Via the Affordable Care Act: Medicaid Health Homes}, author = {Elizabeth Lockhart and DeAnne Turner and Dinorah Martinez-Tyson and Julie A Baldwin and Stephanie L Marhefka}, url = {https://journals.lww.com/jphmp/Fulltext/2021/03000/Opportunities_for_and_Perceptions_of_Integrating.14.aspx}, doi = {10.1097/PHH.0000000000001118}, year = {2021}, date = {2021-03-01}, journal = {Journal of Public Health Management and Practice}, volume = {27}, number = {01}, pages = {193-200}, abstract = {The Affordable Care Act created opportunities for innovative, cost-saving measures to improve health care access. Community health workers (CHWs) are frontline public health workers who have a close understanding of the communities they serve. States that expanded Medicaid coverage could also create Medicaid Health Homes (MHHs)-virtual health care networks-to coordinate care for people with chronic conditions. New York was the second state to implement MHHs and gave the option to include CHWs as part of the health care team.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The Affordable Care Act created opportunities for innovative, cost-saving measures to improve health care access. Community health workers (CHWs) are frontline public health workers who have a close understanding of the communities they serve. States that expanded Medicaid coverage could also create Medicaid Health Homes (MHHs)-virtual health care networks-to coordinate care for people with chronic conditions. New York was the second state to implement MHHs and gave the option to include CHWs as part of the health care team. |
2019 |
Valdez, Elizabeth Salerno; Sabo, Samantha; Butler, Matthew; Camplain, Ricky; Simpson, Rosi; Castro, Yara Perinatal Depression Symptom Prevalence on the U.S.–Mexico Border Journal Article Journal of Rural Mental Health, 43 (1), pp. 38-44, 2019. @article{Valdez2019, title = {Perinatal Depression Symptom Prevalence on the U.S.–Mexico Border}, author = {Elizabeth Salerno Valdez and Samantha Sabo and Matthew Butler and Ricky Camplain and Rosi Simpson and Yara Castro}, editor = {PhD James L. Werth}, url = {https://psycnet.apa.org/record/2019-06780-004?doi=1}, year = {2019}, date = {2019-01-01}, journal = {Journal of Rural Mental Health}, volume = {43}, number = {1}, pages = {38-44}, abstract = {At the U.S.–Mexico border, immigration policies have been documented to exacerbate health inequities among immigrant communities. We examined the prevalence of perinatal depressive symptomatology among Mexican-origin mothers living on the U.S.–Mexico border. Data for 1,629 pre- and postnatal women were drawn from a Community Health Worker Home Visiting Program from 2008 to 2016. Participants were screened for perinatal depressive symptomatology using the Edinburgh Postnatal Depression Scale (EPDS). Prevalence and associated 95% confidence intervals for prenatal and postnatal depression scores were estimated among women with prenatal depression scores only, postnatal depression scores only, and among women with both prenatal and postnatal scores by year and by participant characteristics. Participants were predominantly Mexican, Spanish-speaking, unmarried, with less than high school education, and with an annual income of less than $15,000. Prenatal and postnatal EPDS scores indicating low risk for depression (i.e., 0–5) ranged from 59.4% to 64.8% and 62.2% to 71.9%, respectively. Moderate risk prenatal and postnatal EPDS scores (i.e., 6–12) ranged from 28.6% to 32.1% and 22.8% to 25.6%, respectively. High-risk prenatal and postnatal EPDS scores (i.e., ≥13) ranged from 6.6% to 8.5% and 5.3% to 12.3%, respectively. In the context of a proliferation of anti-immigrant policies that jeopardize social determinants of maternal well-being, we observed a sustained upward trend in mean EPDS scores. U.S.–Mexico border women may be at particular risk for discrimination, stress, and victimization because of U.S. immigration and border security policies. This brief report generates a baseline prevalence of perinatal depressive symptomatology among women of Mexican origin and offers public health research explanations for maternal mental well-being at the U.S.–Mexico border. (PsycINFO Database Record (c) 2019 APA, all rights reserved)}, keywords = {}, pubstate = {published}, tppubtype = {article} } At the U.S.–Mexico border, immigration policies have been documented to exacerbate health inequities among immigrant communities. We examined the prevalence of perinatal depressive symptomatology among Mexican-origin mothers living on the U.S.–Mexico border. Data for 1,629 pre- and postnatal women were drawn from a Community Health Worker Home Visiting Program from 2008 to 2016. Participants were screened for perinatal depressive symptomatology using the Edinburgh Postnatal Depression Scale (EPDS). Prevalence and associated 95% confidence intervals for prenatal and postnatal depression scores were estimated among women with prenatal depression scores only, postnatal depression scores only, and among women with both prenatal and postnatal scores by year and by participant characteristics. Participants were predominantly Mexican, Spanish-speaking, unmarried, with less than high school education, and with an annual income of less than $15,000. Prenatal and postnatal EPDS scores indicating low risk for depression (i.e., 0–5) ranged from 59.4% to 64.8% and 62.2% to 71.9%, respectively. Moderate risk prenatal and postnatal EPDS scores (i.e., 6–12) ranged from 28.6% to 32.1% and 22.8% to 25.6%, respectively. High-risk prenatal and postnatal EPDS scores (i.e., ≥13) ranged from 6.6% to 8.5% and 5.3% to 12.3%, respectively. In the context of a proliferation of anti-immigrant policies that jeopardize social determinants of maternal well-being, we observed a sustained upward trend in mean EPDS scores. U.S.–Mexico border women may be at particular risk for discrimination, stress, and victimization because of U.S. immigration and border security policies. This brief report generates a baseline prevalence of perinatal depressive symptomatology among women of Mexican origin and offers public health research explanations for maternal mental well-being at the U.S.–Mexico border. (PsycINFO Database Record (c) 2019 APA, all rights reserved) |
2017 |
Sabo, Samantha; Allen, Caitlin G; Sutkowi, Katherine; Wennerstrom, Ashley Community health workers in the United States: Challenges in identifying, surveying, and supporting the workforce Journal Article American Journal of Public Health, 107 (12), pp. 1964-1969, 2017. @article{Sabo2017, title = {Community health workers in the United States: Challenges in identifying, surveying, and supporting the workforce}, author = {Samantha Sabo and Caitlin G Allen and Katherine Sutkowi and Ashley Wennerstrom}, url = {https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304096}, year = {2017}, date = {2017-11-08}, journal = {American Journal of Public Health}, volume = {107}, number = {12}, pages = {1964-1969}, abstract = {Community health workers (CHWs) are members of a growing profession in the United States. Studying this dynamic labor force is challenging, in part because its members have more than 100 different job titles. The demand for timely, accurate information about CHWs is increasing as the profession gains recognition for its ability to improve health outcomes and reduce costs. Although numerous surveys of CHWs have been conducted, the field lacks well-delineated methods for gaining access to this hard-to-identify workforce. We outline methods for surveying CHWs and promising approaches to engage the workforce and other stakeholders in conducting local, state, and national studies. We also highlight successful strategies to overcome challenges in CHW surveys and future directions for surveying the field.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community health workers (CHWs) are members of a growing profession in the United States. Studying this dynamic labor force is challenging, in part because its members have more than 100 different job titles. The demand for timely, accurate information about CHWs is increasing as the profession gains recognition for its ability to improve health outcomes and reduce costs. Although numerous surveys of CHWs have been conducted, the field lacks well-delineated methods for gaining access to this hard-to-identify workforce. We outline methods for surveying CHWs and promising approaches to engage the workforce and other stakeholders in conducting local, state, and national studies. We also highlight successful strategies to overcome challenges in CHW surveys and future directions for surveying the field. |
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. |
Ingram, Maia; Doubleday, Kevin; Bell, Melanie L; Lohr, Abby; Murrieta, Lucy; Velasco, Maria; Blackburn, John; Sabo, Samantha; de Zapien, Jill Guernsey; Carvajal, Scott C Community health worker impact on chronic disease outcomes within primary care examined using electronic health records Journal Article American Journal of Public health, 107 (10), pp. 1668-1674, 2017. @article{Ingram2017b, title = {Community health worker impact on chronic disease outcomes within primary care examined using electronic health records}, author = {Maia Ingram and Kevin Doubleday and Melanie L Bell and Abby Lohr and Lucy Murrieta and Maria Velasco and John Blackburn and Samantha Sabo and Jill Guernsey de Zapien and Scott C Carvajal}, url = {https://www.ncbi.nlm.nih.gov/pubmed/28817321}, doi = {10.2105/AJPH.2017.303934}, year = {2017}, date = {2017-09-13}, journal = {American Journal of Public health}, volume = {107}, number = {10}, pages = {1668-1674}, abstract = {Objectives. To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). Methods. We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. Results. Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = −0.24, −0.06), body mass index decreased 0.29 kilograms per meter squared (CI = –0.39, −0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = −13.5, −10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = –0.7, −0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = −0.14, −0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = −39.0, −6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = −6.6, −0.6) in health center 1 was the only improvement tied to CHW contact. Conclusions. Although patients’ chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs’ evolution may elucidate CHW contributions moving forward.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objectives. To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). Methods. We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. Results. Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = −0.24, −0.06), body mass index decreased 0.29 kilograms per meter squared (CI = –0.39, −0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = −13.5, −10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = –0.7, −0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = −0.14, −0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = −39.0, −6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = −6.6, −0.6) in health center 1 was the only improvement tied to CHW contact. Conclusions. Although patients’ chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs’ evolution may elucidate CHW contributions moving forward. |
2015 |
Sabo, Samantha; Wennerstrom, Ashley; Phillips, David; Haywoord, Catherine; Redondo, Floribella; Bell, Melanie L; Ingram, Maia Community Health Worker Professional Advocacy: Voices of Action from the 2014 National Community Health Worker Advocacy Survey Journal Article The Journal of Ambulatory Care Management, 38 (2), pp. 225-235, 2015. @article{Sabo2015, title = {Community Health Worker Professional Advocacy: Voices of Action from the 2014 National Community Health Worker Advocacy Survey}, author = {Samantha Sabo and Ashley Wennerstrom and David Phillips and Catherine Haywoord and Floribella Redondo and Melanie L Bell and Maia Ingram}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26049652}, doi = {10.1097/JAC.0000000000000089}, year = {2015}, date = {2015-08-01}, journal = {The Journal of Ambulatory Care Management}, volume = {38}, number = {2}, pages = {225-235}, abstract = {This mixed-methods study explores community health worker (CHW) engagement in professional advocacy. Data from the National Community Health Worker Advocacy Survey (n = 1661) assessed the relationship between CHW professional advocacy and CHW demographics, and work characteristics. Qualitative data articulated the quality of professional advocacy efforts. Approximately, 30% of CHW respondents advocated for professional advancement or collaborated with other CHWs to advance the workforce. Advocacy was more prevalent among CHWs affiliated with a professional network. CHW advocacy targeted recognition of the field, appropriate training and compensation, and sustainable funding. CHW professional advocacy is imperative to advancement of the field.}, keywords = {}, pubstate = {published}, tppubtype = {article} } This mixed-methods study explores community health worker (CHW) engagement in professional advocacy. Data from the National Community Health Worker Advocacy Survey (n = 1661) assessed the relationship between CHW professional advocacy and CHW demographics, and work characteristics. Qualitative data articulated the quality of professional advocacy efforts. Approximately, 30% of CHW respondents advocated for professional advancement or collaborated with other CHWs to advance the workforce. Advocacy was more prevalent among CHWs affiliated with a professional network. CHW advocacy targeted recognition of the field, appropriate training and compensation, and sustainable funding. CHW professional advocacy is imperative to advancement of the field. |
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. |
Gwede, Clement K; Ashley, Atalie A; McGinnis, Kara; Montiel-Ishino, Alejandro F; Standifer, Maisha; Baldwin, Julie A; Williams, Coni; Sneed, Kevin B; Wathington, Deanna; Dash-Pitts, Lolita; Green, Lee B Designing a community-based lay health advisor training curriculum to address cancer health disparities Journal Article Health Promotion Practice, 14 (3), pp. 415-424, 2013. @article{Gwede2013, title = {Designing a community-based lay health advisor training curriculum to address cancer health disparities}, author = {Clement K Gwede and Atalie A Ashley and Kara McGinnis and Alejandro F Montiel-Ishino and Maisha Standifer and Julie A Baldwin and Coni Williams and Kevin B Sneed and Deanna Wathington and Lolita Dash-Pitts and Lee B Green}, url = {https://www.ncbi.nlm.nih.gov/pubmed/22982709}, doi = {10.1177/1524839912458675}, year = {2013}, date = {2013-05-01}, journal = {Health Promotion Practice}, volume = {14}, number = {3}, pages = {415-424}, abstract = {INTRODUCTION: Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. DISCUSSION AND CONCLUSIONS: Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.}, keywords = {}, pubstate = {published}, tppubtype = {article} } INTRODUCTION: Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. DISCUSSION AND CONCLUSIONS: Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research. |
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. |