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PubMed1996

Enhancing the role of community-health workers in research.

With recognition of the importance of meeting the needs of underserved communities and the shift to more primary care-community-health workers need to be part of health teams. Community-health workers, in voluntary and salaried positions, augment the roles of professionals through outreach and community-based work and serve as liaisons between communities and institutions. This article describes the rationale for inclusion of community-health workers in research; their roles and responsibilities; and issues in their selection, training, and supervision. Examples are given from the authors' experience with interventions by nurse and community teams. Inclusion of community-health workers enriches the comprehensiveness of a holistic scientific approach to understanding health in a community.

Career Mobility↗
PubMed2005

Improving asthma research in an inner-city Latino neighborhood with community health workers.

This study tests the feasibility of a partnership between an academic medical center and community health workers to perform mutually beneficial research investigating asthma in an urban Latino neighborhood. Community heath workers participated in the study design, instrument development, implementation, and analysis. The 103 participants recruited by the community health workers were primarily Mexican with very low education and acculturation levels. After the 1-year enrollment period, the community health workers described the challenges of data collection and gave explanations for the access to care outcomes. This academic-community partnership showed that community health workers can be effective research partners.

Academic Medical Centers↗
PubMed2003

Poor performance of community health workers in Kalabo District, Zambia.

OBJECTIVE: To determine the factors contributing to low performance of community health workers in Kalabo District, Zambia. METHODS: In a cross-sectional descriptive study, 86 community members, 27 community health workers and nine rural health centre staff were interviewed using semi-structured questionnaires. Other methods were focus group discussions and checklists. Data analysis was done manually. RESULTS: The low performance of community health workers is a real problem for Kalabo District. The two most important factors are the irregular and unreliable supply of drugs and selection of the wrong people to be trained for community health workers. CONCLUSION: Though initially implemented as such, the comprehensive approach of the primary health care project is no longer functioning in Kalabo. Community health workers are mainly valued because of their curative services. Communities do not properly follow the official criteria for selection of people to be trained, but have other considerations. Strategies will have to be formulated to rehabilitate the programme, mainly focussing on these two findings. Other factors, like inadequate community support and inadequate supervision, were mentioned by many contributors.

Adolescent↗
PubMed1987

Characteristics and functions of community health workers in Saradidi, Kenya.

A community-based health development programme in Saradidi, Kenya had 126 village health helpers (VHH's) for the 56 villages. These volunteer health workers lived in the community and served a total population of about 43,000 in an area of 225 km2. Each VHH served a maximum of 100 households averaging 4.0 persons. Conditions imposed by the community were that the VHH be perceived to be a mature person, to be compassionate and to have a desire to help people and to live in the village. Literacy or formal education were not requirements. VHH's were chosen and supported by the people who lived in their village. Characteristics of the 126 VHH's were that 96.8% were women, 99.2% were married, 75.4% were between 25 and 39 years of age, and 80.2% had at least five years of formal education (only 7.1% had none). The VHH's spent an average five to ten days each month on programme activities in addition to their other responsibilities which included preparing meals, cleaning their homes, carrying water and firewood from long distances, caring for their children and cultivating food for their family. Each VHH visited about 15 households per month, spending one to two hours on a visit. Problems experienced by a random sample of 36 VHH's included difficulties due to lack of transport, lack of medicines, slowness of the community to accept new ideas, distance from project clinic, lack of food in the village, weak village health committees, and no payment for services. The main support for the VHH's came from village women individually, women's groups, and the central programme committee. Village Health Committees did not provide effective support. Nevertheless, in four years only four of the 126 VHH's dropped out of the programme. The main reasons that 36 VHH's reported for continuing to volunteer were as follows: the continuous training they were given was beneficial (mentioned by all); they agreed to serve the villages and did not want to go back on their word (36.1%); they liked the work (19.4%); they felt they have an impact on the health of people in the village (16.7%); the allowances they sometimes receive (22.2%); and personal development (13.9%). The characteristics and responsibilities of community health workers in Saradidi were similar to those elsewhere. The ingredients for a successful volunteer programme such as this one are present in many areas.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗
PubMed2006

People Improving the Community's Health: community health workers as agents of change.

People Improving the Community's Health (PITCH) uses teams of community health workers to provide targeted outreach, to enroll those eligible in health coverage plans, to provide information and linkages to health and social support services, and to engage community members in community improvement activities. The initiative is based on the assumption that communities must work on the determinants of health and effectively mobilize all their assets to improve not only individual health, but also community health. Developed with support from the Kellogg Foundation's Community Voices Initiative, PITCH addresses intertwined public health concerns about access to health care and community health improvement. Outcomes of PITCH include increased enrollment in health coverage plans as well as increased participation in community improvement activities. The PITCH initiative helps community members work together to unleash the enormous power for change that emerges when people connect to one another, thereby tapping the knowledge, skills, and resources of community members and institutions alike.

Community Health Planning↗
PubMed1998

Urban community health workers: selection, training, practice and outcomes.

The role, desirability and success of community health workers is debated. Conflicting reports have highlighted important concerns and provided guidelines. Particular issues identified are the necessity for both community and health professional input to determine needs and to ensure an acceptable selection process, training, support and accountability. Such steps were followed in the Greater Soweto Maternal Child Project. These are described together with the results achieved. Eight trained Soweto community health workers centered at Chiawelo Clinic and providing home based and neighbourhood health care undertake supervised Tuberculosis treatment, tracing of immunisation defaulters, and health education based on GOBI FFF (Grant JP, UNICEF:1985;94) and "Facts for Life" (UNICEF 1989-1993). They form a link between the community and government health care services and also other available resources. Over a period of 26 months, working from their own homes, they provided 14,254 health related services and in addition undertook 14,501 neighbourhood home visits. They were responsible for 8,710 referrals to the clinic or other relevant agencies for assistance. Incremental training has included HIV/AIDS counselling, advice on family planning with regular report back sessions and discussions. Participatory management involves all major role players. The community health workers have the approval and support of the Local Soweto Health Authority, the Civic Association and the communities they serve. On completion of the project, all were redeployed into local health service posts where it is intended that they form the nucleus of an expanding service. Delegation of selected tasks allows for cost effective functioning of more highly trained staff, an improved service and better use of available resources.

Adult↗
PubMed1999

Impact of community health workers on access, use of services, and patient knowledge and behavior.

Community health workers have been used in health centers for several decades. Known by various names (e.g., community health advisors, outreach workers, promotoras), they are trusted community members providing informal community-based health-related services and establishing vital links between health providers and the community. They perform many functions, including outreach and case finding, health education, translation, patient transportation, and case management (under the supervision of a nurse or social worker). This article, based on a study of community health worker programs at seven sites, is intended to share the lessons learned that could be helpful to other program managers and to examine the outcomes of such programs.

Community Health Centers↗
PubMed1999

Community health workers: examining the Helper Therapy principle.

A community approach to the integration of health and social services for low-income pregnant women is being addressed through Community Integrated Service System (CISS) initiatives of the Maternal Child Health Bureau. This particular CISS program model was designed to enable low-income mothers to function in a Community Health Worker (CHW) role providing social support for at-risk pregnant women. Using Riessman's notion of "helper therapy," the model was also developed to enhance the potential for CHWs to gain helper benefits. The purpose of this exploratory study was to describe perceived helper benefits and stressors associated with the CHW role and to examine the usefulness of an instrument developed to assess benefits and stressors. The study findings revealed that the majority of CHWs perceived helper benefits that included positive feelings about self, a sense of belonging, valuable work experience, and access to health information and skills through training or contact with program staff. Stressors such as feeling inadequate to help, however, were associated with the helper role for some CHWs. Preliminary analysis of the Helper's Perception Measure indicated that it may be an effective measure and should be tested with a larger sample of CHWs.

Adult↗
PubMed2006

Allies community health workers: Bridging the gap.

Allies Against Asthma coalitions each employ a community health worker (CHW) program as part of its community action plan. The structure and management of CHW programs vary in response to the resources and needs of the local community, as do the roles and characteristics of the CHWs hired. All programs utilize CHWs to provide community-based education and/or outreach to community members, primarily in their homes. Using an asthma action plan, most Allies CHW programs function as an extension of and link to the clinician, providing basic asthma education and care coordination in a supportive, family-friendly setting, context, and location. Community health workers rely heavily on relationship building and family empowerment to assist families in improving asthma control. Working within a coalition framework helps integrate the CHW program into other services and resources in the community. As participants in coalition activities, CHWs often bring an important and meaningful viewpoint to the coalition.

Adult↗
PubMed2006

The impact of community health worker training and programs in NYC.

The Northern Manhattan Community Voices Collaborative is committed to improving health care in Harlem, Washington Heights, Inwood, and low-income communities in New York City, large parts of which are home to many immigrants to the U.S. The collaborative developed a program to train and integrate community health workers (CHWs) into ongoing programs at partner community organizations. We report on our 2000-2005 experiences with CHWs for health insurance, child immunizations, and asthma management. A total of 1,504 CHWs were trained, with 16%-200% increase in CHW competency for selected skills. The CHWs facilitated health insurance enrollment for about 30,000 individuals, assisted 8,000 children to become completely immunized, and supported 4,000 families improving asthma management. Integration of CHW training into community programs is effective for empowering health promotion in underserved communities.

Community Health Planning↗
PubMed2006

Effectiveness of community health workers in the care of persons with diabetes.

AIMS: The purpose of this systematic review was to examine the effectiveness of community health workers in supporting the care of persons with diabetes. METHODS: Computerized searches were conducted of multiple electronic bibliographic dababases until March 2004. We identified studies in any language and of any design that examined the effectiveness of diabetes-related interventions involving community health workers and reported outcomes in persons with diabetes. Results were synthesized narratively. RESULTS: Eighteen studies were identified, including eight randomized controlled trials. Most studies focused on minority populations in the USA. The roles and duties of community health workers in diabetes care were varied, ranging from substantial involvement in patient care to providing instrumental assistance in education sessions taught by other health professionals. Participants were generally satisfied with their contacts with community health workers and participant knowledge increased. Improvements in physiological measures were noted for some interventions and positive changes in lifestyle and self-care were noted in a number of studies. There were few data on economic outcomes, but several studies demonstrated a decrease in inappropriate health care utilization. CONCLUSIONS: Diabetes programmes include community health workers as team members in a variety of roles. There are some preliminary data demonstrating improvements in participant knowledge and behaviour. Much additional research, however, is needed to understand the incremental benefit of community health workers in multicomponent interventions and to identify appropriate settings and optimal roles for community health workers in the care of persons with diabetes.

Community Health Services↗
PubMed1995

The clinical competency of community health workers in the eastern highlands province of Papua New Guinea.

A case study of the clinical competency of community health workers employed in the Eastern Highlands Province of Papua New Guinea was conducted in March 1993. Of the 79 who graduated from the Onamuga Community Health Worker Training School between 1989 and 1992, only 24 were currently employed in the province. Current knowledge and clinical competency were compared with results on completion of basic community health worker training. Results showed that 22 of the 24 maintained their knowledge competency, and 15 maintained clinical competency. It was found that those community health workers (CHWs) employed at a health subcentre use 40% to 50% of their skills, whilst those at a district health centre or provincial hospital use only 20% to 30% of their skills. Only 8% of the CHWs studied used all the skills obtained in their basic training. This study indicates that the CHW is being viewed by some health managers as a replacement for the nurse aide. If CHWs' skills are to be maintained, certainly good supervision, inservice training and adequate logistic support are needed, but so also is a change in management thinking. The CHW has been trained specifically to improve the access to essential primary health care services of people living in rural areas, especially in preventive and maternal and child health care. If in practice the CHW is not given the opportunity to practise and hence maintain these skills, the whole logic of the CHW training scheme will need to be reexamined.

Adult↗
PubMed1980

Workers' and community participation and democratic control in Cuba.

This article is a historical and current analysis and description of the evolution of worker, community, and popular participation and democratic control in Cuba since 1958. It contains: (a) an analysis of the political developments in the Cuban Revolution that led to the establishment of direct forms of democracy at the work-place and in the community; (b) a detailed analysis and account of how workers participate and control the processes of production and distribution of goods and services; and (c) an in-depth account and analysis of how people living in neighborhoods, rural and urban districts, municipalities, and provinces control the different levels and branches of the state apparatus--People's Power--and also how they participate in the implementation--through mass organizations--of state policies. The responsibilites, modus operandi, and relationships of the Communist Party, the trade unions, and other mass organizations, and the organs of People's Power, are also described and analyzed. The opportunities and problems, successes and failures, and strengths and weaknesses of the Cuban road to socialism and democracy are detailed. It is concluded that the Cuban Revolution has enhanced democracy most dramatically through the Cuban people's substantial involvement, participation, and control of their own lives.

Civil Disorders↗
PubMed2002

Validity and utility of community health workers' estimation of kava use.

OBJECTIVE: Estimating illicit substance use in epidemiological studies is challenging, particularly across ethical, cultural and language barriers. While developing the methods for a case-control study of the effects of heavy kava consumption among Aboriginal people in remote Northern Territory (NT), we examined the validity and utility of alternative methods for estimating exposure. METHODS: We assessed the level of agreement between a consensus of Aboriginal health workers in two different communities using interviews conducted with community members and health workers and individuals' self-reported kava consumption. Exposure measures included history of kava use, current kava use and history of heavy use. Agreement between a health worker consensus classification and individuals' self-report was analysed and agreement among several health workers in a consensus classification without self-report was assessed. RESULTS: Health workers concurred about an individual's history of kava use (k=0.83), current use (k=0.43) and also level of use (k=0.33). There was very good agreement between health workers' consensus and self-reported history of use (k=0.77). Agreement among health workers about current kava use was poor (k=0.08), while there was fair agreement between health workers and self-reported heavy kava users (k=0.36). Data from review of clinic patient notes supported agreement between consensus classification and self-reported history and level of use (k=0.39). CONCLUSIONS: Self-reported kava use may be a poor estimate of current use especially when obtained from interviews away from a confidential clinic setting. Consensus classification by knowledgeable Aboriginal health workers provided comprehensive coverage, efficiently and with greater reliability and assisted to identify 'excessive' kava use.

Community Health Workers↗
PubMed1997

Violence against women: an education program for rural community health workers.

This study aimed to identify the educational needs of community-based rural health professionals regarding violence against women, and was funded under the Rural Health Support, Education and Training (RHSET) program. Focus groups and teleconferences were conducted with health workers, organisations and key individuals in the Wide Bay Region, Queensland, Australia. As a result, an education package has been designed that will provide specific training in violence against women for rural and remote health professionals working in the field. Rural health community workers identified the need to enhance their intervention skills and understanding on the issue of violence against women. A distance education framework based on adult and guided learning principles has been developed to meet this need. Six areas were identified as important learning needs and included: (i) violence against women as a public health concern; (ii) The role of the community health worker; (iii) How the community health worker can empower women experiencing violence in their lives; (iv) Enhancing and developing supportive networks; (v) Building on community development action; and (vi) 'Where to next' for community health workers.

Adult↗
PubMed1985

An assessment of community health workers in Nicaragua.

In 1981, the Ministry of Health of Nicaragua began a series of health campaigns whose front-line workers were volunteers from the community called 'brigadistas.' These volunteers have since evolved into a type of community health worker with a multi-disciplinary role and are now called 'primary health care brigadistas'. These brigadistas were formed with the intention of encouraging local community involvement in health and as a means of overcoming rural health manpower shortages. However, in field research at two sites, these primary health care brigadistas were found to have rather limited roles and were dependent upon the nurse auxiliary for direction. A current debate in the Ministry of Health centers around the future role of the brigadistas and their degree of accountability to the Ministry of Health and the Popular Organizations. This article suggests that the brigadistas may be underutilized at present and that increasing their training and expanding their role may be necessary to adequately meet rural health care needs.

Adolescent↗