Diabetes Management: Interventions Engaging Community Health Workers

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends interventions that engage community health workers to help patients manage their diabetes. These interventions have been shown to improve patients’ glycemic and lipid control and reduce their healthcare use. Economic evidence indicates these interventions are cost-effective.

Interventions engaging community health workers in diabetes management are typically implemented in underserved communities and can improve health, reduce health disparities, and enhance health equity.

The CPSTF has related findings for interventions that engage community health workers:

Intervention

Interventions engaging community health workers for diabetes management aim to improve diabetes care and self-management behaviors among patients. Interventions include education, coaching, or social support to improve diabetes testing and monitoring, medication adherence, diet, physical activity, or weight management.

Community health workers deliver services and program content through one-on-one interactions or group sessions. Intervention activities take place in patients’ homes, or community or clinical settings. Community health workers may work alone or as part of an intervention team comprised of clinicians, counselors, or other health professionals (e.g., nutritionists, exercise physiologists).

Community health workers (including promotores de salud, community health representatives, community health advisors, and others) are frontline public health workers who serve as a bridge between underserved communities and healthcare systems. They typically are from or have a unique understanding of the community served. Community health workers often receive on-the-job training and work without professional titles. Organizations may hire paid community health workers or recruit volunteers.

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

About The Systematic Review

The CPSTF recommendation is based on evidence from a systematic review of 44 studies (search period through May 2015).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to diabetes prevention and control.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

Interventions that engage community health workers for diabetes management use one or more of the following models of care (HRSA 2007).

  • Screening and health education. Community health workers deliver individual or group education on diabetes self-management, provide adherence support for medications, and monitor patients’ blood pressure as recommended by the American Diabetes Association. For example, community health workers might teach patients how to plan healthy meals to improve glucose levels, or how to use a medication diary to track adherence (38 studies).
  • Outreach, enrollment, and information. Community health workers reach out to individuals and families who are eligible for medical services, help them apply for these services, and provide them with proactive follow-up and monitoring, such as appointment reminders and home visits. They might deliver social support at home, or monitor and follow-up on patients’ weight and blood pressure by phone (14 studies).
  • Member of care delivery team. Community health workers partner with patients and licensed providers, such as physicians and nurses, to improve coordinated care and support for patients. For example, community health workers could coordinate patients’ vision and foot care management (e.g., screening) with nurses to reduce diabetes complications (27 studies, of which 17 met criteria for team-based care).
  • Patient navigation. Community health workers help individuals and families navigate complex medical service systems and processes to increase their access to care. Community health workers could improve patients’ access to insurance or prepare them for healthcare visits (9 studies).
  • Community organizers. Community health workers may facilitate self-directed change and community development by serving as liaisons between communities and healthcare systems. For example, community health workers might serve as liaisons between the community and those implementing an intervention to ensure program materials are culturally appropriate and specific to their community (1 study).

Overall, included studies showed the following:

  • Interventions engaging community health workers improved patients’ glycemic or blood sugar control (HbA1c, proportion at goal A1c [A1c < 7.0%], fasting blood glucose) and reduced their healthcare use.
  • Improvements were seen for self-reported lifestyle changes (i.e. physical activity, nutrition).
  • Results were mixed for cardiovascular disease risk factors and weight-related outcomes.

Glycemic (Blood Sugar) Control

  • Mean HbA1c: median decrease of 0.49% (36 studies; median intervention duration: 12 months)
  • Proportion at goal A1c (A1c < 7.0%): median increase of 6.6% (7 studies; median duration: 12 months)
    • Three additional studies measured the proportion of participants who reached their A1c goal at different cutoffs and showed favorable increases.
  • Mean fasting blood glucose: median decrease of 29.5 mg/dL (6 studies; median duration: 12 months)
  • One study reported a mean decrease of 1.85% in A1c among participants whose baseline A1c was 9% or higher (p<0.001).

Healthcare Use

  • Studies reported decreases in emergency department visits among patients in intervention groups when compared to those in control groups.
    • There was a 26 percentage point decrease in the number of visits (p<0.05; 1 study)
    • The rate of visits was reduced by 44% (95% CI: -67% to -4%; 1 study)
    • There were 0.18 fewer visits (p=0.02; 1 study)
  • Studies reported changes in hospitalizations among patients in intervention groups when compared to those in control groups.
    • The rate of visits was reduced by 5% (95% CI: -45% to 66%; 1 study)
    • There were 0.45 more visits (p=0.02; 1 study)
  • One study reported non-significant improvements or decreases across all outcomes (i.e., outpatient visits, emergency department visits, hospitalizations, hospital days).

Cardiovascular Disease Risk Factors

  • Mean total cholesterol: median decrease of 8.9 mg/dL (12 studies; median duration: 12 months)
  • Mean low-density lipoprotein (LDL) cholesterol: median decrease of 6.9 mg/dL (14 studies; median duration: 12 months)
  • Mean high-density lipoprotein (HDL) cholesterol: median increase of 1.1 mg/dL (9 studies; median duration: 18 months)
  • Mean triglycerides: median decrease of 12.6 mg/dL (9 studies; median duration: 18 months)
  • Mean systolic blood pressure: median decrease of 0.5 mg/dL (22 studies; median duration: 12 months)
  • Mean diastolic blood pressure: median decrease of 0.74 mg/dL (18 studies; median duration: 12 months)

Weight-Related Outcomes

  • Mean weight: median increase of 1.1 lbs. (10 studies; median duration: 15 months)
  • Mean body mass index (BMI): median decrease of 0.2 kg/m2 (17 studies; median duration: 6 months)

Health Behavior Outcomes

  • Physical activity: significant improvements (median duration: 3 months; 3 studies), non-significant improvements (median duration: 6 months; 7 studies), no change (median duration: 9 months; 4 studies), and a decrease in physical activity (1 study)
  • Nutrition: significant improvements (2 studies), non-significant improvements (median duration: 6 months; 8 studies), and no change (2 studies).

Most included studies engaged community health workers to work with underserved groups suggesting these interventions can be effective in improving health and reducing health disparities related to populations at risk for diabetes (36 studies).

Additional Findings

In 17 of the included studies, community health workers were used in team-based care.

  • Patients’ glycemic control was the same when community health workers implemented interventions alone or were engaged in team-based care (-0.6% A1c for both)
  • Greater changes in blood pressure were seen among patients when community health workers were used in team-based care.
    • Interventions that engaged community health workers in team-based care decreased systolic blood pressure by 2.6 mmHg and diastolic blood pressure by 3.0 mmHg (10 studies)
    • Interventions that used community health workers alone increased systolic blood pressure by 2.2 mmHg and diastolic blood pressure by 1.4 mmHg (12 studies)
  • Three studies evaluated the incremental effectiveness of adding community health workers to diabetes management interventions and reported improvements in glycemic control (1 study) and blood pressure (2 studies).

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

Economic evidence indicates that interventions engaging community health workers for diabetes management are cost-effective. All monetary values are reported in 2016 U.S. dollars.

The economic review included 13 studies (10 from the United States, 2 from the United Kingdom, and 1 from Australia). Most patients in the studies came from minority or low-income populations.

  • Median intervention cost per person per year: $585 (13 studies)
  • Median change in healthcare cost per person per year: $72 reduction (4 studies)
  • Median cost per quality adjusted life year (QALY) gained: $38,276 (5 studies). This estimate falls below $50,000 a benchmark for cost-effectiveness.

Applicability

Based on results, the CPSTF finding should be applicable to interventions that engage community health workers in the following settings and populations:
  • Adults with type 2 diabetes
  • Women and men
  • Hispanics, African-Americans, and Asians
  • Low-income and low-education populations
  • Urban and rural environments
  • Clinics, community, and home settings

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)
  • How effective are large-scale programs (i.e., >500 participants), programs conducted in rural settings, and programs evaluated over a longer time period?
  • What are the challenges or barriers that impact the recruitment and retention of male clients?
  • How will changes in Centers for Medicaid (CMS) reimbursement rules affect the use of community health workers and the roles and services they provide?
  • How effective are interventions among younger and older adult populations?
  • What are the long-term effects on diabetes-related complications and health outcomes?
  • How can community health workers be more engaged as outreach, enrollment, and information agents, patient navigators, and community organizers?
  • What are the roles and effects of community health workers in a team-based care environment?

Study Characteristics

  • Included studies had the greatest suitability of design (individual randomized control trials [15 studies], group randomized controlled trials [5 studies], before-after with a comparison group [5 studies], other design with concurrent comparison groups [5 studies]); moderate suitability of design (retrospective cohort [1 study]); and least suitability of design (before-after without a comparison group [13 studies]).
  • Studies were conducted in the United States (39 studies), the United Kingdom (3 studies), and Australia (2 studies).
  • Studies were conducted in urban (21 studies), rural (6 studies), or mixed (3 studies) areas; 14 studies did not report this information.
  • Included studies evaluated interventions in clinics (e.g., primary care settings, Federally Qualified Health Centers; 13 studies), community centers (e.g., YMCA, faith-based organization; 6 studies), homes (3 studies), or multiple settings (22 studies).
  • In the included studies, CHWs served adults ages 18 64 years old (32 studies), older adults ages 65 years and older (1 study), adults 18 years and older (3 studies), or patients of all ages (3 studies); 5 studies did not report this information.
  • Participants had type 2 diabetes (31 studies), type 1 or 2 diabetes (6 studies), or diabetes of unspecified type (7 studies).
  • Across all 44 studies, more than 70% of participants were female.
  • Included studies mainly focused on underserved populations and targeted the following populations:
    • Latinos (16 studies), African-Americans (2 studies), Asians (3 studies), Native Hawaiian or Pacific Islanders (2 studies study), and American Indians (2 studies)
    • Low-income populations (18 studies; annual incomes of $30,000 or less)
    • People with less than high school education (14 studies), or people who averaged less than 12 years of education (8 studies)
  • Community health workers engaged participants using a team-based care approach (17 studies), as a member of care delivery team (10 studies), or as the primary implementer (17 studies).
    • In the 27 team studies, the other team members were most often physicians (19 studies), nurses (15 studies), or registered dietitians (12 studies).
  • Community health workers met a median of 3.5 of the 10 core roles defined in the Community Health Worker Core Consensus (C3 Project, 2016). These included the following:
    • Providing culturally appropriate information (37 studies)
    • Building individual and community capacity (33 studies)
    • Coaching (32 studies)
    • Coordinating care or case management (17 studies)

Analytic Framework

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

No content is available for this section.

Summary Evidence Table

Effectiveness Review

Content is in development.

Economic Review

Summary Evidence Table – Economic Review

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Babamoto KS, Sey KA, Camilleri AJ, Karlan VJ, Catalasan J, Morisky DE. Improving diabetes care and health measures among hispanics using community health workers: results from a randomized controlled trial. Health Education & Behavior 2009;36(1):113-26.

Beckham S, Bradley S, Washburn A, Taumua T. Diabetes management: utilizing community health workers in a Hawaiian/Samoan population. Journal of Health Care for the Poor and Underserved 2008;19(2):416-27.

Brown SA, Garcia AA, Kouzekanani K, Hanis CL. Culturally competent diabetes self-management education for Mexican Americans. Diabetes Care 2002;25(2):259-68.

Brown SA, Blozis SA, Kouzekanani K, Garcia AA, Winchell M, Hanis CL. Dosage effects of diabetes self-management education for Mexican Americans. Diabetes Care 2005;28(3):527-32.

Bush K, Thomas R, Raymond NT, Sankar S, Barker PJ, O’Hare JP. Cluster randomised controlled trial evaluation of a Link Worker delivered intervention to improve uptake of diabetic retinopathy screening in a South Asian population. Diabetes and Vascular Disease Research 2014;11(4):294-7.

Castillo A, Giachello A, Bates R, Concha J, Ramirez V, et al. Community-based diabetes education for Latinos The Diabetes Empowerment Education Program. Diabetes Educator 2010;36(4):586-94.

Collinsworth AW, Vulimiri M, Schmidt KL, Snead CA. Effectiveness of a community health worker led diabetes self-management education program and implications for CHW involvement in care coordination strategies. Diabetes Educator 2013;39(6):792-9.

Comellas M, Walker EA, Movsas S, Merkin S, Zonszein J, Strelnick H. Training community health promoters to implement diabetes self-management support programs for urban minority adults. Diabetes Educator 2010;36(1):141-51.

Culica D, Walton JW, Harker K, Prezio EA. Effectiveness of a community health worker as sole diabetes educator: comparison of CoDE with similar culturally appropriate interventions. Journal of Health Care for the Poor and Underserved 2008;19(4):1076-95.

Gary TL, Bone LR, Hill MN, Levine DM, McGuire M, et al. Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Preventive Medicine 2003;37(1):23-32.

Gary TL, Batts-Turner M, Yeh HC, Hill-Briggs F, Bone LR, et al. The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial. Archives of Internal Medicine 2009;169(19):1788-94.

Gilmer TP, Philis-Tsimikas A, Walker C. Outcomes of Project Dulce: a culturally specific diabetes management program. Annals of Pharmacotherapy 2005;39(5):817-22.

Grace SM, Rich J, Chin W, Rodriguez HP. Fidelity of implementation to a care team redesign and improved outcomes of diabetes care. International Journal for Quality in Health Care 2015;27(1):60-6.

Greenhalgh T, Campbell-Richards D, Vijayaraghavan S, Collard A, Malik F, et al. New models of self-management education for minority ethnic groups: pilot randomized trial of a story-sharing intervention. Journal of Health Services Research & Policy 2011;16(1):28-36.

Hargraves JL, Ferguson WJ, Lemay CA, Pernice J. Community health workers assisting patients with diabetes in self-management. Journal of Ambulatory Care Management 2012;35(1):15-26.

Heath GW, Leonard BE, Wilson RH, Kendrick JS, Powell KE. Community-based exercise intervention: Zuni diabetes project. Diabetes Care 1987;10(5):579-83.

Heisler M, Choi H, Palmisano G, Mase R, Richardson C, et al. Comparison of community health worker led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial, models of community health worker led diabetes medication decision-making support. Annals of Internal Medicine 2014;161(10_Supplement):S13-22.

Holtrop JS, Hickner J, Dosh S, Noel M, Ettenhofer TL. “Sticking to it Diabetes Mellitus”: a pilot study of an innovative behavior change program for women with type 2 diabetes. American Journal of Health Education 2002;33(3):161-6.

Humphry J, Jameson LM, Beckham S. Overcoming social and cultural barriers to care for patients with diabetes. Western Journal of Medicine 1997;167(3):138.

Jenkins C, McNary S, Carlson BA, King MG, Hossler CL, et al. Reducing disparities for African Americans with diabetes: progress made by the REACH 2010 Charleston and Georgetown Diabetes Coalition. Public Health Reports 2004;119(3):322-30.

Keyserling TC, Samuel-Hodge CD, Ammerman AS, Ainsworth BE, Henr quez-Rold n CF, et al. A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes. Diabetes Care 2002;25(9):1576-83.

Lorig K, Gonzalez VM. Community-based diabetes self-management education: definition and case study. Diabetes Spectrum 2000;13(4):234.

Lorig K, Ritter PL, Villa F, Piette JD. Spanish diabetes self-management with and without automated telephone reinforcement. Diabetes Care 2008;31(3):408-14.

Lujan J, Ostwald SK, Ortiz M. Promotora diabetes intervention for Mexican Americans. Diabetes Educator 2007;33(4):660-70.

McDermott RA, Schmidt B, Preece C, Owens V, Taylor S, Li M, Esterman A. Community health workers improve diabetes care in remote Australian Indigenous communities: results of a pragmatic cluster randomized controlled trial. BMC Health Services Research 2015;15(1):68.

McEwen MM, Pasvogel A, Gallegos G, Barrera L. Type 2 diabetes self-management social support intervention at the US-Mexico border. Public Health Nursing 2010;27(4):310-9.

O’Hare JP, Raymond NT, Mughal S, Dodd L, Hanif W, et al. Evaluation of delivery of enhanced diabetes care to patients of South Asian ethnicity: the United Kingdom Asian Diabetes Study (UKADS). Diabetic Medicine 2004;21(12):1357-65.

Otero-sabogal R, Arretz D, Siebold S, Hallen E, Lee R, et al. Physician community health worker partnering to support diabetes self-management in primary care. Quality in Primary Care 2010;18(6):363-72.

Palmas W, Findley SE, Mejia M, Batista M, Teresi J, et al. Results of the Northern Manhattan Diabetes Community Outreach Project: a randomized trial studying a community health worker intervention to improve diabetes care in Hispanic adults. Diabetes Care 2014;37(4):963-9.

P rez-Escamilla R, Damio G, Chhabra J, Fernandez ML, Segura-P rez S, et al. Impact of a community health workers led structured program on blood glucose control among Latinos with type 2 diabetes: the DIALBEST trial. Diabetes Care 2015;38(2):197-205.

Philis-Tsimikas A, Walker C, Rivard L, Talavera G, Reimann JO, et al. Improvement in diabetes care of underinsured patients enrolled in Project Dulce. Diabetes Care 2004;27(1):110-5.

Prezio EA, Cheng D, Balasubramanian BA, Shuval K, Kendzor DE, Culica D. Community Diabetes Education (CoDE) for uninsured Mexican Americans: a randomized controlled trial of a culturally tailored diabetes education and management program led by a community health worker. Diabetes Research and Clinical Practice 2013;100(1):19-28.

Ratanawongsa N, Handley MA, Quan J, Sarkar U, Pfeifer K, et al. Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps) in a Medicaid managed care plan: study protocol. BMC Health Services Research 2012;12(1):22.

Rosal MC, Ockene IS, Restrepo A, White MJ, Borg A, et al. Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income Latinos. Diabetes Care 2011;34(4):838-44.

Rothschild SK, Martin MA, Swider SM, Tumial n Lynas CM, Janssen I, et al. Mexican American trial of community health workers: a randomized controlled trial of a community health worker intervention for Mexican Americans with type 2 diabetes mellitus. American Journal of Public Health 2014;104(8):1540-8.

Ryabov I. The impact of community health workers on behavioral outcomes and glycemic control of diabetes patients on the US-Mexico border. International Quarterly of Community Health Education 2011;31(4):387-99.

Samuel-Hodge CD, Keyserling TC, Park S, Johnston LF, Gizlice Z, Bangdiwala SI. A randomized trial of a church-based diabetes self-management program for African Americans with type 2 diabetes. Diabetes Educator 2009;35(3):439-54.

Shah VO, Carroll C, Mals R, Ghahate D, Bobelu J, et al. A home-based educational intervention improves patient activation measures and diabetes health indicators among Zuni Indians. PloS One 2015;10(5):e0125820.

Simmons D. Impact of an integrated approach to diabetes care at the Rumbalara Aboriginal Health Service. Internal Medicine Journal 2003;33(12):581-5.

Soto NI, Bazyler LR, O’toole ML, Brownson CA, Pezzullo JC. Starting a diabetes self-management program in a free clinic. Diabetes Educator 2007;33(Supplement 6):166S-71S.

Spencer MS, Rosland AM, Kieffer EC, Sinco BR, Valerio M, et al. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. American Journal of Public Health 2011;101(12):2253-60.

Thom DH, Ghorob A, Hessler D, De Vore D, Chen E, Bodenheimer TA. Impact of peer health coaching on glycemic control in low-income patients with diabetes: a randomized controlled trial. Annals of Family Medicine 2013;11(2):137-44.

Thompson JR, Horton C, Flores C. Advancing diabetes self-management in the Mexican American population a community health worker model in a primary care setting. Diabetes Educator 2007;33(Supplement 6):159S-65S.

Two Feathers J, Kieffer EC, Palmisano G, Anderson M, Sinco B, et al. Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership: improving diabetes-related outcomes among African American and Latino adults. American Journal of Public Health 2005;95(9):1552-60.

Economic Review

Bellary S, O’Hare JP, Raymond NT, et al. Enhanced diabetes care to patients of south Asian ethnic origin (the United Kingdom Asian Diabetes Study): a cluster randomised controlled trial. Lancet 2008;371(9626):1769-76.

Brown H, Wilson KJ, Pag n JA, et al. Cost-effectiveness analysis of a community health worker intervention for low-income Hispanic adults with diabetes. Prev Chronic Dis 2012;9:E140.

Brown SA, Blozis SA, Kouzekanani K, Garcia AA, Winchell M, Hanis CL. Dosage effects of diabetes self-management education for Mexican Americans the Starr county border health initiative. Diabetes Care 2005;28(3):527-32.

Brown SA, Garcia AA, Kouzekanani K, Hanis CL. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care 2002;25(2):259-68.

Brown SA, Hanis CL. Culturally competent diabetes education for Mexican Americans: the Starr County study. Diabetes Educator 1999;25(2):226-36.

Prezio EA, Pag n JA, Shuval K, Culica D. The Community Diabetes Education (CoDE) program: cost-effectiveness and health outcomes. American Journal of Preventive Medicine 2014;47(6):771-9.

Culica D, Walton JW, Prezio EA. CoDE: community diabetes education for uninsured Mexican Americans. In: Baylor University Medical Center Proceedings; 2007: Baylor University Medical Center. p. 111.

Esperat MC, Flores D, McMurry L, et al. Transformacion Para Salud: a patient navigation model for chronic disease self-management. Online journal of issues in nursing 2012;17(2):G1.

Gilmer TP, Philis-Tsimikas A, Walker C. Outcomes of Project Dulce: a culturally specific diabetes management program. Annals of Pharmacotherapy 2005;39(5):817-22.

Gilmer TP, Roze S, Valentine WJ, et al. Cost-effectiveness of diabetes case management for low-income populations. Health Services Research 2007;42(5):1943-59.

Greenhalgh T, Campbell-Richards D, Vijayaraghavan S, et al. New models of self-management education for minority ethnic groups: pilot randomized trial of a story-sharing intervention. Journal of Health Services Research & Policy 2011;16(1):28-36.

Kane EP, Collinsworth AW, Schmidt KL, et al. Improving diabetes care and outcomes with community health workers. Family Practice 2016;33(5):523-8.

Rothschild SK, Martin MA, Swider SM, et al. Mexican American trial of community health workers: a randomized controlled trial of a community health worker intervention for Mexican Americans with type 2 diabetes mellitus. American Journal of Public Health 2014;104(8):1540-8.

Ryabov I. Cost-effectiveness of community health workers in controlling diabetes epidemic on the US Mexico border. Public Health 2014;128(7):636-42.

Segal L, Nguyen H, Schmidt B, et al. Economic evaluation of Indigenous health worker management of poorly controlled type 2 diabetes in north Queensland. Med J Aust 2016;204(5):196.

Tang TS, Funnell M, Sinco B, et al. Comparative Effectiveness of Peer Leaders and Community Health Workers in Diabetes Self-management Support: Results of a Randomized Controlled Trial. Diabetes Care. 2014;37(6):1525-1534.

Additional Materials

Webinar

Implementation Product

  • Including Community Health Workers in Health Care Settings: A Checklist for Public Health Practitioners. This resource from CDC’s Division for Heart Disease and Stroke Prevention offers a general framework for public health practitioners who want to integrate a community health worker scope of practice in health care settings. The checklist is designed to be a conversation facilitator and can help to establish and strengthen relationships between community health workers and health care providers looking to address a range of health issues.

Search Strategies

A research librarian searched for published studies in the following databases: PubMed, Cochrane, CRD-York, EconLit, GoogleScohlar, NTIS (National Technical Information Service), Sociological Abstracts (ProQuest), SSRN, WorldCat, and CINAHL. Additional studies were identified via suggestions from subject matter experts and hand-searches from reference lists.

Studies published in English from beginning of database through May 2015, limited to countries with high income economies as defined by the World Bank were searched and screened for inclusion.

Effectiveness Review

Database: CINAHL (EBSCOHost)

Date Searched: 5/27/2015

Search Strategy:

S5 S1 and S2 and S3 and S4

S4 (TX(“team-based care” OR “integrated care” OR “coordinated care” OR “collaborative care” OR “primary care team” OR “primary care teams” OR navigator* OR liaison* OR screening* OR education* OR outreach* OR “home visit” OR “home visits” OR “home visiting” OR enroll* OR “community organizer” OR “community development” OR “health advocacy” OR “counseling” OR “self-management” OR “health behavior change” OR “behavior changes” OR “changed behavior” OR “changing behavior” OR “changed behaviors” OR “changed behavior” OR “changing behavior” OR “changed behaviors” OR “changing behaviors” OR “lifestyle modification” OR “lifestyle modifications” OR “modified lifestyle” OR “modified lifestyles”) OR MH “Life Style Changes” OR MH “Counseling+” OR MH “Home Visits” OR MH Education+” OR MH “Health Screening+” OR MH “Multidisciplinary Care Team+” OR MH “Health Care Delivery, Integrated” )

S3 (TX(“hypertension” OR “blood pressure” OR cholesterol* OR “diabetes” OR diabetic* OR “obese” OR “obesity” OR “physical activity” OR “tobacco” OR “nutrition” OR “diet” OR “diets” OR “dieting” OR alcohol* OR “aspirin” OR adher* OR “cardiovascular disease” or “cardiovascular diseases” or “comprehensive CVD risk reduction” OR “comprehensive cardiovascular disease risk reduction” OR “chronic disease” OR “chronic diseases”) OR MH “Chronic Disease” OR MH “Patient Compliance+” OR MH “Medication Compliance” OR MH “Aspirin” OR MH “Alcoholic Intoxication” OR MH “Alcoholism” OR MH “Alcohol Rehabilitation Programs+” OR MH “Ethanol+” OR MH “Alcohol-Induced Disorders, Nervous System+” OR MH “Diet+” OR MH “Geriatric Nutrition” OR MH “Infant Nutrition+” OR MH “Child Nutrition” OR MH “Adolescent Nutrition” OR MH “Nutrition+” OR MH “Smoking Cessation Programs” OR MH “Smoking Cessation” OR MH “Smoking+” OR MH “Tobacco+” OR MH “Physical Activity” OR MH “Exercise+” OR MH “Obesity, Morbid” OR MH “Obesity” OR MH “Diabetes Mellitus+” OR MH Hypercholesterolemia” OR MH “Cholesterol+” OR MH “Hypertension+”)

S2 (TX(“Outcome Assessment Health Care” OR “Treatment Outcome” OR “Outcome and Process Assessment Health Care” OR “Fatal Outcome” OR “effectiveness” OR “effective” OR “evaluation” OR “evaluations”) OR MH “Fatal Outcome” OR MH “Outcome Assessment” OR MH “Treatment Outcomes+” OR MH “Evaluation”)

S1 (TX(“community health worker” OR “community health workers” OR “health advisor” OR “health advisors” OR “health worker” OR “health workers” OR “health advocate” OR “health advocates” OR “health paraprofessional” OR “health paraprofessionals” OR “community health representative” OR “community health representatives” OR “outreach worker” OR “outreach workers” OR “lay health worker” OR “lay health workers” OR “patient navigator” OR “patient navigators” OR promotora OR promotoras OR embajadores OR “embajadora” OR “embajadoras” OR “embajador” OR consejera OR consejeras) OR MH “Community Health Workers”

Database: Cochrane

Date Searched: 5/27/2015

Search Strategy:

#1 community health worker or community health workers or community health aide or community health aides or health advisor or health advisors or health worker or health workers or health advocate or health advocates or health paraprofessional or health paraprofessionals or community health representative or community health representatives or outreach worker or outreach workers or patient navigator or patient navigators or promotora or promotoras or embajador or embajadores or consejera or consejeras:ti,ab,kw [Word variations have been searched]

#2 Hypertension or blood pressure or cholesterol or diabetes or obesity or physical activity or tobacco or nutrition or diet or alcohol or aspirin or adherence or comprehensive CVD risk reduction or chronic disease or cardiovascular disease or cardiovascular diseases:ti,ab,kw [Word variations have been searched]

#3 #1 and #2

#4 Team-based care or integrated care or coordinated care or collaborative care or primary care teams or navigator or liaison or screening or education or outreach or home visits or enroll or community organizer or community development or health advocacy or counseling or self-management or health behavior change or lifestyle modification or Team-based care or integrated care or coordinated care or collaborative care or primary care teams or navigator or liaison or screening or education or outreach or home visits or enroll or community organizer or community development or health advocacy or counseling or self-management or health behavior change or lifestyle modification:ti,ab,kw [Word variations have been searched]

#5 #3 and #4

Database: CRD-York http://www.york.ac.uk/inst/crd/

Date Searched: 5/27/2015

Search Strategy:

Any Field
community health worker* or community health aide* or health advisor* or health worker* or health advocate* or health paraprofessional* or community health representative* or outreach worker* or lay health worker* or patient navigator* or promotora* or embajador* or consejer*

AND

Any Field
hypertension or blood pressure or cholesterol* or hypercholesterol* or diabet* or obes* or exercise or physical activit* or tobacco or smoking or smoker* or nutrition* or diet* or alcohol* or aspirin or adhere* or cvd or cardiovascular or chronic

Database: EconLit (EBSCOHost)

Date searched: 5/27/2015

Search Strategy:

S5 s1 and s2 and s3 and s4

S4 “team-based care” OR “integrated care” OR “coordinated care” OR “collaborative care” OR “primary care team” OR “primary care teams” OR navigator* OR liaison* OR screening* OR education* OR outreach* OR “home visit” OR “home visits” OR “home visiting” OR enroll* OR “community organizer” OR “community development” OR “health advocacy” OR “counseling” OR “self-management” OR “health behavior change” OR “behavior changes” OR “changed behavior” OR “changing behavior” OR “changed behaviors” OR “changing behaviors” OR “lifestyle modification” OR “lifestyle modifications” OR “modified lifestyle” OR “modified lifestyles”

S3 “hypertension” OR “blood pressure” OR cholesterol* OR “diabetes” OR diabetic* OR “obese” OR “obesity” OR “physical activity” OR “tobacco” OR “nutrition” OR “diet” OR “diets” OR “dieting” OR alcohol* OR “aspirin” OR adher* OR “cardiovascular disease” or “cardiovascular diseases” or “comprehensive CVD risk reduction” OR “comprehensive cardiovascular disease risk reduction” OR “chronic disease” OR “chronic diseases”

S2 “Outcome Assessment Health Care” OR “Treatment Outcome” OR “Outcome and Process Assessment Health Care” OR “Fatal Outcome” OR “effectiveness” OR “effective” OR “evaluation” OR “evaluations”

S1 “community health worker” OR “community health workers” OR “health advisor” OR “health advisors” OR “health worker” AND “health workers” OR “health advocate” OR “health advocates” OR “health paraprofessional” OR “health paraprofessionals” OR “community health representative” OR “community health representatives” OR “outreach worker” OR “outreach workers” OR “lay health worker” OR “lay health workers” OR “patient navigator” OR “patient navigators” OR promotora OR promotoras OR embajadores OR “embajadoras” OR “embajador” OR consejera OR consejeras

Database: Google

Date Searched: 5/27/2014

Search Strategy:

“health advisors” +hypertension

“community health workers” +cardiovascular

“community health workers” +hypertension

Database: NTIS (Dialog File 6)

Date Searched: 5/27/2015

Search Strategy:

S1 COMMUNITY()HEALTH()WORKER? ? OR AIDE? ? OR
HEALTH()ADVISOR? ? OR HEALTH()WORKER? ? OR
HEALTH()ADVOCATE? ? OR HEALTH()PARAPROFESSIONAL? ? OR
COMMUNITY()HEALTH()REPRESENTATIVE? ? OR OUTREACH()WORKER?
? OR PATIENT()NAVIGATOR? ? OR PROMOTORA OR PROMOTORAS OR
EMBAJADOR OR EMBAJADORES OR CONSEJERA OR CONSEJERAS OR VOLUNTEER? OR HEALTH()VOLUNTEER? OR COMMUNITY()MEMBER? ? OR COMMUNITY()VOLUNTEER? ? OR HEALTH()AUXILIARIES OR
COMMUNITY()CARE()COORDINATOR? ? OR LAY()HEALTH()ADVISOR? ? OR COMMUNITY()HEALTH()AIDE? ? OR HEALTH()AGENT? ? OR
PEER()HEALTH()PROMOTER? ? OR PEER()COUNSELOR? ? OR PEER()HEALTH()WORKER? ? OR PEER()VOLUNTEER? ? OR COMMUNITY()HEALTH()PERSONNEL OR COMMUNITY()PROMOTER? ?

S2 HYPERTENSION OR BLOOD()PRESSURE OR CHOLESTEROL OR
DIABETES OR OBESITY OR PHYSICAL()ACTIVITY OR TOBACCO OR
NUTRITION OR DIET OR ALCOHOL OR ASPIRIN OR ADHERENCE OR
COMPREHENSIVE()CVD()RISK()REDUCTION? ? OR
CHRONIC()DISEASE? ? OR CARDIOVASCULAR()DISEASE? ? OR CORONARY()HEART()DISEASE? ? OR ISCHEMIC OR CORONARY()ARTERY()DISEASE? ? OR HEART()DISEASE? ? OR
HEART()ATTACK? ? OR MYOCARDIAL()INFARCTION? ? OR STROKE
OR STROKES OR HEART()FAILURE OR CEREBROVASCULAR()DISEASE?
? OR ANGINA

S3 S1 AND S2

Database: PubMed (NLM)
Date Searched: 5/27/2015
Search Strategy:

(“Hypertension”[Mesh] OR “Blood Pressure”[Mesh] OR “Hypercholesterolemia”[Mesh] OR “Cholesterol”[Mesh] OR “Diabetes Mellitus”[Mesh] OR “Diabetes Complications”[Mesh] OR “Obesity”[Mesh] OR “Tobacco Use Cessation Products”[Mesh] OR “Tobacco”[Mesh] OR “Tobacco Products”[Mesh] OR “Tobacco Use Cessation”[Mesh] OR “Tobacco, Smokeless”[Mesh] OR “Tobacco Use Disorder”[Mesh] OR “Tobacco Smoke Pollution”[Mesh] OR “Smoking”[Mesh] OR “Nutrition Policy”[Mesh] OR “Nutrition Therapy”[Mesh] OR “Nutritional Status”[Mesh] OR “Nutritional Sciences”[Mesh] OR “Elder Nutritional Physiological Phenomena”[Mesh] OR “Diet”[Mesh] OR “Alcohol Drinking”[Mesh] OR “Alcoholic Beverages”[Mesh] OR “Alcoholism”[Mesh] OR “Ethanol”[Mesh] OR “Aspirin”[Mesh] OR “Guideline Adherence”[Mesh] OR “Medication Adherence”[Mesh] OR “Patient Compliance”[Mesh] OR “Chronic Disease”[Mesh] OR “hypertension”[Title/Abstract] OR “blood pressure”[Title/Abstract] OR “cholesterol”[Title/Abstract] OR “hypercholesterol”[Title/Abstract] OR “hypercholesterolemia”[Title/Abstract] OR “diabetes”[Title/Abstract] OR diabetic[Title/Abstract] OR “diabetics”[Title/Abstract] OR “obese”[Title/Abstract] OR “obesity”[Title/Abstract] OR “physical activity” OR “tobacco” OR “nutrition”[Title/Abstract] OR “diet”[Title/Abstract] OR “diets”[Title/Abstract] OR “dieting”[Title/Abstract] OR “alcohol”[Title/Abstract] OR “aspirin”[Title/Abstract] OR adherence[Title/Abstract] OR “cardiovascular disease”[Title/Abstract] OR “cardiovascular diseases”[Title/Abstract] OR “comprehensive CVD risk reduction”[Title/Abstract] OR “comprehensive cardiovascular disease risk reduction”[Title/Abstract] OR “chronic disease”[Title/Abstract] OR “chronic diseases”[Title/Abstract] OR “coronary heart disease”[Title/Abstract] OR “coronary heart diseases”[Title/Abstract] OR “ischemic”[Title/Abstract] OR “coronary artery disease”[Title/Abstract] OR “coronary artery diseases”[Title/Abstract] OR “heart disease”[Title/Abstract] OR “heart diseases”[Title/Abstract] OR “heart attack”[Title/Abstract] OR “heart attacks”[Title/Abstract] OR “myocardial infarction”[Title/Abstract] OR “myocardial infarctions”[Title/Abstract] OR “stroke”[Title/Abstract] OR “strokes”[Title/Abstract] OR “heart failure”[Title/Abstract] OR “cerebrovascular disease”[Title/Abstract] OR “cerebrovascular diseases”[Title/Abstract] OR “cerebrovascular event”[Title/Abstract] OR “cerebrovascular events”[Title/Abstract] OR “angina”[Title/Abstract] OR “Coronary Artery Disease”[Mesh] OR “Coronary Disease”[Mesh] OR “Ischemia”[Mesh] OR “Ischemic Preconditioning, Myocardial”[Mesh] OR “Ischemic Attack, Transient”[Mesh] OR “Hypoxia-Ischemia, Brain”[Mesh] OR “Myocardial Ischemia”[Mesh] OR “Heart Diseases”[Mesh] OR “Myocardial Infarction”[Mesh] OR “Stroke”[Mesh] OR “Cerebrovascular Disorders”[Mesh] OR “Basal Ganglia Cerebrovascular Disease”[Mesh] OR “Angina Pectoris”[Mesh] OR “Hypercholesterolemia”[Mesh])

AND

(“Community Health Workers”[Mesh] OR “community health worker”[Title/Abstract] OR “community health workers”[Title/Abstract] OR “health advisor”[Title/Abstract] OR “health advisors”[Title/Abstract] OR “health worker”[Title/Abstract] OR “health workers”[Title/Abstract] OR “health advocate”[Title/Abstract] OR “health advocates”[Title/Abstract] OR “health paraprofessional”[Title/Abstract] OR “health paraprofessionals”[Title/Abstract] OR “community health representative”[Title/Abstract] OR “community health representatives”[Title/Abstract] OR “outreach worker”[Title/Abstract] OR “outreach workers”[Title/Abstract] OR “lay health worker”[Title/Abstract] OR “lay health workers”[Title/Abstract] OR “patient navigator”[Title/Abstract] OR “patient navigators”[Title/Abstract] OR “promotora”[Title/Abstract] OR “promotoras”[Title/Abstract] OR “embajadores”[Title/Abstract] OR “embajadora”[Title/Abstract] OR “embajadoras”[Title/Abstract] OR “embajador”[Title/Abstract] OR “consejera”[Title/Abstract] OR “consejeras”[Title/Abstract])) OR (“lady health workers”[Title/Abstract] OR “lady health worker”[Title/Abstract] OR “peer health promoter”[Title/Abstract] OR “peer health promoters”[Title/Abstract] OR “community care coordinator”[Title/Abstract] OR “community care coordinators”[Title/Abstract] OR “community health personnel”[Title/Abstract] OR “community promoter”[Title/Abstract] OR “community promoters”[Title/Abstract] OR “community member”[Title/Abstract] OR “community members”[Title/Abstract] OR “health volunteer”[Title/Abstract] OR “health volunteers”[Title/Abstract] OR “health volunteering”[Title/Abstract] OR “community volunteer”[Title/Abstract] OR “community volunteers”[Title/Abstract] OR “health auxiliaries”[Title/Abstract] OR “lay health advisor”[Title/Abstract] OR “lay health advisors”[Title/Abstract])) OR (“community health aide”[Title/Abstract] OR “community health aides”[Title/Abstract] OR “health agent”[Title/Abstract] OR “health agents”[Title/Abstract] OR “peer health promoter”[Title/Abstract] OR “peer health promoters”[Title/Abstract] OR “peer counselor”[Title/Abstract] OR “peer counselors”[Title/Abstract] OR “peer health”[Title/Abstract] OR “peer health worker”[Title/Abstract] OR “peer health workers”[Title/Abstract] OR “peer volunteer”[Title/Abstract] OR “peer volunteers”[Title/Abstract] OR “barefoot doctor”[Title/Abstract] OR “barefoot doctors”[Title/Abstract] OR “Voluntary Workers”[Mesh] OR ((((“care team”[title/abstract] OR “community health service”[title/abstract] or “community health services”[title/abstract] OR “adherence support”[title/abstract] OR “compliance support”[title/abstract] OR “community capacity”[title/abstract] OR “community development”[title/abstract] OR “community organizer”[title/abstract] OR “community organizers”[title/abstract] OR “cultural mediation”[title/abstract] OR “culturally appropriate information”[title/abstract] OR “supporting compliance”[title/abstract]) OR “culturally appropriate”[title/abstract]) OR (“culturally sensitive”[title/abstract] or “cultural sensitivity”[title/abstract])

AND

(English[lang])

Database: Sociological Abstracts (ProQuest)

Date Searched: 5/27/2015

Search Strategy:

S1 (community health worker OR community health workers OR community health aide OR community health aides OR health advisor OR health advisors OR health worker OR health workers OR health advocate OR health advocates OR health paraprofessional OR health paraprofessionals OR community health representative OR community health representatives or outreach worker OR outreach workers OR patient navigator OR patient navigators OR promotora OR promotoras OR embajador OR embajadores OR consejera OR consejeras) AND (Hypertension OR blood pressure OR cholesterol OR diabetes OR obesity OR physical activity OR tobacco OR nutrition OR diet OR alcohol OR aspirin OR adherence OR comprehensive CVD risk reduction OR chronic disease OR cardiovascular disease OR cardiovascular diseases)

S2 (Hypertension OR blood pressure OR cholesterol OR diabetes OR obesity OR physical activity OR tobacco OR nutrition OR diet OR alcohol OR aspirin OR adherence OR comprehensive CVD risk reduction OR chronic disease OR cardiovascular disease OR cardiovascular diseases) AND (Team-based care OR integrated care OR coordinated care OR collaborative care OR primary care teams OR primary care team OR navigator OR liaison OR screening OR education OR outreach OR home visits OR enroll OR community organizer OR community development OR health advocacy OR counseling OR self-management OR health behavior change OR lifestyle modification)

S3 (Team-based care OR integrated care OR coordinated care OR collaborative care OR primary care teams OR primary care team OR navigator OR liaison OR screening OR education OR outreach OR home visits OR enroll OR community organizer OR community development OR health advocacy OR counseling OR self-management OR health behavior change OR lifestyle modification)

S4 (Outcome Assessment* OR Treatment Outcome* OR Process Assessment* OR Fatal Outcome* OR effectiv* OR evaluat*)

S5 S1 AND S2 AND S3 AND S4

Database: SSRN

Date Searched: 5/28/2015

Search Strategy:

“Community Health Workers” hypertension

“Community Health Workers” “cardiovascular disease”

Database: WorldCat

Date Searched: 5/27/2015

Search Strategy:

“Community Health Workers” hypertension

“Community Health Workers” “cardiovascular disease”

Economic Review

This literature search was performed to find studies on the economics of interventions engaging community health workers for the prevention of cardiovascular disease, prevention of diabetes, and management of diabetes.

Ten bibliographic databases were searched during August 2016, using the terms listed below. The databases searched were: CINAHL, Cochrane, the Centre for Reviews and Dissemination (CRD-York), EconLit, Google Scholar, NTIS, PubMed, Sociological Abstracts, SSRN, and WorldCat. Publications listed from inception of databases to August, 2016 were covered, and the types of documents retrieved by the search included journal articles, books, book chapters, reports, and conference papers. In addition, reference lists of included studies were screened and subject matter experts were consulted for additional studies that may have been missed.

Search terms and strategies were adjusted for each database, based on controlled and uncontrolled vocabularies and software.

Community Guide: Cardiovascular Diseases Community Health Workers

Database: CINAHL (EBSCOHost)

Date Searched : 8/8/2016
Results: 2463

Search Strategy:

S5 S1 and S2 and S3 and S4

S4 (TX(“team-based care” OR “integrated care” OR “coordinated care” OR “collaborative care” OR “primary care team” OR “primary care teams” OR navigator* OR liaison* OR screening* OR education* OR outreach* OR “home visit” OR “home visits” OR “home visiting” OR enroll* OR “community organizer” OR “community development” OR “health advocacy” OR “counseling” OR “self-management” OR “health behavior change” OR “behavior changes” OR “changed behavior” OR “changing behavior” OR “changed behaviors” OR “changed behavior” OR “changing behavior” OR “changed behaviors” OR “changing behaviors” OR “lifestyle modification” OR “lifestyle modifications” OR “modified lifestyle” OR “modified lifestyles”) OR MH “Life Style Changes” OR MH “Counseling+” OR MH “Home Visits” OR MH Education+” OR MH “Health Screening+” OR MH “Multidisciplinary Care Team+” OR MH “Health Care Delivery, Integrated” )

S3 (TX(“hypertension” OR “blood pressure” OR cholesterol* OR “diabetes” OR diabetic* OR “obese” OR “obesity” OR “physical activity” OR “tobacco” OR “nutrition” OR “diet” OR “diets” OR “dieting” OR alcohol* OR “aspirin” OR adher* OR “cardiovascular disease” or “cardiovascular diseases” or “comprehensive CVD risk reduction” OR “comprehensive cardiovascular disease risk reduction” OR “chronic disease” OR “chronic diseases”) OR MH “Chronic Disease” OR MH “Patient Compliance+” OR MH “Medication Compliance” OR MH “Aspirin” OR MH “Alcoholic Intoxication” OR MH “Alcoholism” OR MH “Alcohol Rehabilitation Programs+” OR MH “Ethanol+” OR MH “Alcohol-Induced Disorders, Nervous System+” OR MH “Diet+” OR MH “Geriatric Nutrition” OR MH “Infant Nutrition+” OR MH “Child Nutrition” OR MH “Adolescent Nutrition” OR MH “Nutrition+” OR MH “Smoking Cessation Programs” OR MH “Smoking Cessation” OR MH “Smoking+” OR MH “Tobacco+” OR MH “Physical Activity” OR MH “Exercise+” OR MH “Obesity, Morbid” OR MH “Obesity” OR MH “Diabetes Mellitus+” OR MH Hypercholesterolemia” OR MH “Cholesterol+” OR MH “Hypertension+”)

S2 (TX(“Outcome Assessment Health Care” OR “Treatment Outcome” OR “Outcome and Process Assessment Health Care” OR “Fatal Outcome” OR “effectiveness” OR “effective” OR “evaluation” OR “evaluations”) OR MH “Fatal Outcome” OR MH “Outcome Assessment” OR MH “Treatment Outcomes+” OR MH “Evaluation”)

S1 (TX(“community health worker” OR “community health workers” OR “health advisor” OR “health advisors” OR “health worker” OR “health workers” OR “health advocate” OR “health advocates” OR “health paraprofessional” OR “health paraprofessionals” OR “community health representative” OR “community health representatives” OR “outreach worker” OR “outreach workers” OR “lay health worker” OR “lay health workers” OR “patient navigator” OR “patient navigators” OR promotora OR promotoras OR embajadores OR “embajadora” OR “embajadoras” OR “embajador” OR consejera OR consejeras) OR MH “Community Health Workers”

Database: Cochrane

Date Searched: 8/5/2016
Results: 1862

Search Strategy:

#1 community health worker or community health workers or community health aide or community health aides or health advisor or health advisors or health worker or health workers or health advocate or health advocates or health paraprofessional or health paraprofessionals or community health representative or community health representatives or outreach worker or outreach workers or patient navigator or patient navigators or promotora or promotoras or embajador or embajadores or consejera or consejeras:ti,ab,kw [Word variations have been searched]

#2 Hypertension or blood pressure or cholesterol or diabetes or obesity or physical activity or tobacco or nutrition or diet or alcohol or aspirin or adherence or comprehensive CVD risk reduction or chronic disease or cardiovascular disease or cardiovascular diseases:ti,ab,kw [Word variations have been searched]

#3 #1 and #2

#4 Team-based care or integrated care or coordinated care or collaborative care or primary care teams or navigator or liaison or screening or education or outreach or home visits or enroll or community organizer or community development or health advocacy or counseling or self-management or health behavior change or lifestyle modification or Team-based care or integrated care or coordinated care or collaborative care or primary care teams or navigator or liaison or screening or education or outreach or home visits or enroll or community organizer or community development or health advocacy or counseling or self-management or health behavior change or lifestyle modification:ti,ab,kw [Word variations have been searched]

#5 #3 and #4

Database: CRD-York http://www.york.ac.uk/inst/crd/

Date Searched: 5/27/2015
Results: 131

Search Strategy:

Any Field

community health worker* or community health aide* or health advisor* or health worker* or health advocate* or health paraprofessional* or community health representative* or outreach worker* or lay health worker* or patient navigator* or promotora* or embajador* or consejer*

AND

Any Field

hypertension or blood pressure or cholesterol* or hypercholesterol* or diabet* or obes* or exercise or physical activit* or tobacco or smoking or smoker* or nutrition* or diet* or alcohol* or aspirin or adhere* or cvd or cardiovascular or chronic

Database: EconLit (EBSCOHost)

Date searched: 8/5/2016
Results: 125

Search Strategy:

S5 s1 and s2 and s3 and s4

S4 “team-based care” OR “integrated care” OR “coordinated care” OR “collaborative care” OR “primary care team” OR “primary care teams” OR navigator* OR liaison* OR screening* OR education* OR outreach* OR “home visit” OR “home visits” OR “home visiting” OR enroll* OR “community organizer” OR “community development” OR “health advocacy” OR “counseling” OR “self-management” OR “health behavior change” OR “behavior changes” OR “changed behavior” OR “changing behavior” OR “changed behaviors” OR “changing behaviors” OR “lifestyle modification” OR “lifestyle modifications” OR “modified lifestyle” OR “modified lifestyles”

S3 “hypertension” OR “blood pressure” OR cholesterol* OR “diabetes” OR diabetic* OR “obese” OR “obesity” OR “physical activity” OR “tobacco” OR “nutrition” OR “diet” OR “diets” OR “dieting” OR alcohol* OR “aspirin” OR adher* OR “cardiovascular disease” or “cardiovascular diseases” or “comprehensive CVD risk reduction” OR “comprehensive cardiovascular disease risk reduction” OR “chronic disease” OR “chronic diseases”

S2 “Outcome Assessment Health Care” OR “Treatment Outcome” OR “Outcome and Process Assessment Health Care” OR “Fatal Outcome” OR “effectiveness” OR “effective” OR “evaluation” OR “evaluations”

S1 “community health worker” OR “community health workers” OR “health advisor” OR “health advisors” OR “health worker” AND “health workers” OR “health advocate” OR “health advocates” OR “health paraprofessional” OR “health paraprofessionals” OR “community health representative” OR “community health representatives” OR “outreach worker” OR “outreach workers” OR “lay health worker” OR “lay health workers” OR “patient navigator” OR “patient navigators” OR promotora OR promotoras OR embajadores OR “embajadoras” OR “embajador” OR consejera OR consejeras

Database: Google

Date Searched: 8/9/2016
Results: 28

Search Strategy:

“health advisors” +hypertension

“community health workers” +cardiovascular

“community health workers” +hypertension

Database: NTIS (Dialog File 6)

Date Searched: 8/8/2016
Results: 716

Search Strategy:

S1 COMMUNITY()HEALTH()WORKER? ? OR AIDE? ? OR HEALTH()ADVISOR? ? OR HEALTH()WORKER? ? OR HEALTH()ADVOCATE? ? OR HEALTH()PARAPROFESSIONAL? ? OR COMMUNITY()HEALTH()REPRESENTATIVE? ? OR OUTREACH()WORKER? ? OR PATIENT()NAVIGATOR? ? OR PROMOTORA OR PROMOTORAS OR EMBAJADOR OR EMBAJADORES OR CONSEJERA OR CONSEJERAS OR VOLUNTEER? OR HEALTH()VOLUNTEER? OR COMMUNITY()MEMBER? ? OR COMMUNITY()VOLUNTEER? ? OR HEALTH()AUXILIARIES OR COMMUNITY()CARE()COORDINATOR? ? OR LAY()HEALTH()ADVISOR? ? OR COMMUNITY()HEALTH()AIDE? ? OR HEALTH()AGENT? ? OR PEER()HEALTH()PROMOTER? ? OR PEER()COUNSELOR? ? OR PEER()HEALTH()WORKER? ? OR PEER()VOLUNTEER? ? OR COMMUNITY()HEALTH()PERSONNEL OR COMMUNITY()PROMOTER? ?

S2 HYPERTENSION OR BLOOD()PRESSURE OR CHOLESTEROL OR DIABETES OR OBESITY OR PHYSICAL()ACTIVITY OR TOBACCO OR NUTRITION OR DIET OR ALCOHOL OR ASPIRIN OR ADHERENCE OR COMPREHENSIVE()CVD()RISK()REDUCTION? ? OR CHRONIC()DISEASE? ? OR CARDIOVASCULAR()DISEASE? ? OR CORONARY()HEART()DISEASE? ? OR ISCHEMIC OR CORONARY()ARTERY()DISEASE? ? OR HEART()DISEASE? ? OR HEART()ATTACK? ? OR MYOCARDIAL()INFARCTION? ? OR STROKE OR STROKES OR HEART()FAILURE OR CEREBROVASCULAR()DISEASE? ? OR ANGINA

S3 S1 AND S2

Database: PubMed (NLM)

Date Searched: 8/5/2016
Results: 8480

Search Strategy:

(“Hypertension”[Mesh] OR “Blood Pressure”[Mesh] OR “Hypercholesterolemia”[Mesh] OR “Cholesterol”[Mesh] OR “Diabetes Mellitus”[Mesh] OR “Diabetes Complications”[Mesh] OR “Obesity”[Mesh] OR “Tobacco Use Cessation Products”[Mesh] OR “Tobacco”[Mesh] OR “Tobacco Products”[Mesh] OR “Tobacco Use Cessation”[Mesh] OR “Tobacco, Smokeless”[Mesh] OR “Tobacco Use Disorder”[Mesh] OR “Tobacco Smoke Pollution”[Mesh] OR “Smoking”[Mesh] OR “Nutrition Policy”[Mesh] OR “Nutrition Therapy”[Mesh] OR “Nutritional Status”[Mesh] OR “Nutritional Sciences”[Mesh] OR “Elder Nutritional Physiological Phenomena”[Mesh] OR “Diet”[Mesh] OR “Alcohol Drinking”[Mesh] OR “Alcoholic Beverages”[Mesh] OR “Alcoholism”[Mesh] OR “Ethanol”[Mesh] OR “Aspirin”[Mesh] OR “Guideline Adherence”[Mesh] OR “Medication Adherence”[Mesh] OR “Patient Compliance”[Mesh] OR “Chronic Disease”[Mesh] OR “hypertension”[Title/Abstract] OR “blood pressure”[Title/Abstract] OR “cholesterol”[Title/Abstract] OR “hypercholesterol”[Title/Abstract] OR “hypercholesterolemia”[Title/Abstract] OR “diabetes”[Title/Abstract] OR diabetic[Title/Abstract] OR “diabetics”[Title/Abstract] OR “obese”[Title/Abstract] OR “obesity”[Title/Abstract] OR “physical activity” OR “tobacco” OR “nutrition”[Title/Abstract] OR “diet”[Title/Abstract] OR “diets”[Title/Abstract] OR “dieting”[Title/Abstract] OR “alcohol”[Title/Abstract] OR “aspirin”[Title/Abstract] OR adherence[Title/Abstract] OR “cardiovascular disease”[Title/Abstract] OR “cardiovascular diseases”[Title/Abstract] OR “comprehensive CVD risk reduction”[Title/Abstract] OR “comprehensive cardiovascular disease risk reduction”[Title/Abstract] OR “chronic disease”[Title/Abstract] OR “chronic diseases”[Title/Abstract] OR “coronary heart disease”[Title/Abstract] OR “coronary heart diseases”[Title/Abstract] OR “ischemic”[Title/Abstract] OR “coronary artery disease”[Title/Abstract] OR “coronary artery diseases”[Title/Abstract] OR “heart disease”[Title/Abstract] OR “heart diseases”[Title/Abstract] OR “heart attack”[Title/Abstract] OR “heart attacks”[Title/Abstract] OR “myocardial infarction”[Title/Abstract] OR “myocardial infarctions”[Title/Abstract] OR “stroke”[Title/Abstract] OR “strokes”[Title/Abstract] OR “heart failure”[Title/Abstract] OR “cerebrovascular disease”[Title/Abstract] OR “cerebrovascular diseases”[Title/Abstract] OR “cerebrovascular event”[Title/Abstract] OR “cerebrovascular events”[Title/Abstract] OR “angina”[Title/Abstract] OR “Coronary Artery Disease”[Mesh] OR “Coronary Disease”[Mesh] OR “Ischemia”[Mesh] OR “Ischemic Preconditioning, Myocardial”[Mesh] OR “Ischemic Attack, Transient”[Mesh] OR “Hypoxia-Ischemia, Brain”[Mesh] OR “Myocardial Ischemia”[Mesh] OR “Heart Diseases”[Mesh] OR “Myocardial Infarction”[Mesh] OR “Stroke”[Mesh] OR “Cerebrovascular Disorders”[Mesh] OR “Basal Ganglia Cerebrovascular Disease”[Mesh] OR “Angina Pectoris”[Mesh] OR “Hypercholesterolemia”[Mesh])

AND

(“Community Health Workers”[Mesh] OR “community health worker”[Title/Abstract] OR “community health workers”[Title/Abstract] OR “health advisor”[Title/Abstract] OR “health advisors”[Title/Abstract] OR “health worker”[Title/Abstract] OR “health workers”[Title/Abstract] OR “health advocate”[Title/Abstract] OR “health advocates”[Title/Abstract] OR “health paraprofessional”[Title/Abstract] OR “health paraprofessionals”[Title/Abstract] OR “community health representative”[Title/Abstract] OR “community health representatives”[Title/Abstract] OR “outreach worker”[Title/Abstract] OR “outreach workers”[Title/Abstract] OR “lay health worker”[Title/Abstract] OR “lay health workers”[Title/Abstract] OR “patient navigator”[Title/Abstract] OR “patient navigators”[Title/Abstract] OR “promotora”[Title/Abstract] OR “promotoras”[Title/Abstract] OR “embajadores”[Title/Abstract] OR “embajadora”[Title/Abstract] OR “embajadoras”[Title/Abstract] OR “embajador”[Title/Abstract] OR “consejera”[Title/Abstract] OR “consejeras”[Title/Abstract])) OR (“lady health workers”[Title/Abstract] OR “lady health worker”[Title/Abstract] OR “peer health promoter”[Title/Abstract] OR “peer health promoters”[Title/Abstract] OR “community care coordinator”[Title/Abstract] OR “community care coordinators”[Title/Abstract] OR “community health personnel”[Title/Abstract] OR “community promoter”[Title/Abstract] OR “community promoters”[Title/Abstract] OR “community member”[Title/Abstract] OR “community members”[Title/Abstract] OR “health volunteer”[Title/Abstract] OR “health volunteers”[Title/Abstract] OR “health volunteering”[Title/Abstract] OR “community volunteer”[Title/Abstract] OR “community volunteers”[Title/Abstract] OR “health auxiliaries”[Title/Abstract] OR “lay health advisor”[Title/Abstract] OR “lay health advisors”[Title/Abstract])) OR (“community health aide”[Title/Abstract] OR “community health aides”[Title/Abstract] OR “health agent”[Title/Abstract] OR “health agents”[Title/Abstract] OR “peer health promoter”[Title/Abstract] OR “peer health promoters”[Title/Abstract] OR “peer counselor”[Title/Abstract] OR “peer counselors”[Title/Abstract] OR “peer health”[Title/Abstract] OR “peer health worker”[Title/Abstract] OR “peer health workers”[Title/Abstract] OR “peer volunteer”[Title/Abstract] OR “peer volunteers”[Title/Abstract] OR “barefoot doctor”[Title/Abstract] OR “barefoot doctors”[Title/Abstract] OR “Voluntary Workers”[Mesh] OR ((((“care team”[title/abstract] OR “community health service”[title/abstract] or “community health services”[title/abstract] OR “adherence support”[title/abstract] OR “compliance support”[title/abstract] OR “community capacity”[title/abstract] OR “community development”[title/abstract] OR “community organizer”[title/abstract] OR “community organizers”[title/abstract] OR “cultural mediation”[title/abstract] OR “culturally appropriate information”[title/abstract] OR “supporting compliance”[title/abstract]) OR “culturally appropriate”[title/abstract]) OR (“culturally sensitive”[title/abstract] or “cultural sensitivity”[title/abstract])

AND

(English[lang])

Database: Sociological Abstracts (ProQuest)

Date Searched: 8/8/2016
Results: 767

Search Strategy:

S1 (community health worker OR community health workers OR community health aide OR community health aides OR health advisor OR health advisors OR health worker OR health workers OR health advocate OR health advocates OR health paraprofessional OR health paraprofessionals OR community health representative OR community health representatives or outreach worker OR outreach workers OR patient navigator OR patient navigators OR promotora OR promotoras OR embajador OR embajadores OR consejera OR consejeras) AND (Hypertension OR blood pressure OR cholesterol OR diabetes OR obesity OR physical activity OR tobacco OR nutrition OR diet OR alcohol OR aspirin OR adherence OR comprehensive CVD risk reduction OR chronic disease OR cardiovascular disease OR cardiovascular diseases)

S2 (Hypertension OR blood pressure OR cholesterol OR diabetes OR obesity OR physical activity OR tobacco OR nutrition OR diet OR alcohol OR aspirin OR adherence OR comprehensive CVD risk reduction OR chronic disease OR cardiovascular disease OR cardiovascular diseases) AND (Team-based care OR integrated care OR coordinated care OR collaborative care OR primary care teams OR primary care team OR navigator OR liaison OR screening OR education OR outreach OR home visits OR enroll OR community organizer OR community development OR health advocacy OR counseling OR self-management OR health behavior change OR lifestyle modification)

S3 (Team-based care OR integrated care OR coordinated care OR collaborative care OR primary care teams OR primary care team OR navigator OR liaison OR screening OR education OR outreach OR home visits OR enroll OR community organizer OR community development OR health advocacy OR counseling OR self-management OR health behavior change OR lifestyle modification)

S4 (Outcome Assessment* OR Treatment Outcome* OR Process Assessment* OR Fatal Outcome* OR effectiv* OR evaluat*)

S5 S1 AND S2 AND S3 AND S4

Database: SSRN

Date Searched: 8/5/2016
Results: 4

Search Strategy:

“Community Health Workers” hypertension

“Community Health Workers” “cardiovascular disease”

Database: WorldCat

Date Searched: 8/9/2016
Results: 42

Search Strategy:

“Community Health Workers” hypertension

“Community Health Workers” “cardiovascular disease”

Review References

Mason T, Rush C, Wilkinson G. Community health workers: orientation for state health departments: 2016 ASTHO state technical assistance presentation. ASTHO. Arlington (VA); 2016. Available at URL: http://www.astho.org/Community-Health-Workers/CHW-Orientation-Presentation-Slides/ [cited 8-15-17]

C3 Project. The Community health worker core consensus (C3) project: 2016 recommendations on CHW roles, skills, and qualities. Available at URL: https://sph.uth.edu/dotAsset/55d79410-46d3-4988-a0c2-94876da1e08d.pdf [cited 8-15-17]

U.S. Department of Health and Human Services, Health Resources Services Administration (HRSA), Bureau of Health Professions. Community health worker national workforce study. U.S. Department of Health and Human Services. Rockville (MD); 2007. Available at URL: https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/communityhealthworkforce.pdf [cited 8-15-17]

Nelson K, Taylor L, Silverman J, Kiefer M, Hebert P, Lessler D, et al. Randomized controlled trial of a community health worker self-management support intervention among low-income adults with diabetes, Seattle, Washington, 2010 2014. Prev Chronic Dis 2017;14:160344. DOI: http://dx.doi.org/10.5888/pcd14.160344

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.
  • The 2013 ruling by the Centers for Medicaid and Medicaid Services (CMS) allows states to provide Medicaid reimbursement for preventive services recommended by the U.S. Preventive Services Task Force. Services must be “recommended by a physician or other licensed practitioner,” and they must be delivered by health professionals, which may include community health workers.
  • States are addressing reimbursement challenges through referral systems that use bidirectional linkages, feedback loops that facilitate communication between referring providers and those delivering services, and educational programs that aim to raise awareness.
  • Multisite healthcare systems may associate community health workers with each site or centralize community health worker services through an organization such as a health department. A health department (i.e., central organization) may provide greater efficiency and coordination when working with smaller systems and clinics (Nelson et al., 2017).
  • Community health workers may be a member of a team or implement interventions alone. Community health workers are typically matched to the populations they serve (i.e., location, race or ethnicity, language or disease status).
  • Community health workers most often provide participants with culturally appropriate information and education on diabetes management, help build individual and community capacity, provide informal counseling, coaching, and social support, and facilitate and assist with care coordination and case management.
  • In this review, studies reported limited information about training standards and community health worker credentialing and certification. Many states, however, are establishing laws, regulations, and statutes to guide these processes (Mason et al., 2016).