Diabetes Prevention: Interventions Engaging Community Health Workers

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends interventions that engage community health workers for diabetes prevention to improve glycemic (blood sugar) control and weight-related outcomes among people at increased risk for type 2 diabetes.

Economic evidence indicates these interventions are cost-effective. Some evidence suggests interventions may reduce rates of progression to type 2 diabetes, though more research is needed. Interventions implemented in underserved communities may improve health, reduce health disparities, and enhance health equity.

Intervention

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.

Community health workers may address a broad range of health issues. Interventions that focus on diabetes prevention aim to reduce one or more risk factors for type 2 diabetes among members of the community by improving their diet, physical activity, and weight management.

Interventions are delivered to community groups or individuals at increased risk for type 2 diabetes. Programs may include education about diabetes prevention and lifestyle changes, or informal counseling, coaching, and extended support for people with a higher risk for diabetes. Content is delivered through one-on-one interactions, group sessions, or a combination of the two and may be offered in homes or community-based settings.

Community health workers may work alone or as part of an intervention team comprising counselors, clinicians, or other health professionals.

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

This CPSTF finding is based on evidence from a Community Guide systematic review of 22 studies (search period through May 2015).

This 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 prevention use one or more of the following models of care (HRSA 2007).

  • Screening and health education. Community health workers deliver education about diabetes prevention and lifestyle changes as primary health education providers or lifestyle coaches. Community health workers, for example, might teach clients about healthy meal planning or show them how to use a physical activity diary (22 studies).
  • Outreach, enrollment, and information. Community health workers reach out to individuals and families who are eligible for medical services and help them obtain these services. They might deliver social support at home, or monitor and follow-up on clients’ physical activity by phone (6 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. Community health workers could coordinate client weight management session with nurses. (4 studies).
  • 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 client access to insurance, or prepare clients for healthcare visits (3 studies).
  • Community organizers. Although not reported in the included studies from this review, Community health workers may facilitate self-directed change and community development by serving as liaisons between communities and healthcare systems (0 studies).

Overall, included studies showed the following:

  • Interventions engaging community health workers improved participants’ glycemic or blood sugar control (HbA1c, fasting blood glucose) and weight-related outcomes, and reduced rates of progression to type 2 diabetes.
  • Improvements were seen for self-reported lifestyle changes (i.e. physical activity, nutrition) and mixed for CVD risk factors.

Glycemic (Blood Sugar) Control and Progression to Type 2 Diabetes

  • Mean HbA1c: median decrease of 0.09% (6 studies; median intervention duration: 9 months)
  • Mean fasting blood glucose: median decrease of 2.4 mg/dL (7 studies; median duration: 12 months)
  • Proportion of participants who progressed to type 2 diabetes (3 studies): 1 study (24 months) reported a non-significant decrease of 5.1 percentage points, 1 study (12 months) reported a decrease of 2.2 percentage points (significance not reported), and 1 study (12 months) showed no effect.

Weight-related Outcomes

  • Mean weight: median decrease of 3.0 lbs (14 studies; median duration: 9.5 months)
  • Mean body mass index (BMI): median decrease of 0.5 kg/m2 (13 studies; median duration: 9.5 months)
  • Mean waist circumference: median decrease of 1.4 inches (10 studies; median duration: 6.5 months)

CVD Risk Factors Outcomes

  • Mean total cholesterol: median decrease of 5.7 mg/dL (6 studies; median duration: 6 months)
  • Mean LDL: median decrease of 5.0 mg/dL (6 studies; median duration: 6 months)
  • Mean HDL: median increase of 0.3 mg/dL (4 least suitable design studies; median: 5.5 months)
  • Mean triglycerides: median decrease of 13.8 mg/dL and an increase of 3.8 mg/dL (2 least suitable design studies; 6 and 12 months respectively)
  • Mean SBP: median decrease of 2.6 mg/dL (8 studies; median duration: 6 months)
  • Mean DBP: median decrease of 2.4 mg/dL (8 studies; median duration: 6 months)

Health Behavior Outcomes

  • Physical activity (19 studies): 5 studies reported significant improvements (median duration: 7 months), 8 reported non-significant improvements (median duration: 6 months), 5 showed no change, and 1 reported decreases in physical activity (median duration: 12 months),
  • Nutrition (15 studies): 4 studies reported significant improvements (median duration: 4.5 months), 6 reported non-significant improvements (median duration: 6 months), and 5 showed no change (median duration: 12 months).

Most included studies engaged community health workers to work with underserved groups suggesting these interventions can be effective in improving minority health and reducing health disparities related to populations at risk for diabetes (19 studies).

Additional Findings

One study evaluated access to service (i.e., insurance coverage) and reported a favorable increase in the number of insured participants after community health worker engagement.

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 prevention are cost-effective. All monetary values are reported in 2015 U.S. dollars.

  • The economic review included 7 studies (6 from the United States, 1 from the United Kingdom). Most patients in the studies came from minority or low-income populations.
    • The median intervention cost per person per year was $600 (7 studies).
    • One study reported an increase in per person per year healthcare cost of $1,242, and another study reported no change.
    • Estimated costs per quality adjusted life year (QALY) gained were $4,720 and $41,154 (2 studies). Both estimates were below were below $50,000 a conservative benchmark for cost effectiveness.

Applicability

Based on results, the CPSTF finding should be applicable to interventions that engage community health workers in a range of settings and populations:

Based on results, findings are applicable to the following:

  • Adults and youth who are at risk for type 2 diabetes
  • Women and men
  • Hispanics, African-Americans, and Asians
  • Low-income and low-education populations
  • Urban environments
  • 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 roles and impacts of community health workers in a team-based care environment?
  • What are the challenges or barriers that impact the recruitment and retention of male clients in lifestyle modification interventions?
  • How can community health workers be more engaged as outreach/enrollment/information agents, members of care delivery teams patient navigators, and community organizers?
  • How will implementation and funding of community health worker services by the Centers for Medicaid Services (CMS), through clinical or community-based providers, impact reimbursement arrangements?

Study Characteristics

  • Studies included greatest suitability of design (group randomized controlled trials [7 studies], before-after with a comparison group [3 studies]) and least suitable design (before-after without a comparison group [12 studies])
  • Studies were conducted in the United States (21 studies) and New Zealand (1 study).
  • Included studies evaluated interventions in communities (16 studies), homes (1 study), both communities and homes (4 studies), or worksites (1 study). Within communities, studies were conducted in church-based settings and culturally tailored to target smaller groups in underserved areas (5 studies).
  • Studies were set primarily in urban areas (7 studies).
  • Study populations mainly included adults ages 18-64 years old (19 studies) and youth (2 studies) who were at risk for type 2 diabetes.
  • Across all studies (22 studies), more than 70% of participants were female, including a few studies with 100% female clients enrolled (3 studies).
  • Included studies mainly focused on underserved populations.
    • Studies targeted Latinos (10 studies), African-Americans (3 studies), and Asians (3 studies).
    • Studies targeted low-income populations (4 studies), or those with less than high school education (7 studies).
  • Included studies limited their population to clients at risk for diabetes (10 studies) or allowed clients with diabetes to participate (12 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.

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

Bazzano AT, Zeldin AS, Diab IR, Garro NM, Allevato NA, Lehrer D, Team WP. The Healthy Lifestyle Change Program: a pilot of a community-based health promotion intervention for adults with developmental disabilities. American Journal of Preventive Medicine 2009;37(6):S201-8.

Cen CW, Haymore LB, Ellis D, Whitaker S, Henderson S, et al. Implementation of the Power to Prevent diabetes prevention educational curriculum into rural African American communities: a feasibility study. Diabetes Educator 2013:39(6): 776-85.

Duggan C, Carosso E, Mariscal N, Islas I, Ibarra G, et al. Diabetes prevention in Hispanics: report from a randomized controlled trial. Preventing Chronic Disease 2014;11:E28.

Faridi Z, Shuval K, Njike VY, et al. PREDICT Project Working Group. Partners Reducing Effects of Diabetes (PREDICT): a diabetes prevention physical activity and dietary intervention through African-American churches. Health Education Research 2010;25(2):306-15.

Islam NS, Zanowiak JM, Wyatt LC, Chun K, Lee L, et al. A randomized-controlled, pilot intervention on diabetes prevention and healthy lifestyles in the New York City Korean community. Journal of Community Health 2013;38(6):1030-41.

Islam NS, Zanowiak JM, Wyatt LC, Kayathe R, Singh H, et al. Diabetes prevention in the New York City Sikh Asian Indian community: a pilot study. International Journal of Environmental Research and Public Health 2014;11(5):5462-86.

Katula JA, Vitolins MZ, Morgan TM, et al. The Healthy Living Partnerships to Prevent Diabetes study: 2-year outcomes of a randomized controlled trial. American Journal of Preventive Medicine 2013;44(4):S324-32.

Kieffer EC, Welmerink DB, Sinco BR, et al. Dietary outcomes in a Spanish-language randomized controlled diabetes prevention trial with pregnant Latinas. American Journal of Public Health 2014 Mar;104(3):526-33.

Mau MK, Kaholokula JK, West MR, et al. Translating diabetes prevention into native Hawaiian and Pacific Islander communities: the PILI ‘Ohana Pilot project. Progress in Community Health Partnerships: Research, Education, and Action 2010;4(1):7.

O’Brien MJ, Perez A, Alos VA, Whitaker RC, Ciolino, et al. The feasibility, acceptability, and preliminary effectiveness of a Promotora-Led Diabetes Prevention Program (PL-DPP) in Latinas: a pilot study. Diabetes Educator 2015;41(4):485-94.

Ockene IS, Tellez TL, Rosal MC, et al. Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino Diabetes Prevention Project. American Journal of Public Health 2012;102(2):336-42.

Parikh P, Simon EP, Fei K, Looker H, Goytia C, Horowitz CR. Results of a pilot diabetes prevention intervention in East Harlem, New York City: Project HEED. American Journal of Public Health 2010;100(S1):S232-9.

Philis-Tsimikas A, Fortmann AL, Dharkar-Surber S, et al. Dulce Mothers: an intervention to reduce diabetes and cardiovascular risk in Latinas after gestational diabetes. Translational Behavioral Medicine 2014;4(1):18-25.

Ruggiero L, Oros S, Choi YK. Community-based translation of the diabetes prevention program’s lifestyle intervention in an underserved Latino population. Diabetes Educator 2011;37(4):564-72.

Schwartz R, Powell L, Keifer M. Family-based risk reduction of obesity and metabolic syndrome: an overview and outcomes of the Idaho partnership for Hispanic health. Journal of Health Care for the Poor and Underserved 2013;24(2):129-44.

Shaibi GQ, Konopken Y, Hoppin E, Keller CS, Ortega R, Castro FG. Effects of a culturally grounded community-based diabetes prevention program for obese Latino adolescents. Diabetes Educator 2012;38(4):504-12.

Simmons D, Fleming C, Voyle J, Fou F, Feo S, Gatland B. A pilot urban church based programme to reduce risk factors for diabetes among Western Samoans in New Zealand. Diabetic Medicine 1998;15(2):136-42.

Staten LK, Scheu LL, Bronson D, Pe a V, Elenes J. Pasos Adelante: the effectiveness of a community-based chronic disease prevention program. Preventing Chronic Disease 2005;2(1):A18.

Tang TS, Nwankwo R, Whiten Y, Oney C. Outcomes of a church-based diabetes prevention program delivered by peers: a feasibility study. Diabetes Educator 2014;40(2):223-30.

Teufel-Shone NI, Gamber M, Watahomigie H, Siyuja Jr TJ, Crozier L, Irwin SL. Peer Reviewed: Using a Participatory Research Approach in a School-Based Physical Activity Intervention to Prevent Diabetes in the Hualapai Indian Community, Arizona, 2002 2006. Preventing Chronic Disease 2014;11:E166.

Wagner J, Kong S, Kuoch T, Scully MF, Tan HK, Bermudez-Millan A. Patient reported outcomes of eat, walk, sleep: a cardiometabolic lifestyle program for Cambodian Americans delivered by community health workers. Journal of Health Care for the Poor and Underserved 2015;26(2):441-52.

Wilson MG, DeJoy DM, Vandenberg R, Padilla H, Davis M. FUEL your life: a translation of the Diabetes Prevention Program to worksites. American Journal of Health Promotion 2016;30(3):188-97.

Economic Review

Irvine L, Barton GR, Gasper AV, et al. Cost-effectiveness of a lifestyle intervention in preventing Type 2 diabetes. International Journal of Technology Assessment in Health Care 2011;27(04):275-82.

Kramer MK, McWilliams JR, Chen H-Y, Siminerio LM. A community-based diabetes prevention program evaluation of the group lifestyle balance program delivered by diabetes educators. Diabetes Educator 2011;37(5):659-68.

Krukowski RA, Pope RA, Love S, et al. Examination of costs for a lay health educator-delivered translation of the Diabetes Prevention Program in senior centers. Preventive Medicine 2013;57(4):400-2.

Lawlor MS, Blackwell CS, Isom SP, et al. Cost of a group translation of the diabetes prevention program: healthy living partnerships to prevent diabetes. American Journal of Preventive Medicine 2013;44(4):S381-S9.

Ockene IS, Tellez TL, Rosal MC, et al. Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino Diabetes Prevention Project. American Journal of Public Health 2012;102(2):336-42.

Smith KJ, Hsu HE, Roberts MS, et al. Cost-effectiveness analysis of efforts to reduce risk of type 2 diabetes and cardiovascular disease in southwestern Pennsylvania, 2005 2007. Preventing Chronic Disease 2010;7(5):A109.

Vadheim LM, Brewer KA, Kassner DR, et al. Effectiveness of a lifestyle intervention program among persons at high risk for cardiovascular disease and diabetes in a rural community. Journal of Rural Health 2010;26(3):266-72.

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

CMS 2013: Centers for Medicare & Medicaid Services (CMS). 78 Fed Reg 42160 (July 15, 2013). “a. Diagnostic, Screening, Preventive, and Rehabilitative Services (Preventive Services) ( 440.130)” (paragraph citation: 78 FR 42226) Available at URL: http://www.gpo.gov/fdsys/pkg/FR-2013-07-15/pdf/2013-16271.pdf Last updated: 10/3/2016.

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/bureau-health-workforce/data-research/community-health-workforce.pdf Last updated: 12/1/2016.

Valentine W, Palmer A, Nicklasson L, Cobden D, Roze S. Improving life expectancy and decreasing the incidence of complications associated with type 2 diabetes: a modelling study of HbA1c targets. International Journal of Clinical Practice 2006;60(9):1138-45.

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.
  • The National Diabetes Prevention Program (National DPP) provides communities an opportunity to implement sustainable programs which engage community health workers for diabetes prevention, especially in diverse and underserved communities. Trained community health workers may be potentially important providers of CDC-recognized lifestyle change programs which meet standards and use curriculum approved by the Diabetes Prevention Recognition Program (DPRP). They could serve as lifestyle coaches for clients who are referred to the program, either by healthcare providers or through the use of the National DPP web-based risk assessment tool [PDF – 758 kB].
  • 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 delivered by a health professionals, which may include community health workers.
  • Community health workers may work with clients alone or as part of a team. Services may be limited to health education, informal counseling, and extended support, or they may include a broader range of services in community and clinical settings.
  • Community health workers are typically matched to the populations they serve (i.e. location, race or ethnicity, or language) and the specific services they deliver (e.g. culturally appropriate lifestyle programs).
  • Community health workers typically provide clients with culturally appropriate information and education on diabetes prevention, lifestyle counseling to build individual capacity and social support.

Crosswalks

Healthy People 2030

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.