Heart Disease and Stroke Prevention: Interventions Engaging Community Health Workers

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends interventions that engage community health workers to prevent cardiovascular disease (CVD) among clients at increased risk.
  • The CPSTF finds strong evidence of effectiveness for interventions that engage community health workers in a team-based care model to improve blood pressure and cholesterol.
  • The CPSTF finds sufficient evidence of effectiveness for interventions that engage community health workers for health education, and as outreach, enrollment, and information agents to increase self-reported health behaviors (physical activity, healthful eating habits, and smoking cessation) in clients at increased risk for CVD.

A small number of studies suggest that engaging community health workers improves appropriate use of healthcare services and reduces morbidity and mortality related to CVD.

When interventions engaging community health workers are implemented in minority or underserved communities, they can improve health, reduce health disparities, and enhance health equity.

Economic evidence indicates these interventions are cost-effective.

Intervention

Interventions that engage community health workers to prevent cardiovascular disease aim to reduce risk factors among those at higher risk by providing culturally appropriate education, offering social support and informal counseling, connecting people with services, and in some cases delivering health services such as blood pressure screening.

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.

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About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 31 studies with 35 study arms (search period: beginning of database July 2013).

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 cardiovascular disease prevention.

Summary of Results

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

Interventions that engage community health workers (CHW) for cardiovascular disease prevention use one or more of the following models of care (HRSA 2007).

  • Screening and health education. CHWs screen for high blood pressure, cholesterol, and behavioral risk factors recommended by the United States Preventive Services Task Force (USPSTF); deliver individual or group education on CVD risk factors; provide adherence support for medications; and offer self-management support for health behavior changes, such as increasing physical activity and smoking cessation (31 study arms).
  • Outreach, enrollment, and information. CHWs reach out to individuals and families who are eligible for medical services, help them apply for these services, and provide proactive client follow-up and monitoring, such as appointment reminders and home visits (20 study arms).
  • Team-based care. As care team members, CHWs partner with clients and licensed providers, such as physicians and nurses, to improve coordination of care and support for clients (17 study arms).
  • Patient navigation. CHWs help individuals and families navigate complex medical service systems and processes to increase their access to care (8 study arms).
  • Community organizers. CHWs facilitate self-directed change and community development by serving as liaisons between the community and healthcare systems (4 study arms).

Overall, included studies showed the following:

  • Among populations at increased risk for CVD, interventions that engaged CHWs in a team-based care model led to large improvements in blood pressure and cholesterol outcomes. Interventions that engaged CHWs as health educators or as outreach, enrollment, and information agents led to modest improvements in health behavior outcomes.
  • There was not enough evidence to draw conclusions about interventions that engaged CHWs as patient navigators or community organizers.
  • Studies reported improvements for appropriate use of health care services (2 studies); screening for CVD risk factors (1 study); and CVD-related morbidity and mortality (2 studies).
  • Most included studies engaged CHWs to work with underserved groups, suggesting these interventions can be effective in improving minority health and reducing health disparities related to cardiovascular disease (22 studies).

Included studies were stratified based on suitability of study designs, as defined by the CPSTF (Briss et al., 2000).

  • Eighteen studies used designs considered to be of greatest/moderate suitability:
    • Individual randomized controlled trial (7 studies)
    • Group randomized controlled trial (4 studies)
    • Non-randomized trial (3 studies)
    • Prospective cohort (1 study)
    • Case-control (1 study)
    • Other designs with a concurrent comparison group (2 studies)
  • Thirteen studies used a design considered to be least suitable:
    • Before-after without a comparison group

Interventions that Engaged CHWs in a Team-Based Care Model

  • Blood pressure outcomes
    • Proportion of clients with blood pressure at goal
      • Greatest/moderate suitability studies: median increase of 17.6 percentage points (4 studies)
      • Least suitable studies: increase of 10.8 percentage points (1 study) and increase of 14.5 percentage points (1 study)
    • Change in systolic blood pressure
      • Greatest/moderate suitability studies: median reduction of 6.0 mmHg (6 studies with 7 study arms)
      • Least suitable studies: median reduction of 11.2 mmHg (4 studies)
    • Change in diastolic blood pressure
      • Greatest/moderate suitability studies: median reduction of 1.1 mmHg (6 studies with 7 study arms)
      • Least suitable studies: median reduction of 4.2 mmHg (3 studies)
  • Cholesterol outcomes
    • Proportion of clients with total cholesterol at goal
      • Greatest/moderate suitability studies: increase of 7.0 percentage points (1 study)
    • Change in total cholesterol
      • Greatest/moderate suitability studies: decreases of 19.7 mg/dL (1 study) and 0.4 mg/dL (not significant; 1 study)
      • Least suitable studies: increase of 1.5 mg/dL (not significant; 1 study)
    • Proportion of clients with low-density lipoprotein (LDL) cholesterol at goal
      • Greatest/moderate suitability studies: increases of 28.9 percentage points (1 study) and 3.2 percentage points (1 study)
      • Least suitable studies: increase of 10.0 percentage points (1 study)
    • Change in LDL cholesterol
      • Greatest/moderate suitability studies: median decrease of 15.5 mg/dL (3 studies)
      • Least suitable studies: median decrease of 15.0 mg/dL (3 studies)
    • Change in high-density lipoprotein (HDL) cholesterol
      • Greatest/moderate suitability studies: median change of 0 mg/dL (3 studies)
      • Least suitable studies: increase of 1.0 mg/dL (not significant; 1 study) and decrease of 2.1 mg/dL (not significant; 1 study)
    • Change in triglycerides
      • Greatest/moderate suitability studies: median decrease of 8.0 mg/dL (3 studies)
      • Least suitable studies: decrease of 23.0 mg/dL (1 study) and increase of 1.7 mg/dL (not significant; 1 study)
  • Improvements in blood pressure and cholesterol outcomes were smaller when interventions engaged CHWs using other models of care other than team-based care.

Interventions that Engaged CHWs as Health Educators

  • Physical activity outcomes
    • Greatest/moderate suitability studies: significant (1 study) and nonsignificant (1 study) improvements in physical activity
    • Least suitable studies: significant improvements (5 studies with 6 study arms)
  • Nutrition outcomes
    • Greatest/moderate suitability studies: significant improvements (2 studies)
    • Least suitable studies: significant improvements (5 studies with 6 study arms)
  • Smoking outcomes
    • Greatest/moderate suitability studies: median decrease of 0.5 percentage points in the proportion of current smokers (3 studies)
    • Least suitable studies: decreases in the proportion of current smokers of 3.7 percentage points (1 study) and 0.6 percentage points (1 study)

Interventions that Engaged CHWs as Outreach, Enrollment, and Information Agents

  • Physical activity outcomes
    • Greatest/moderate suitability studies: significant (1 study) and nonsignificant (1 study) improvements in physical activity
    • Least suitable studies: significant improvements (3 studies with 4 study arms)
  • Nutrition outcomes
    • Greatest/moderate suitability studies: significant improvements (2 studies)
    • Least suitable studies: significant improvements (3 studies with 4 study arms)
  • Smoking outcomes
    • Greatest/moderate suitability studies: decreases in the proportion of current smokers of 1.9 percentage points (1 study) and 0.5 percentage points (1 study)

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 the prevention of cardiovascular disease are cost-effective. All monetary values are reported in 2015 U.S. dollars.

The economic review included nine studies (6 from the United States, 2 from the United Kingdom, and 1 from Canada). Most patients in the studies came from minority or low-income populations.

  • The median intervention cost per person per year was $329 (8 studies)
  • The median change in healthcare cost per person per year was $82 (7 studies)
  • The median estimated cost per quality adjusted life year (QALY) gained was $17,670 (4 studies)
  • All estimates were below $50,000 a frequently used benchmark for cost-effectiveness.

Applicability

Based on results for interventions in different settings and populations, the CPSTF finding should be applicable to the following:
  • Adults and older adults who have high blood pressure or high cholesterol
  • Women and men
  • African-American, Hispanic, and low-income populations
  • Urban environments
  • Healthcare systems and community 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?)
  • Most studies evaluated outcomes at 12 months, a relatively short follow-up time for some CVD risk factors. How effective are longer interventions and what are the sustained, ongoing effects of these programs on different CVD risk factors (e.g., blood pressure, cholesterol, morbidity)?
  • How effective are programs implemented among diverse populations that vary by comorbidity, sexual orientation, disability, race and ethnicity (e.g., American Indian, Alaskan native, Asian), and socioeconomic status (e.g., educational attainment, health coverage)?
  • How does intervention effectiveness vary by the frequency of CHW-patient interactions, visit length, mode of delivery (e.g., face-to-face, telephone), and context (e.g., individual or group session)?
  • How can financing, communication, and organization better facilitate the integration of CHWs into health promotion and health care efforts that bridge clients, community resources, and healthcare systems?
  • Do CHWs who work in both community and healthcare settings build and enhance community-clinical linkages that support effective patient navigation?
  • How can clients at high risk for cardiovascular disease be identified, particularly when they do not have a usual source of care?
  • How effectively do CHWs connect clients who lack sufficient health coverage with appropriate care and services?
  • Most of the included studies were funded by public grants. How can CHW programs be sustained and funded? How could reimbursement arrangements be used to pay for CHW services? Does the funding mechanism have an impact on intervention effectiveness?
  • How effective are interventions that use a community-based participatory approach?
  • What are best practices for recruiting, selecting, training, supervising, and evaluating CHWs?
  • What are optimal ways to match CHWs with patient populations (e.g., SES, personal experience)?
  • How effective are interventions that engage CHWs using the five identified models of care (i.e., screening and health education; outreach, enrollment and information; team-based care; patient navigation; community organization)?
  • What is the incremental effectiveness and cost of adding CHWs to team-based care programs?
  • In most studies, interventions delivered services in either community or healthcare settings and on a smaller-scale (i.e., = 500 clients). How effective are interventions that engage CHWs in rural and worksite settings, or on a larger-scale (i.e., >500 clients)?
  • What are the complete and detailed costs and economic benefits of CHW interventions? What cost should be assigned for CHW services, whether they are volunteer or salaried?

Study Characteristics

  • Studies were conducted in the United States (28 studies), Canada (2 studies), and Western Europe (1 study).
  • Included studies evaluated interventions in healthcare systems (13 studies), communities (11 studies), or both (7 studies).
  • Studies were set primarily in urban areas (22 studies).
  • Study populations mainly included adults who were ages 18-64 years old (23 studies) and older adults who were 65 years and older (5 studies) who had one or more of the following risk factors: high blood pressure, high cholesterol, obesity, diabetes, or tobacco use.
  • In the included studies, 75% or more of the clients enrolled were African-American (9 studies), Hispanic (8 studies), or low-income (12 studies).
  • CHWs were frequently matched to the population they served by location (16 study arms), race/ethnicity (17 study arms), or language (15 study arms).
  • CHWs provided clients with culturally appropriate information and education on cardiovascular disease risk factors (21 study arms), lifestyle counseling (20 study arms), informal counseling and social support (22 study arms), and information on community resources (16 study arms).

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

Adair R, Christianson J, Wholey DR, et al. Care guides: employing nonclinical laypersons to help primary care teams manage chronic disease. J Ambul Care Manage 2012;35(1):27-37.

Allen JK, Dennison-Himmelfarb CR, Szanton SL, et al. Community Outreach and Cardiovascular Health (COACH) Trial: a randomized, controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers. In: Circulation. Cardiovascular quality and outcomes; 2011: 595-602.

Balcazar H, Alvarado M, Cantu F, Pedregon V, Fulwood R. A promotora de salud model for addressing cardiovascular disease risk factors in the US-Mexico border region. Prev Chronic Dis 2009;6(1):A02.

Balcazar H, Alvarado M, Hollen ML, Gonzalez-Cruz Y, Pedregon V. Evaluation of Salud Para Su Corazon (Health for your Heart) — National Council of La Raza Promotora Outreach Program. Prev Chronic Dis 2005;2(3):A09.

Balcazar HG, de Heer H, Rosenthal L, et al. A promotores de salud intervention to reduce cardiovascular disease risk in a high-risk Hispanic border population, 2005-2008. Prev Chronic Dis 2010;7(2):A28.

Becker DM, Yanek LR, Johnson WR, Jr., et al. Impact of a community-based multiple risk factor intervention on cardiovascular risk in black families with a history of premature coronary disease. Circulation 2005;111(10):1298-304.

Bloom JR, Syme SL, Pendergrass S, Robinson RG, Gay M, Stroud FM. Improving hypertension control through tailoring: a pilot study using selective assignment of patients to treatment approaches. Patient Education & Counseling 1987;10(1):39-51.

Chen EH, Thom DH, Hessler DM, et al. Using the Teamlet Model to improve chronic care in an academic primary care practice. J Gen Intern Med 2010;25 Suppl 4:S610-4.

Cooper LA, Roter DL, Carson KA, et al. A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients. J Gen Intern Med 2011;26(11):1297-304.

Daniels EC, Powe BD, Metoyer T, McCray G, Baltrus P, Rust GS. Increasing knowledge of cardiovascular risk factors among African Americans by use of community health workers: the ABCD community intervention pilot project. J Natl Med Assoc 2012;104(3-4):179-85.

El Fakiri F, Bruijnzeels MA, Uitewaal PJ, Frenken RA, Berg M, Hoes AW. Intensified preventive care to reduce cardiovascular risk in healthcare centres located in deprived neighbourhoods: a randomized controlled trial. Eur J Cardiovasc Prev Rehabil 2008;15(4):488-93.

Fedder DO, Chang RJ, Curry S, Nichols G. The effectiveness of a community health worker outreach program on healthcare utilization of west Baltimore City Medicaid patients with diabetes, with or without hypertension. Ethn Dis 2003;13(1):22-7.

Fernandes R, Braun KL, Spinner JR, et al. Healthy Heart, Healthy Family: A NHLBI/HRSA Collaborative Employing Community Health Workers to Improve Heart Health. J Health Care for the Poor and Underserved 2012;23(3):988.

Hayashi T, Farrell MA, Chaput LA, Rocha DA, Hernandez M. Lifestyle intervention, behavioral changes, and improvement in cardiovascular risk profiles in the California WISEWOMAN project. J Womens Health (Larchmt) 2010;19(6):1129-38.

Hill MN, Bone LR, Hilton SC, Roary MC, Kelen GD, Levine DM. A clinical trial to improve high blood pressure care in young urban black men: recruitment, follow-up, and outcomes. Am J Hypertension 1999:548-54.

Hill MN, Han HR, Dennison CR, et al. Hypertension care and control in underserved urban African American men: behavioral and physiologic outcomes at 36 months. Am J Hypertension 2003: 906-13.

Hovell MF, Geary DC, Black DR, Kamachi K, Kirk R. The effects of lay counseling on medication adherence and blood pressure: adjunctive treatment for hypertension. Patient Educ Couns 1984;6(2):91-4.

Jones C, Simpson SH, Mitchell D, et al. Enhancing hypertension awareness and management in the elderly: lessons learned from the Airdrie Community Hypertension Awareness and Management Program (A-CHAMP). Can J Cardiol 2008;24(7):561-7.

Kaczorowski J, Chambers LW, Dolovich L, et al. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP). BMJ 2011;342:d442.

Kim S, Koniak-Griffin D, Flaskerud JH, Guarnero PA. The impact of lay health advisors on cardiovascular health promotion: using a community-based participatory approach. J Cardiovasc Nurs 2004;19(3):192-9.

Krantz MJ, Coronel SM, Whitley EM, Dale R, Yost J, Estacio RO. Effectiveness of a community health worker cardiovascular risk reduction program in public health and health care settings. Am J Public Health 2013;103(1):e19-27.

Medina A, Balc zar H, Hollen ML, Nkhoma E, Mas FS. Promotores de Salud: educating Hispanic communities on heart-healthy living. American J Health Education 2007;38(4):194-202.

Morisky DE, Lees NB, Sharif BA, Liu KY, Ward HJ. Reducing disparities in hypertension control: a community-based hypertension control project (CHIP) for an ethnically diverse population. Health Promotion Practice 2002;3(2):264-75.

Plescia M, Herrick H, Chavis L. Improving health behaviors in an African American community: the Charlotte Racial and Ethnic Approaches to Community Health Project. Am J Public Health 2008;98(9):1678-84.

Rorie JA, Smith A, Evans T, et al. Using resident health advocates to improve public health screening and follow-up among public housing residents, Boston, 2007-2008. Prev Chronic Dis 2011;8(1):A15.

Shlay JC, Barber B, Mickiewicz T, et al. Reducing cardiovascular disease risk using patient navigators, Denver, Colorado, 2007-2009. Prev Chronic Dis 2011;8(6):A143.

Spinner JR, Alvarado M. Salud Para Su Carozon–a Latino promotora-led cardiovascular health education program. Fam Community Health 2012;35(2):111-9.

Truncali A, Dumanovsky T, Stollman H, Angell SY. Keep on track: a volunteer-run community-based intervention to lower blood pressure in older adults. J Am Geriatr Soc 2010;58(6):1177-83.

Tsui EW, Wang G, Zahler A, Simoyan OM, White MV, McKee M. A multilingual population health management program. J Ambul Care Manage 2013;36(2):140-6.

Yeo G, F. V, G R. Outcomes and challenges of Familias Saludables: a rural latino chronic disease screening and management project. Hispanic Health Care International 2011;9(3):137-43.

Zoellner JM, Connell CC, Madson MB, et al. H.U.B city steps: methods and early findings from a community-based participatory research trial to reduce blood pressure among African Americans. Int J Behav Nutr Phys Act 2011;8:59.

Additional References Linked to Included Studies

Allen JK, Dennison Himmelfarb CR, Szanton SL, Frick KD. Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities. J Cardiovascular Nursing 2013:epub.

Allen JK, Himmelfarb CR, Szanton SL, Bone L, Hill MN, Levine DM. COACH trial: a randomized controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers: rationale and design. Contemp Clin Trials 2011;32(3):403-11.

Balcazar H, Alvarado M, Hollen ML, et al. Salud Para Su Corazon-NCLR: a comprehensive Promotora outreach program to promote heart-healthy behaviors among hispanics. Health Promot Pract 2006;7(1):68-77.

Balcazar H, Alvarado M, Ortiz G. Salud Para Su Corazon (health for your heart) community health worker model: community and clinical approaches for addressing cardiovascular disease risk reduction in Hispanics/Latinos. J Ambul Care Manage 2011;34(4):362-72.

Balcazar H, Rosenthal L, De Heer H, et al. Use of community-based participatory research to disseminate baseline results from a cardiovascular disease randomized community trial for Mexican Americans living in a U.S.-Mexico border community. Educ Health (Abingdon) 2009;22(3):279.

Carter M, Karwalajtys T, Chambers L, et al. Implementing a standardized community-based cardiovascular risk assessment program in 20 Ontario communities. Health Promotion International 2009;24(4):325-33.

Cene CW, Yanek LR, Moy TF, Levine DM, Becker LC, Becker DM. Sustainability of a multiple risk factor intervention on cardiovascular disease in high-risk African American families. Ethnicity & Disease 2008:169-75.

Coleman KJ, Farrell MA, Rocha DA, et al. Readiness to be physically active and self-reported physical activity in low-income Latinas, California WISEWOMAN, 2006-2007. Prev Chronic Dis 2012;9:E87.

Cooper LA, Roter DL, Bone LR, et al. A randomized controlled trial of interventions to enhance patient-physician partnership, patient adherence and high blood pressure control among ethnic minorities and poor persons: study protocol NCT00123045. Implementation Science 2009;4(1):7.

Farrell MA, Hayashi T, Loo RK, et al. Clinic-based nutrition and lifestyle counseling for Hispanic women delivered by community health workers: design of the California WISEWOMAN study. J Womens Health (Larchmt) 2009;18(5):733-9.

Hill MN, Bone LR, Kim MT, Miller DJ, Dennison CR, Levine DM. Barriers to hypertension care and control in young urban black men. Am J Hypertension 1999;12(10):951-8.

Kaczorowski J, Chambers LW, Karwalajtys T, et al. Cardiovascular Health Awareness Program (CHAP): A community cluster-randomised trial among elderly Canadians. Prev Med 2008;46(6):537-44.

Plescia M, Groblewski M, Chavis L. A lay health advisor program to promote community capacity and change among change agents. Health Promot Pract 2008;9(4):434-9.

Thomson JL, Landry AS, Zoellner JM, et al. Participant Adherence Indicators Predict Changes in Blood Pressure, Anthropometric Measures, and Self-Reported Physical Activity in a Lifestyle Intervention HUB City Steps. Health Ed & Behavior 2014:1090198114537069.

Ward HJ, Morisky DE, Lees NB, Fong R. A clinic and community-based approach to hypertension control for an underserved minority population: design and methods. Am J Hypertension; 2000:177-83.

Zoellner J, Connell C, Madson MB, et al. HUB City Steps: A 6-Month Lifestyle Intervention Improves Blood Pressure among a Primarily African-American Community. J Acad Nutrition and Dietetics 2014;114(4):603-12.

Economic Review

Adair R, Christianson J, Wholey DR, et al. Care guides: employing nonclinical laypersons to help primary care teams manage chronic disease. Journal of Ambulatory Care Management 2012;35(1):27-37.

Allen JK, Himmelfarb CRD, Szanton SL, Frick KD. Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities. Journal of Cardiovascular Nursing 2014;29(4):308.

Barton GR, Goodall M, Bower P, Woolf S, Capewell S, Gabbay MB. Increasing heart-health lifestyles in deprived communities: economic evaluation of lay health trainers. Journal of Evaluation in Clinical Practice 2012;18(4):835-40.

Dixon P, Hollinghurst S, Ara R, Edwards L, Foster A, Salisbury C. Cost-effectiveness modelling of telehealth for patients with raised cardiovascular disease risk: evidence from a cohort simulation conducted alongside the Healthlines randomised controlled trial. BMJ Open 2016;6(9):e012355.

Dixon P, Hollinghurst S, Edwards L, et al. Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial. BMJ Open 2016;6(8):e012352.

Fedder DO, Chang RJ, Curry S, Nichols G. The effectiveness of a community health worker outreach program on healthcare utilization of west baltimore city medicaid patients with diabetes with or without hypertension. Ethnicity and Disease 2003;13(1):22-7.

Goeree R, von Keyserlingk C, Burke N, et al. Economic appraisal of a community-wide cardiovascular health awareness program. Value in Health 2013;16(1):39-45.

Hollenbeak C, Weiner MG, Turner BJ. Cost-effectiveness of a peer and practice staff support intervention. American Journal of Managed Care 2014;20(3):253-60.

Kangovi S, Carter T, Charles D, et al. Toward a scalable, patient-centered community health worker model: adapting the IMPaCT intervention for use in the outpatient setting. Population Health Management 2016;19(6):380-8.

Kangovi S, Mitra N, Smith RA, et al. Decision-making and goal-setting in chronic disease management: baseline findings of a randomized controlled trial. Patient Education and Counseling 2016; September.

Yun S, Ehrhardt E, Britt L, Brendel B, Wilson J, Berwanger A. Missouri Community, Public Health, and Primary Care Linkage: 2011-2012 Pilot Project Results & Evaluation. Mo Med 2015;112(4):323-8.

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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 July 2013, 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: 8/25/2013
Results: 2375

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: 8/24/2013
Results: 909

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: 8/23/2013
Results: 118

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: 8/19/2013
Results: 124

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: 8/24/2013
Results: 6

Search Strategy:

“health advisors” +hypertension

“community health workers” +cardiovascular

“community health workers” +hypertension

Database: NTIS (Dialog File 6)

Date Searched: 8/20/2013
Results: 711

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: 8/26/2013
Results: 5263

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: 8/20/2013
Results: 624

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

Name of Database: SSRN

Date Searched: 8/24/2013
2 Results

Search Strategy:

“Community Health Workers” hypertension

“Community Health Workers” “cardiovascular disease”

Name of Database: WorldCat

Date Searched: 8/24/2013
30 Results

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.

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

Name of Database: SSRN

Date Searched: 8/5/2016
Results: 4

Search Strategy:

“Community Health Workers” hypertension

“Community Health Workers” “cardiovascular disease”

Name of Database: WorldCat

Date Searched: 8/9/2016
Results: 42

Search Strategy:

“Community Health Workers” hypertension

“Community Health Workers” “cardiovascular disease”

Review References

Briss PA, Zaza S, Pappaionau M et al. Developing an evidence-based Guide to Community Preventive Services-methods [PDF – 105 kB]. Am J Prev Med 2000;18(1S):35-43.

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) www.gpo.gov/fdsys/pkg/FR-2013-07-15/pdf/2013-16271.pdf

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: http://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/communityhealthworkforce.pdf.

Mason JM, Freemantle N, Gibson JM, New JP. Specialist nurse-led clinics to improve control of hypertension and hyperlipidemia in diabetes. Diabetes Care 2005;28(1):40.

McEwan P, Peters JR, Bergenheim K, Currie CJ. Evaluation of the costs and outcomes from changes in risk factors in type 2 diabetes using the Cardiff stochastic simulation cost-utility model (DiabForecaster). Current Medical Research and Opinion 2005;22(1):121-9

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 Services (CMS) allows states to provide Medicaid reimbursement for USPSTF recommended preventive services when “recommended by a physician or other licensed practitioner” and delivered by a broad array of health professionals, including CHWs. Implementers of CHW interventions should consider state-specific regulations in accordance with this ruling when making decisions about CHW engagement in their organizations.
  • The type of education and training provided to CHWs is important and should address collaboration with other healthcare providers.
  • Supervision, performance feedback, and coaching should be provided for CHWs.
  • Included studies suggested the following approaches to address implementation barriers:
    • Achieve community buy-in during the planning phase
    • Address issues related to gender and culture
    • Conduct periodic quality assurance checks to make sure interventions have been appropriately implemented and adapted to different cultures
  • The Community Health Worker Toolkit includes information state health departments can use to train and further build capacity for CHWs. It also provides resources CHWs can use in their communities. The site is maintained by CDC’s Division for Heart Disease and Stroke Prevention.

CDC’s Division for Heart Disease and Stroke Prevention developed Best Practices for Cardiovascular Disease Prevention Programs: A Guide to Effective Health Care System Interventions and Community-Clinical Links to help communities select and implement successful interventions. The guide summarizes the effectiveness and economic evidence behind eight strategies to prevent cardiovascular disease, including interventions engaging community health workers. For each strategy, the guide offers information on implementation, such as settings where the strategies have been successful, resources available to support implementation, and policy considerations. “Stories from the Field” feature specific settings where strategies have been successfully implemented.