Teams of community health workers and nursing students effect health promotion of underserved urban neighborhoods.

The purpose of this study was to explore the effectiveness of CHW/nursing student teams in promoting secondary protection and improving access to care for residents of three urban underserved neighborhoods. The study also sought to measure CHW and resident satisfaction of such a program.
Quasi-experimental and non-experimental designs were used for the study. Convenience samples consisted of residents who participated in the CHW program during 2005-2006, CHWs and residents who participated in the CHW program during 2005-2007 and a systematic random sample of residents across the three neighborhoods.
Three quantitative measures were used in the study: a pre/post test with residents who participated in the program, a satisfaction survey of CHWs and participants, and a community assessment survey of the neighborhoods in which the program occurred.
CHW/nursing student teams were shown to increase awareness of community resources, increase access to dental care, decrease use of the ER, promote use of a medical home/regular source of care, and increase the percentage of people having their blood pressure screened in the last 2 years.
CHW/nursing student teams can positively impact the health of underserved populations.

Affiliation

Calvin College, Grand Rapids, Michigan 49546-4403, USA. gzandee@calvin.edu

Similar Publications

The purpose of this study was to explore the effectiveness of CHW/nursing student teams in promoting secondary protection and improving access to care for residents of three urban underserved neighborhoods. The study also sought to measure CHW and resident satisfaction of such a program.
Quasi-experimental and non-experimental designs were used for the study. Convenience samples consisted of residents who participated in the CHW program during 2005-2006, CHWs and residents who participated in the CHW program during 2005-2007 and a systematic random sample of residents across the three neighborhoods.
Three quantitative measures were used in the study: a pre/post test with residents who participated in the program, a satisfaction survey of CHWs and participants, and a community assessment survey of the neighborhoods in which the program occurred.
CHW/nursing student teams were shown to increase awareness of community resources, increase access to dental care, decrease use of the ER, promote use of a medical home/regular source of care, and increase the percentage of people having their blood pressure screened in the last 2 years.
CHW/nursing student teams can positively impact the health of underserved populations.

The model of volunteer community health workers (CHWs) is a common approach to serving the poor communities in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in this area, has been using female CHWs as core workers in its community-based health programs since 1977. After 25 years of implementing of the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through a community-based maternal health intervention. However, BRAC experiences high dropout rates among CHWs suggesting a need to better understand the impact of their dropout which would help to reduce dropout and increase program sustainability. The main objective of the study was to estimate impact of dropout of volunteer CHWs from both BRAC and community perspectives. Also, we estimated cost of possible strategies to reduce dropout and compared whether these costs were more or less than the costs borne by BRAC and the community.
We used the 'ingredient approach' to estimate the cost of recruiting and training of CHWs and the so-called 'friction cost approach' to estimate the cost of replacement of CHWs after adapting. Finally, we estimated forgone services in the community due to CHW dropout applying the concept of the friction period.
In 2009, average cost per regular CHW was US$ 59.28 which was US$ 60.04 for an ad-hoc CHW if a CHW participated a three-week basic training, a one-day refresher training, one incentive day and worked for a month in the community after recruitment. One month absence of a CHW with standard performance in the community meant substantial forgone health services like health education, antenatal visits, deliveries, referrals of complicated cases, and distribution of drugs and health commodities. However, with an additional investment of US$ 121 yearly per CHW BRAC could save another US$ 60 invested an ad-hoc CHW plus forgone services in the community.
Although CHWs work as volunteers in Dhaka urban slums impact of their dropout is immense both in financial term and forgone services. High cost of dropout makes the program less sustainable. However, simple and financially competitive strategies can improve the sustainability of the program.

2006Feb
J Health Care Poor Underserved
J Health Care Poor Underserved 2006 Feb;17(1 Suppl):26-43

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

2012Aug

Volunteer community health workers (CHWs) are one approach to addressing the health workforce crisis in developing countries. BRAC, a large Bangladeshi NGO, a pioneer in this area, uses female volunteer CHWs as core workers in its health programs. After 25 years of implementing the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through its community-based mother, newborn and child health interventions. However, the program experienced suboptimal performance among CHWs, with a high percentage of them remaining in their positions but becoming "inactive", not truly participating in daily community health activities. This suggests a need to better understand the relative importance of factors affecting their active participation and to recommend strategies for improving their participation. This mixed-method study included a descriptive correlational design to assess factors relating to level of activity of CHWs and focus group discussions to explore solutions to these problems. A sample of 542 current female CHWs from project areas participated in the survey. Financial incentives were the main factor linked to the activity of CHWs. CHWs who thought that running their families would be difficult without CHW income had more than three times greater odds to become active. In addition, social prestige and positive community feedback to the CHWs were important non-financial factors associated with level of activity. In order to improve volunteer CHWs' performance, a combination of financial and non-financial incentives should be used.

The role of Community Health Workers (CHWs) in improving access to basic healthcare services, and mobilising community actions on health is broadly recognised. The Primary Health Care (PHC) approach, identified in the Alma Ata conference in 1978, stressed the role of CHWs in addressing community health needs. Training of CHWs is one of the key aspects that generally seeks to develop new knowledge and skills related to specific tasks and to increase CHWs' capacity to communicate with and serve local people. This study aimed to analyse the CHW training process in Iran and how different components of training have impacted on CHW performance and satisfaction.
Data were collected from both primary and secondary sources. Training policies were reviewed using available policy documents, training materials and other relevant documents at national and provincial levels. Documentary analysis was supplemented by individual interviews with ninety-one Iranian CHWs from 18 provinces representing a broad range of age, work experience and educational levels, both male and female.
Recognition of the CHW program and their training in the national health planning and financing facilitates the implementation and sustainability of the program. The existence of specialised training centres managed by district health network provides an appropriate training environment that delivers comprehensive training and increases CHWs' knowledge, skills and motivation to serve local communities. Changes in training content over time reflect an increasing number of programs integrated into PHC, complicating the work expected of CHWs. In-service training courses need to address better local needs.
Although CHW programs vary by country and context, the CHW training program in Iran offers transferable lessons for countries intending to improve training as one of the key elements in their CHW program.

Affiliation Details

  • Calvin College, Grand Rapids, Michigan 49546-4403, USA. gzandee@calvin.edu
  • Calvin College
Affiliation Calvin College, Grand Rapids, Michigan 49546-4403, USA. gzandee@calvin.edu