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06-01-2023 | Vaccination | Original Paper

Evaluation of the Community Health Worker Model for COVID-19 Response and Recovery

Authors: Saira Nawaz, Kyle J. Moon, Rosa Vazquez, Jasmin R. Navarrete, Anne Trinh, Lizette Escobedo, Gloria Itzel Montiel

Published in: Journal of Community Health | Issue 3/2023

Abstract

Community health workers (CHWs), or promotores de salud, have long played a role in health promotion, but the COVID-19 pandemic has brought renewed attention to the functions, sustainability, and financing of CHW models. ¡Andale! ¿Que Esperas? was a 12-month (June 2021–May 2022) campaign that expanded the CHW workforce to increase COVID-19 vaccination rates in structurally vulnerable, Latinx communities across California. This mixed-methods evaluation aims to elucidate (1) the role of CHWs in COVID-19 response, recovery, and rebuilding and (2) the importance, needs, and perils of CHW models in the COVID-19 era and beyond. CHWs facilitated 159,074 vaccinations and vaccine appointments by countering mis/disinformation, addressing mental health and social needs, building digital competencies, and meeting people where they are, all of which expanded access and instilled confidence in the COVID-19 vaccine. CHWs’ success in engaging the community lies in their shared lived experience as well as their accessibility and recognition in the community, enabling their role in both immediate response and long-term recovery. Funding instability imperils the advances made by CHWs, and efforts are needed to institutionalize the CHW workforce with sustainable funding models. While Medicaid reimbursement models exist in some states, these models are often limited to healthcare services, overlooking a critical function of the CHW model: building community resilience and mobilizing the community for social change.

Centers for Disease Control and Prevention (CDC) (2022). COVID Data Tracker. Retrieved August 26, 2022, from https://covid.cdc.gov/covid-data-tracker/

Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., Weaver, M. D., Robbins, R., Facer-Childs, E. R., Barger, L. K., Czeisler, C. A., Howard, M. E., & Rajaratnam, S. M. W. . (2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. Morbidity and Mortality Weekly Report, 69(32), 1049–1057. https://doi.org/10.15585/mmwr.mm6932a1CrossRefPubMedPubMedCentral

Hillis, S. D., Blenkinsop, A., Villaveces, A., Annor, F. B., Liburd, L., Massetti, G. M., & Unwin, H. J. T. (2021). COVID-19 associated orphanhood and caregiver death in the United States. Pediatrics, 148(6), 31–43. https://doi.org/10.1542/peds.2021-053760CrossRef

Holden, T. M., Simon, M. A., Arnold, D. T., Halloway, V., & Gerardin, J. (2022). Structural racism and COVID-19 response: Higher risk of exposure drives disparate COVID-19 deaths among Black and Hispanic/Latinx residents of Illinois, USA. BMC Public Health, 22(312), 1–13. https://doi.org/10.1186/s12889-022-12698-9CrossRef

Vargaz, E. D., & Sanchez, G. R. (2020). COVID-19 is having a devastating impact on the economic well-being of Latino families. Journal of Economics, Race, and Policy, 3, 262–269. https://doi.org/10.1007/s41996-020-00071-0CrossRef

Villatoro, A. P., Wagner, K. M., Salgado de Snyder, V. N., Garcia, D., Walsdorf, A. A., & Valdez, C. R. (2022). Economic and social consequences of COVID-19 and mental health burden among Latinx young adults during the 2020 pandemic. Journal of Latinx Psychology, 10(1), 25–38. https://doi.org/10.1037/lat0000195CrossRef

Carson, S. L., Casillas, A., Castellon-Lopez, Y., Mansfield, L. N., Morris, D., Barron, J., Ntekume, E., Landovitz, R., Vassar, S. D., Norris, K. C., Dubinett, S. M., Garrison, N. A., & Brown, A. F. (2021). COVID-19 vaccine decision-making factors in racial and ethnic minority communities in Los Angeles, California. JAMA Network Open, 4(9), e2127582. https://doi.org/10.1001/jamanetworkopen.2021.27582CrossRefPubMedPubMedCentral

Ndugga, N., Hill, L., Artiga, S., & Haldar, S. (2022). Latest data on COVID-19 vaccinations by race/ethnicity. Kaiser Family Foundation. . Retrieved November 1, 2022, from https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-by-race-ethnicity/

Bracho, A., Lee, G., Giraldo, G., & de Prado, M. R. (2016). Recruiting the heart, training the brain. Hesperian Health Guides.

10.

Wiggins, N., Johnson, D., Avila, M., Farquhar, S. A., Michael, Y. L., Rios, T., & Lopez, A. (2009). Using popular education for community empowerment: Perspectives of community health workers in the Poder es Salud/Power for Health program. Critical Public Health, 19(1), 11–22. https://doi.org/10.1080/09581590802375855CrossRef

11.

Wiggins, N. (2012). Popular education for health promotion and community empowerment: A review of the literature. Health Promotion International, 27(3), 356–371. https://doi.org/10.1093/heapro/dar046CrossRefPubMed

12.

Montiel, G. I., Cantero, P. J., Montiel, I., Moon, K., & Nawaz, S. (2021). Rebuilding with impacted communities at the center: The case for a civic engagement approach to COVID-19 response and recovery. Family and Community Health, 44(2), 81–83. https://doi.org/10.1097/FCH.0000000000000294CrossRefPubMed

13.

Moon, K. J., Montiel, G. I., Cantero, P. J., & Nawaz, S. (2021). Addressing emotional wellness during the COVID-19 pandemic: The role of promotores in delivering integrated mental health care and social services. Preventing Chronic Disease, 18, 200656. https://doi.org/10.5888/pcd18.200656CrossRef

14.

Dasgupta, S., Bowen, V. B., Leidner, A., Fletcher, K., Musial, T., Rose, C., Cha, A., Kang, G., Dirlikov, E., Pevzner, E., Rose, D., Ritchey, M. D., Villanueva, J., Philip, C., Liburd, L., & Oster, A. M. (2020). Association between social vulnerability and a county’s risk for becoming a COVID-19 hotspot – United States, June 1–July 25, 2020. Morbidity and Mortality Weekly Report, 69(42), 1535–1541. https://doi.org/10.15585/mmwr.mm6942a3CrossRefPubMedPubMedCentral

15.

Palazuelos, D., Farmer, P. E., & Mukherjee, J. (2018). Community health and equity of outcomes: The partners in health experience. The Lancet Global Health, 6, e491-493. https://doi.org/10.1016/S2214-109X(18)30073-1CrossRefPubMed

16.

Chaidez, V., Palmer-Wackerly, A. L., & Trout, K. E. (2018). Community health worker employer survey: Perspectives on CHW workforce development in the Midwest. Journal of Community Health, 43, 1145–1154. https://doi.org/10.1007/s10900-018-0533-xCrossRefPubMed

17.

Ibe, C. A., Hickman, D., & Cooper, L. A. (2021). To advance health equity during COVID-19 and beyond, elevate and support community health workers. JAMA Health Forum, 2(7), e212724. https://doi.org/10.1001/jamahealthforum.2021.2724CrossRefPubMed

18.

Pérez, L. M., & Martinez, J. (2008). Community health workers: Social justice and policy advocates for community health and well-being. American Journal of Public Health, 98(1), 11–14. https://doi.org/10.2105/AJPH.2006.100842CrossRefPubMedPubMedCentral

19.

Rahman, R., Ross, A., & Pinto, R. (2021). The critical importance of community health workers as first responders to COVID-19 in USA. Health Promotion International, 36(5), 1498–1507. https://doi.org/10.1093/heapro/daab008CrossRefPubMed

20.

Montiel, G. I., Moon, K. J., Cantero, P. J., Pantoja, L., Ortiz, H. M., & Arpero, S. (2021). Queremos transformar comunidades: Incorporating civic engagement as an equity strategy in promotor-led COVID-19 response efforts in Latinx communities. Harvard Journal of Hispanic Policy, 33, 79–101.

21.

Wong, C. A., Alzuru, C., Kinsley, K., Jury, R., Sauer, M. L., Jones, T. V., & Armstrong, V. (2022). COVID-19 vaccination in North Carolina: Promoting equity by partnering with communities and health care providers. North Carolina Medical Journal, 83(3), 197–202. https://doi.org/10.18043/ncm.83.3.197CrossRefPubMed

22.

Garfield, C., & Kangovi, S. (2019). Integrating community health workers into health care teams without coopting them. Health Affairs Blog. https://doi.org/10.1377/hblog20190507.746358CrossRef

23.

Shorten, A., & Smith, J. (2017). Mixed methods research: Expanding the evidence base. Evidence-Based Nursing, 20(3), 74–75. https://doi.org/10.1136/eb-2017-102699CrossRefPubMed

24.

Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O’Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J., & Duda, S. N. (2019). The REDCap consortium: Building an international community of software partners. Journal of Biomedical Informatics, 95, 103208. https://doi.org/10.1016/j.jbi.2019.10320CrossRefPubMedPubMedCentral

25.

Castleberry, A., & Nolen, A. (2018). Thematic analysis of qualitative research data: Is it as easy as it sounds? Currents in Pharmacy Teaching and Learning, 10(6), 807–815. https://doi.org/10.1016/j.cptl.2018.03.019CrossRefPubMed

26.

Dadwal, V., Basu, L., Weston, C. M., Hwang, S., Ibe, C., Bone, L., Boonyasai, R. T., Gentry, J., Purnell, L., & Albert, W. W. (2017). How co-developed are community and academic partnerships? Progress in Community Health Partnerships, 11(4), 387–395. https://doi.org/10.1353/cpr.2017.0046CrossRefPubMed

27.

Perry, H. B., Zulliger, R., & Roger, M. M. (2014). Community health workers in low-, middle-, and high-income countries: An overview of their history, recent evolution, and current effectiveness. Annual Review of Public Health, 35, 399–421. https://doi.org/10.1146/annurev-publhealth-032013-182354CrossRefPubMed

28.

Peretz, P. J., Islam, N., & Matiz, L. A. (2020). Community health workers and COVID-19 – addressing social determinants of health in times of crisis and beyond. New England Journal of Medicine, 383, e108. https://doi.org/10.1056/NEJMp2022641CrossRefPubMed

29.

Perry, H. B., Chowdhury, M., Were, M., LeBan, K., Crigler, L., Lewin, S., Musoke, D., Kok, M., Scott, K., Ballard, M., & Hodgins, S. (2021). Community health workers at the dawn of a new era: CHWs leading the way to “Health for All.” Health Research Policy and Systems, 19(3), 111. https://doi.org/10.1186/s12961-021-00755-5CrossRefPubMedPubMedCentral

30.

Schmit, C. D., Washburn, D. J., LaFleur, M., Martinez, D., Thompson, E., & Callaghan, T. (2021). Community health worker sustainability: Funding, payment, and reimbursement laws in the United States. Public Health Reports, 137(3), 597–603. https://doi.org/10.1177/00333549211006072CrossRefPubMedPubMedCentral

31.

Smith, D. O., & Wennerstrom, A. (2020). To strengthen the public health response to COVID-19, we need community health workers. Health Affairs Blog. https://doi.org/10.1377/hblog20200504.336184CrossRef

32.

Rich, M. L., Miller, A. C., Niyigena, P., Franke, M. F., Niyonzima, J. B., Socci, A., Drobac, P. C., Hakizamungu, M., Mayfield, A., Ruhayisha, R., Epino, H., Stulac, S., Cancedda, C., Karamaga, A., Niyonzima, S., Yarbrough, C., Fleming, J., Amoroso, C., Mukherjee, J., … Binagwaho, A. (2012). Excellent clinical outcomes and high retention in care among adults in a community-based HIV treatment program in rural Rwanda. Journal of Acquired Immune Deficiency Syndrome, 59(3), e35–e42. https://doi.org/10.1097/QAI.0b013e31824476c4CrossRef

33.

Kangovi, S., Mitra, N., Grande, D., Long, J. A., & Asch, D. A. (2020). Evidence-based community health worker program addresses unmet social needs and generates positive return on investment. Health Affairs, 39(2), 207–213. https://doi.org/10.1377/hlthaff.2019.00981CrossRefPubMed

34.

Waters, R. (2021). California poised for major expansion of community health workers. California Health Care Foundation. Retrieved August 17, 2021, from chcf.org/blog/california-poised-major-expansion-community-health-workers/

35.

Medicaid and CHIP Payment and Access Commission (MACPAC). (2022). Medicaid coverage of community health worker services. Retrieved April 2022, from https://www.macpac.gov/wp-content/uploads/2022/04/Medicaid-coverage-of-community-health-worker-services-1.pdf

36.

Letter from Robert Casey et al., (2020). U.S. Senate, to Alex Azar, Secretary of Department of Health and Human Services. Retrieved September 30, 2020, from https://www.casey.senate.gov/download/senate-chw-letter-to-sec-azar

37.

Letter from Ted Deutch et al., (2020). U.S. Senate, to Alex Azar, Secretary of Department of Health and Human Services. Retrieved October 01, 2020, from https://teddeutch.house.gov/posts/bipartisan-bicameral-letters-urge-hhs-to-promote-use-of-community-health-workers-in-covid-19-response

Title: Evaluation of the Community Health Worker Model for COVID-19 Response and Recovery
Authors: Saira Nawaz
Kyle J. Moon
Rosa Vazquez
Jasmin R. Navarrete
Anne Trinh
Lizette Escobedo
Gloria Itzel Montiel
Publication date: 06-01-2023
Publisher: Springer US
Keywords: Vaccination
COVID-19
Published in: Journal of Community Health / Issue 3/2023
Print ISSN: 0094-5145
Electronic ISSN: 1573-3610
DOI: https://doi.org/10.1007/s10900-022-01183-4

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Evaluation of the Community Health Worker Model for COVID-19 Response and Recovery

Abstract

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