Community Health Worker Activities in Public Health Programs to Prevent Violence: Coding Roles and Scope.

In multiple and related forms, violence is a serious public health issue with lasting impacts on health and wellness in the United States. Community health workers (CHWs) are frontline public health workers and trusted members of communities. We aimed to analyze recent examples of CHW activities in violence prevention public health programs with a goal of informing future programs and research. We collected more than 300 documents published between 2010 and 2020 to identify public health programs to prevent violence including CHW activities. We used an iterative process to develop and apply a coding scheme to the CHW activities. We identified 20 public health programs to prevent violence which included CHW activities. CHWs most often addressed community violence, youth violence, and family violence and played an average of 8 of 10 core roles per program. Fewer than a third (i.e., 6 programs) reported community-focused CHW activities to address upstream and structural determinants of health inequities. This first examination, to our knowledge, of the intersection of the CHW and violence prevention literature shows that CHWs have played many of their core roles in public health programs to address multiple forms of violence. (Am J Public Health. 2022;112(8):1191-1201. https://doi.org/10.2105/AJPH.2022.306865).

Preterm and low birthweight birth in the United States: Black midwives speak of causality, prevention, and healing.

BACKGROUND: Low birthweight (LBW) and preterm birth (PTB) are more common among Black infants than white infants in the United States. Although multiple hypotheses have been proposed to explain elevated rates of PTB and LBW, the perspectives of Black midwives who serve Black communities are largely missing from the literature. METHODS: Using semi-structured interviews and focus groups with a purposive sample of midwives (n = 29), we elicited midwives' perceptions of PTB and LBW causation, as well as insights on culturally congruent strategies for prevention. We used consensus coding and reciprocal ethnography to increase the rigor of our analyses. RESULTS: Midwives identified three intersecting and predisposing root causes: (1) systemic racism; (2) the epigenetic legacy of enslavement; and (3) ongoing cultural loss. In response to these stressors, midwives recommended variants of two additional themes-(4) community building; and (5) culturally centered care-as essential to reversing mortality trends among Black babies. DISCUSSION: Midwives' perspectives, which are supported by relevant literature, provide critical insights that should inform both research and policy aimed at promoting birth justice in the United States and beyond.

A Community Participatory Approach to Identify Common Evaluation Indicators for Community Health Worker Practice.

BACKGROUND: Substantial evidence supports community health workers' (CHWs) contributions to improving health and reducing inequities. Common evaluation indicators can strengthen the evidence base and support the profession. OBJECTIVES: We describe the development of a 6-year community-academic partnership to identify common CHW process and outcome indicators. METHODS: Methods include interviews, focus groups and a survey conducted in Michigan, a Summit in Oregon, consultations at national conferences, and regular conference calls. RESULTS: Using popular education as a primary strategy, we have honed our original goal, identified a set of 20 recommended constructs, developed a national constituency with international connections, and obtained dedicated funding. CONCLUSIONS: Participatory identification, development, and uptake of a set of common indicators (CI) for CHW practice will allow data to be aggregated at multiple levels, potentially leading to more sustainable financing of CHW programs. Given that measurement drives practice, a set of common CHW indicators can help to preserve the flexibility and integrity of the CHW role.

The Community Health Worker (CHW) Common Indicators Project: Engaging CHWs in Measurement to Sustain the Profession.

Despite progress in documenting the outcomes of Community Health Worker interventions, the lack of standardized measures to assess CHW practice has made it difficult for programs to conduct reliable evaluations, and impossible to aggregate data across programs and regions, impeding commitment to sustainable, long-term financing of CHW programs. In addition, while CHWs have sometimes been involved as data collectors, they have seldom been engaged as full partners in all stages of evaluation and research. This manuscript details the current work being done by the CI Project, demonstrating how CHWs are able to contribute to the integrity, sustainability, and viability of CHW programs through the collaborative development and adoption of a set of common process and outcome constructs and indicators for CHW practice and CHW program implementation.

Early Lessons and Strategies from Statewide Efforts to Integrate Community Health Workers into Medicaid.

The 2010 Affordable Care Act provided new impetus and funding opportunities for state Medicaid agencies to integrate community health workers (CHWs) into their health systems. Community health workers are trusted community members who participate in training so they can promote health in their own communities. This qualitative study shares lessons and strategies from Oregon's early efforts to integrate CHWs into Medicaid with concomitant financing, policy, and infrastructure issues. Key informant interviews were conducted with 16 Coordinated care organizations (CCO) and analyzed using an iterative, immersion-crystallization approach. Coordinated care organizations found CHW integration a supportive factor for Medicaid-enrolled members navigating health and social services, educating members about disease conditions, and facilitating member engagement in primary care. Barriers to CHW integration included a lack of understanding about CHW roles and their benefits to health systems, as well as a need for more intensive guidance and support on financing and integrating CHW services.

Using popular education with health promotion students in the USA.

Recent publications have called for new approaches to training the next generation of health promotion professionals, for whom effective practice depends on understanding how systemic inequities are created and function and how they can be dismantled. These approaches gain particular urgency in the context of recent trends toward commodification of knowledge at both the secondary and post-secondary levels. Popular education, a liberatory pedagogy, has been used in social movements around the world for decades. In a health promotion context, its use has been associated with increased empowerment and improved health. To explore the potential of popular education (PE) for helping health promotion students develop a systemic analysis of power and privilege and the concrete skills needed to address health and social inequities, we conducted a case study in the context of a community organizing class in a Master's in Public Health curriculum. Analysis of mixed methods data collected from students suggested that PE, with its focus on concrete practices and interactions, is a valid alternative to conventional pedagogy and a useful complement to liberatory pedagogies more common in university classrooms. Application of PE in higher education will require overcoming barriers, including student resistance and institutional pressures that discourage its use.

"It's In My Veins": Exploring the Role of an Afrocentric, Popular Education-Based Training Program in the Empowerment of African American and African Community Health Workers in Oregon.

The role racism and other social determinants of health play in the creation of health inequities in African American communities in the United States is increasingly understood. In this article, we explore the effectiveness of an Afrocentric, popular education-based community health worker (CHW) training program in creating positive change among CHW participants and their communities in Portland, Oregon. Findings suggest that CHW participants experienced 4 types of awakening, in addition to changes in their interaction with their family members and increased community involvement. The CHWs identified group bond, Afrocentrism, public health knowledge, popular education, facilitators, and time management as important elements of an effective training program for this community. Psychological empowerment, self-reported health status, and health behavior among participants generally increased over time, but changes were not statistically significant.

Increasing the relevance of research to underserved communities: lessons learned from a retreat to engage community health workers with researchers.

This article presents information on a community retreat developed to seek input from community health workers (CHWs) to increase the relevance of our research to underserved communities in Oregon. Retreats facilitating dialogue between researchers and CHWs could yield important insight to enhance the significance of research for communities.

Popular education for health promotion and community empowerment: a review of the literature.

While there is now general agreement that the most effective way to promote health and decrease health inequities is by creating more just economic, social and political conditions, there is much less agreement about concrete ways in which public health practitioners can work with communities to address inequities such as poverty, racism and powerlessness. Practical strategies are desperately needed. Popular education, also known as Freirian and empowerment education, has been used successfully to create more equitable conditions around the world for >50 years. Its use to improve health has been documented in the public health literature since the early 1980s. Nonetheless, it remains largely unknown and its potential unrealized in mainstream public health circles in the industrialized world. In order to explore the potential of popular education as a tool to address inequities and improve health, a systematic review of the peer-reviewed international literature was conducted. Findings revealed that popular education is an effective method for enhancing empowerment and improving health. However, the existing literature does not provide empirical evidence that popular education is more effective than traditional education at increasing health knowledge and empowerment and changing health behavior. In order to fully understand the potential of popular education as a tool to eliminate health inequities and to advocate effectively for its use, further studies are needed that utilize mixed methods, participatory approaches and experimental or quasi-experimental designs.

Community health workers then and now: an overview of national studies aimed at defining the field.

This article compares and contrasts 3 national studies of the US Community Health Worker (CHW) field spanning 15 years. Findings cover 4 areas of overlap among the 3 studies: CHW Demographics, Core Roles and Competencies, Training and Credentialing, and Career Advancement and Workforce Issues. Implications for the future development of research, practice, and policy are discussed. Authors observe that while health care reform has the potential for increasing funding and recognition of CHWs, it is essential that policies support the full range of CHW roles, including CHWs role as change agents, so that CHWs achieve their full potential to improve health outcomes, reduce health disparities, and work for social justice.

Findings from a community-based participatory prevention research intervention designed to increase social capital in Latino and African American communities.

A community-based participatory research intervention, Poder es Salud/Power for Health, employed Community Health Workers who used popular education to identify and address health disparities in Latino and African American communities in a metropolitan area in the United States. We assessed participants' social capital, self-rated health, and depressive symptoms at baseline and the end of the intervention. Social support and self-rated health improved while depressive symptoms decreased. Public health interventions involving diverse communities that are designed to build upon assets, such as existing levels of social capital, may improve health in those communities.

Building on leadership and social capital to create change in 2 urban communities.

There has been an appeal to reduce health inequities by increasing community involvement and social capital. Poder es Salud/Power for Health is a community-based participatory prevention research project that seeks to address health disparities in the African American and Latino communities by enhancing community-level social capital. We provide specific examples of how this intervention uses community health workers and popular education to reduce language and cultural barriers and enhance community social capital. Although the communities share fundamental challenges related to health disparities, the ways in which the Latino and African American communities identify health concerns, create solutions, and think about social capital vary. Members of the project are working together to identify opportunities for cross-cultural collaboration.