An integrated mixed methods approach to clarifying delivery, receipt and potential benefits of CHW-facilitated social support in a health promotion intervention.

BACKGROUND: Social support plays a critical role in physical and emotional health, making it an important component of community health worker (CHW) health promotion interventions. Different types of support operate in different ways, however, and the relationship between the nature of CHW support and the subsequent health benefit for their clients is not well understood. METHODS: This paper describes an integrated mixed methods study of the emotional, informational, appraisal and tangible support CHWs provided to Latinx community members residing in three US-Mexico border communities. Using a cohort (n = 159) from a CHW community-based intervention, we identify and describe four clusters of social support in which participants are characterized by life situations that informed the types of social support provided by the CHW. We examine the association between each cluster and client perceptions of social support over the 6-month intervention. RESULTS: CHWs provided emotional, appraisal, informational and tangible support depending on the needs of participants. Participants who received higher levels of emotional support from the CHW experienced the greatest post intervention increase in perceived social support. CONCLUSIONS: Study findings suggest that CHWs may be adept at providing non-directive social support based on their interaction with a client rather than a health outcome objective. Health promotion interventions should allow CHWs the flexibility to tailor provision of social support based on their assessment of client needs.

A Community Health Worker-Led Community-Clinical Linkage Model to Address Emotional Well-Being Outcomes Among Latino/a People on the US-Mexico Border.

INTRODUCTION: Compared with their non-Hispanic White counterparts, Latino/a people have limited access to health resources that might improve their emotional well-being. Interventions that prioritize the Latino/a population, address social determinants of health, and decrease health disparities are needed. The objective of this study was to describe a community-clinical linkage intervention led by community health workers (CHWs) in 3 Latino/a populations along the US-Mexico border. METHODS: Researchers at the Arizona Prevention Research Center conducted the Linking Individual Needs to Community and Clinical Services (LINKS) study during 2017-2018. Clinic-based CHWs referred participants to community-based CHWs who met with participants monthly for 6 months to assess participant needs, provide support for emotional well-being, and link them to resources. Two community-based CHWs collaborated to maximize participant care; they also administered an emotional well-being questionnaire at baseline and at 3-month and 6-month follow-up. We estimated changes in emotional well-being outcomes. RESULTS: Scores for social support, perceived hopefulness, and quality-of-life measures among 189 LINKS participants increased significantly during the study period, especially among men and participants with low baseline scores. For each of the 3 outcomes, the standardized change was approximately 0.28 per 3 months of intervention, a decrease of more than half an SD (0.56) during 6 months of follow-up. CONCLUSION: A CHW-led community-clinical linkage intervention can result in positive emotional well-being outcomes. We encourage policy makers, funders, and public health practitioners to further investigate such interventions as a solution to reduce disparities in emotional well-being.