Understanding critical factors associated with integration of community health workers into health and hospital systems.

Community health worker (CHW) models have been shown to improve health behaviors and health outcomes and reduce cost, particularly among low-income underserved populations. Consequently, health systems are increasingly employing CHWs to provide health services in clinical environments. A growing body of the literature suggests that effective integration of CHWs within the healthcare system is important to achieve the desired outcomes, but the question of how to achieve effective integration is less clear. This study seeks to explore the integration of CHWs within a large state university health system to identify factors critical to the effective integration of CHWs into the clinical care environment. We conducted a qualitative descriptive multiple embedded case study of the University of Illinois at Chicago's Hospital and Health Science System (UI Health). The embedded subunits of analysis were teams within the UI Health System that currently employ CHWs to assist with the provision of clinical care or services to patients. Data were collected via semi-structured interviews and document review. In total, six sub-units were enrolled, and 17 interviews were conducted with CHWs (n = 9), and administrators or healthcare providers (n = 8). Fourteen factors related to effective CHW integration were identified and organized in four categories: individual, team, organization, and community. Findings suggest that in addition to commonly recognized elements of effective CHW models including training, supervision, and the presence of a champion, programs must consider the organizational context in which the program is positioned as well as the ways in which both CHWs and the organization engage with communities served. This research can serve as a roadmap for health systems that seek to integrate CHWs within healthcare services and can be used to promote best practice in CHW integration.

Why Don't Employees Participate in Well-being Programs? A Research-Informed Systems-Based Model.

OBJECTIVE: Employee nonparticipation in well-being programs is common, but not well understood. Development of a systems-based framework to characterize reasons for nonparticipation can inform efforts to enhance engagement. METHODS: Following literature review and building on previous research, a systems-based model was developed to contextualize participation barriers. RESULTS: Well-being program nonparticipation is more frequent among low-wage workers as well as minority subpopulations. Contributors include employer factors, such as inequitable benefits design, and employee factors, such as lack of perceived relevance, barriers to access, and lower prioritization of personal health needs. CONCLUSIONS: A systems-based approach to evaluating well-being program nonparticipation can help identify factors contributing to employee nonparticipation and lead to targeted policy and practice changes that encourage greater employee engagement.

Leveraging Key Informant Interviews to Inform Intervention Development: The Greater Lawndale Healthy Work Project.

BACKGROUND: The Greater Lawndale Healthy Work project is a sequential mixed methods community based participatory research project that examines work as a structural determinant of health and builds community capacity for healthy work in a predominantly Black and Latinx community in Chicago known as Greater Lawndale (GL). OBJECTIVES: We interviewed community leaders in GL as key informants to understand the barriers to healthy work and inform intervention development. METHODS: We conducted a directed content analysis of transcripts from 20 key informants and coded the social ecology and type of intervention. RESULTS: Every key informant mentioned at least one asset in GL, showing an opportunity to employ a capacity-oriented approach to intervention development. Key informants suggested a variety of interventions to address precarious work across levels of the social ecology, with individual and community level interventions being the most salient. CONCLUSION: Through this approach, we were able to navigate tensions and challenges in conducting research for community-wide change. Key informant stakeholder interviews can be leveraged to meaningfully inform intervention development and support the development of multi-level, sustainable, and culturally acceptable interventions that advance health equity.

Occupational Safety and Health Equity Impacts of Artificial Intelligence: A Scoping Review.

Artificial intelligence (AI) has the potential to either reduce or exacerbate occupational safety and health (OSH) inequities in the workplace, and its impact will be mediated by numerous factors. This paper anticipates challenges to ensuring that the OSH benefits of technological advances are equitably distributed among social groups, industries, job arrangements, and geographical regions. A scoping review was completed to summarize the recent literature on AI's role in promoting OSH equity. The scoping review was designed around three concepts: artificial intelligence, OSH, and health equity. Scoping results revealed 113 articles relevant for inclusion. The ways in which AI presents barriers and facilitators to OSH equity are outlined along with priority focus areas and best practices in reducing OSH disparities and knowledge gaps. The scoping review uncovered priority focus areas. In conclusion, AI's role in OSH equity is vastly understudied. An urgent need exists for multidisciplinary research that addresses where and how AI is being adopted and evaluated and how its use is affecting OSH across industries, wage categories, and sociodemographic groups. OSH professionals can play a significant role in identifying strategies that ensure the benefits of AI in promoting workforce health and wellbeing are equitably distributed.

Understanding the relationship between care team perceptions about CHWs and CHW integration within a US health system, a qualitative descriptive multiple embedded case study.

BACKGROUND: Community health workers (CHW) have grown in prominence within the healthcare sector, yet there is no clear consensus regarding a CHW's role, purpose, and value within health systems. This lack of consensus has the potential to affect how CHWs are perceived, utilized, and ultimately integrated within the healthcare sector. This research examines clinical care teams that currently employ CHWs to (1) understand how members of the care team perceive CHWs' purpose and value, and (2) consider how perceptions of CHWs are related to CHW integration within health care teams. METHODS: Researchers conducted a qualitative descriptive multiple embedded case study at the University of Illinois at Chicago's Hospital and Health Science System (UI Health). The embedded subunits of analysis were teams within UI Health that are currently employing CHWs to assist with the provision of clinical care or services to patients. Data were collected via semi-structured interviews and document review. RESULTS: In total, 6 sub-units were enrolled to participate, and 17 interviews were conducted with CHWs (n = 9), and administrators or health care providers (n = 8). Reported perceptions of CHWs were inconsistent across respondents. CHWs roles were not always understood, and the CHW's purpose and value was perceived differently by different members of the care team. Moreover, evaluation metrics did not always capture CHWs' value to the health care system. In some cases, care teams were more aligned around a shared understanding of the CHW's roles and purpose within the care team. When perceptions regarding CHWs were both positive and aligned, respondents reported higher levels of integration within the healthcare system. CONCLUSIONS: Alignment in a care team's perception of a CHW's role, purpose, and value within the health system could play an important role in the integration of CHWs within healthcare teams.

Community Resident Perceptions of and Experiences with Precarious Work at the Neighborhood Level: The Greater Lawndale Healthy Work Project.

Work is a key social determinant of health. Community health and well-being may be impacted in neighborhoods with high proportions of people engaged in precarious work situations compounded by health inequities produced by other social determinants associated with their residential geography. However, little is known about how community residents experience work at the neighborhood level nor how work impacts health at the community-level, particularly in communities with a high proportion of residents engaged in precarious work. We sought to understand, through participatory research strategies, how work is experienced at the community level and to identify community interventions to establish a culture of healthy work. As part of a mixed-methods community health assessment, community researchers conducted focus groups with residents in two high social and economic hardship neighborhoods on Chicago's southwest side. Community and academic researchers engaged in participatory data analysis and developed and implemented member-checking modules to engage residents in the data interpretation process. Twelve focus group discussions (77 community resident participants) were completed. Three major themes emerged: systematic marginalization from the pathways to healthy work situations; contextual and structural hostility to sustain healthy work; and violations in the rights, agency, and autonomy of resident workers. Findings were triangulated with findings from the concept-mapping research component of the project to inform the development of a community health survey focused on work characteristics and experiences. Listening to residents in communities with a high proportion of residents engaging in precarious work allows for the identification of nuanced community-informed intervention points to begin to build a culture of healthy work.

Public Health Impacts of Underemployment and Unemployment in the United States: Exploring Perceptions, Gaps and Opportunities.

BACKGROUND: Unemployment, underemployment, and the quality of work are national occupational health risk factors that drive critical national problems; however, to date, there have been no systematic efforts to document the public health impact of this situation. METHODS: An environmental scan was conducted to explore the root causes and health impacts of underemployment and unemployment and highlight multilevel perspectives and factors in the landscape of underemployment and unemployment. METHODS: included a review of gray literature and research literature, followed by key informant interviews with nine organizational representatives in employment research and policy, workforce development, and industry to assess perceived needs and gaps in practice. RESULTS: Evidence highlights the complex nature of underemployment and unemployment, with multiple macro-level underlying drivers, including the changing nature of work, a dynamic labor market, inadequate enforcement of labor protection standards, declining unions, wage depression, and weak political will interacting with multiple social determinants of health. Empirical literature on unemployment and physical, mental, and psychological well-being, substance abuse, depression in young adults, and suicides is quite extensive; however, there are limited data on the impacts of underemployment on worker health and well-being. Additionally, organizations do not routinely consider health outcomes as they relate to their work in workforce or policy development. DISCUSSION AND CONCLUSIONS: Several gaps in data and research will need to be addressed in order to assess the full magnitude of the public health burden of underemployment and unemployment. Public health needs to champion a research and practice agenda in partnership with multisector stakeholders to illuminate the role of employment quality and status in closing the gap on health inequities, and to integrate workforce health and well-being into labor and economic development agendas across government agencies and industry.

Framing the Integration of Community Health Workers Into Health Care Systems Along Health Care and Community Spectrums.

Research calls for community health worker (CHW) integration within health systems, yet there is no agreement regarding what CHW integration is or guidance for how it can be achieved. This study examines factors associated with CHW integration in community and health care settings using a qualitative descriptive multiple-embedded case study of CHW teams at the University of Illinois at Chicago. Data were collected via semistructured interviews/document review and analyzed using thematic coding and quantitative content analysis. Factors associated with higher clinical integration included culture, communication, protocols, and training while higher community integration was associated with accessibility, relationships, and empathy.

REDECA: A Novel Framework to Review Artificial Intelligence and Its Applications in Occupational Safety and Health.

INTRODUCTION: The field of artificial intelligence (AI) is rapidly expanding, with many applications seen routinely in health care, industry, and education, and increasingly in workplaces. Although there is growing evidence of applications of AI in workplaces across all industries to simplify and/or automate tasks there is a limited understanding of the role that AI contributes in addressing occupational safety and health (OSH) concerns. METHODS: This paper introduces a new framework called Risk Evolution, Detection, Evaluation, and Control of Accidents (REDECA) that highlights the role that AI plays in the anticipation and control of exposure risks in a worker's immediate environment. Two hundred and sixty AI papers across five sectors (oil and gas, mining, transportation, construction, and agriculture) were reviewed using the REDECA framework to highlight current applications and gaps in OSH and AI fields. RESULTS: The REDECA framework highlighted the unique attributes and research focus of each of the five industrial sectors. The majority of evidence of AI in OSH research within the oil/gas and transportation sectors focused on the development of sensors to detect hazardous situations. In construction the focus was on the use of sensors to detect incidents. The research in the agriculture sector focused on sensors and actuators that removed workers from hazardous conditions. Application of the REDECA framework highlighted AI/OSH strengths and opportunities in various industries and potential areas for collaboration. CONCLUSIONS: As AI applications across industries continue to increase, further exploration of the benefits and challenges of AI applications in OSH is needed to optimally protect worker health, safety and well-being.

Translation research in occupational safety and health: A proposed framework.

Translation research in occupational safety and health is the application of scientific investigative approaches to study how the outputs of basic and applied research can be effectively translated into practice and have an impact. This includes the study of the ways in which useful knowledge and interventions are disseminated, adopted, implemented, and institutionalized. In this paper, a 4-stage framework (Development, Testing, Institutionalization, and Evaluation) is presented. Translation research can be used to enhance the use and impact of occupational safety and health knowledge and interventions to protect workers. This type of research has not received much attention in the occupational safety and health field. However, in contemporary society, it is critical to know how to make an impact with the findings and outputs of basic and applied research. This paper provides a novel framework for consideration of how to advance and prioritize translation research for occupational safety and health.

Occupational Safety and Health in the Temporary Services Industry: A Model for a Community-University Partnership.

Workers in the temporary staffing industry face hazardous working conditions and have a high risk of occupational injury. This project brought together local workers' centers and university investigators to build a corps of Occupational Health Promoters (OHPs) and to test a survey tool and recruitment methods to identify hazards and raise awareness among workers employed by temporary staffing companies. OHPs interviewed ninety-eight workers employed by thirty-three temporary agencies and forty-nine client companies, working mainly in shipping and packing, manufacturing, and warehousing sectors. Surveys identified workplace hazards. OHPs reported two companies to OSHA, resulting in several citations. Partners reported greater understanding of occupational safety and health challenges for temporary workers and continue to engage in training, peer education, and coalition building.

Replacing Windows Reduces Childhood Lead Exposure: Results From a State-Funded Program.

CONTEXT: Despite considerable evidence that window replacement reduces childhood lead exposure and improves energy conservation and market value, federal policies in childhood lead poisoning, home improvement, and weatherization programs all tend to discourage it. OBJECTIVE AND INTERVENTION: To evaluate a state bond-financed pilot program that replaced old lead-contaminated windows with new lead-free energy efficient ones. DESIGN AND SETTING: Pre-/post evaluation in 1 urban and 1 rural jurisdiction. PARTICIPANTS: Low-income households (n = 96). MAIN OUTCOME MEASURES: Dust wipe sampling, visual assessment, and physical and mental self-reported health at baseline and 1 year. RESULTS: Geometric mean lead dust (PbD) from baseline to 1 year for interior floors, interior sills, and exterior troughs declined by 44%, 88%, and 98%, respectively (P < .001); 1 year later, levels remained well below baseline but rose slightly compared with clearance sampling just after intervention. PbD declined significantly on both sills and troughs in both the urban and rural jurisdictions from baseline to 1 year. On interior floors, PbD significantly declined by 58% (P = .003) in the rural area and 25% (P = .38) in the urban area, where the decline did not reach statistical significance. Households reported improvements in uncomfortable indoor temperatures (P < .001) and certain health outcomes. Economic benefits were estimated at $5 912 219 compared with a cost of $3 451 841, resulting in a net monetary benefit of $2 460 378. Residents reported that they were "very satisfied" with the window replacement work (87%). CONCLUSION: Local and state governments should fund and operate window replacement programs to eliminate a major source of childhood lead exposure, improve energy bills, increase home market value, and create local construction and industrial jobs. Federal agencies should encourage (not discourage) replacement of old windows contaminated with lead. In budget climates such as Illinois with reduced public expenditures, making wise investments such as lead-safe window replacement is more important than ever.

Improving water quality communications at beaches: input from stakeholders.

OBJECTIVES: Water quality communication practices vary widely and stakeholder input has not played a role in defining acceptable levels of risk. Although the 2012 Recreational Water Quality Criteria (RWQC) emphasize the importance of promptly notifying the public about hazardous conditions, little is known about the public's understanding of notifications, or about levels of risk deemed acceptable. We sought to address these gaps. METHODS: A mixed methods approach was used. Focus groups (FGs) provided qualitative data regarding the understanding of surface water quality, awareness, and use, of currently available water quality information, and acceptability of risk. Intercept interviews (INTs) at recreation sites provided quantitative data. RESULTS: INTs of 374 people and 15 FG sessions were conducted. Participants had limited awareness about water quality information posted at beaches, even during swim bans and advisories. Participants indicated that communication content should be current, from a trusted source, and describe health consequences. Communicating via mobile electronics should be useful for segments of the population. Risk acceptability is lower with greater outcome severity, or if children are impacted. CONCLUSIONS: Current water quality communications approaches must be enhanced to make notification programs more effective. Further work should build on this initial effort to evaluate risk acceptability among US beachgoers.

Health risks of limited-contact water recreation.

BACKGROUND: Wastewater-impacted waters that do not support swimming are often used for boating, canoeing, fishing, kayaking, and rowing. Little is known about the health risks of these limited-contact water recreation activities. OBJECTIVES: We evaluated the incidence of illness, severity of illness, associations between water exposure and illness, and risk of illness attributable to limited-contact water recreation on waters dominated by wastewater effluent and on waters approved for general use recreation (such as swimming). METHODS: The Chicago Health, Environmental Exposure, and Recreation Study was a prospective cohort study that evaluated five health outcomes among three groups of people: those who engaged in limited-contact water recreation on effluent-dominated waters, those who engaged in limited-contact recreation on general-use waters, and those who engaged in non-water recreation. Data analysis included survival analysis, logistic regression, and estimates of risk for counterfactual exposure scenarios using G-computation. RESULTS: Telephone follow-up data were available for 11,297 participants. With non-water recreation as the reference group, we found that limited-contact water recreation was associated with the development of acute gastrointestinal illness in the first 3 days after water recreation at both effluent-dominated waters [adjusted odds ratio (AOR) 1.46; 95% confidence interval (CI): 1.08, 1.96] and general-use waters (1.50; 95% CI: 1.09, 2.07). For every 1,000 recreators, 13.7 (95% CI: 3.1, 24.9) and 15.1 (95% CI: 2.6, 25.7) cases of gastrointestinal illness were attributable to limited-contact recreation at effluent-dominated waters and general-use waters, respectively. Eye symptoms were associated with use of effluent-dominated waters only (AOR 1.50; 95% CI: 1.10, 2.06). Among water recreators, our results indicate that illness was associated with the amount of water exposure. CONCLUSIONS: Limited-contact recreation, both on effluent-dominated waters and on waters designated for general use, was associated with an elevated risk of gastrointestinal illness.

Beach communications: a need for evaluation of current approaches.

AIMS: Programs to notify the public about water quality at beaches are developed at the state and local levels. We sought to characterize the messages and message delivery options in use, and information about the effectiveness of these beach notification programs. METHODS: A telephone survey of 37 US state, tribal and territorial and 18 county, city or local beach programs was conducted to characterize current public notification practices and any evaluations of those practices. RESULTS: Beach notification practices vary substantially at the state and local levels. Color-coded signs or flags are commonly used, but not universally, and the color schemes and their meanings vary. New communication approaches utilizing text messaging and the internet are in use or under development for local use. Few communication methods had undergone systematic evaluations of their content, delivery methods or effectiveness in promoting behavior change. CONCLUSION: The prevention of waterborne illness requires communications that effectively promote the avoidance of swimming when water quality is impaired. Current communication practices are variable and generally have not undergone formal evaluations for their effectiveness. It is not known whether or how they impact health risk.

Water ingestion during water recreation.

Quantitative risk assessments have estimated health risks of water recreation. One input to risk assessment models is the rate of water ingestion. One published study estimated rates of water ingestion during swimming, but estimates of water ingestion are not available for common limited contact water recreation activities such as canoeing, fishing, kayaking, motor boating, and rowing. In the summer of 2009 two related studies were conducted to estimate water ingestion during these activities. First, at Chicago area surface waters, survey research methods were utilized to characterize self-reported estimates of water ingestion during canoeing, kayaking, and fishing among 2705 people. Second, at outdoor swimming pools, survey research methods and the analysis of cyanuric acid, a tracer of swimming pool water, were used to characterize water ingestion among 662 people who engaged in a variety of full-contact and limited-contact recreational activities. Data from the swimming study was used to derive translation factors that quantify the volume of self-reported estimates. At surface waters, less than 2% of canoers and kayakers reported swallowing a teaspoon or more and 0.5% reported swallowing a mouthful or more. Swimmers in a pool were about 25-50 times more likely to report swallowing a teaspoon of water compared to those who participate in limited-contact recreational activities on surface waters. Mean and upper confidence estimates of water ingestion during limited-contact recreation on surface waters are about 3-4 mL and 10-15 mL, respectively. These estimates of water ingestion rates may be useful in modeling the health risks of water recreation.