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Hum Resour Health ; 18(1): 46, 2020 06 26.
Artículo en Inglés | MEDLINE | ID: mdl-32586328


BACKGROUND: Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort. CASE PRESENTATION: In this article, we describe the process of unifying the two major CHW workforces in Arizona, promotoras de salud in US-Mexico border communities and community health representatives (CHRs) serving American Indian communities. Differences in the origins, financing, and even language of the population-served contributed to historically divergent interests between CHRs and promotoras. In order to move forward as a collective workforce, it was imperative to integrate the perspectives of CHRs, who have a regular funding stream and work closely through the Indian Health Services, with those of promotoras, who are more likely to be grant-funded in community-based efforts. As a unified workforce, CHWs were better positioned to gain advocacy support from key health care providers and health insurance companies with policy influence. We seek to elucidate the lessons learned in our process that may be relevant to CHWs representing diverse communities across the US and internationally. CONCLUSIONS: Legislated voluntary certification provides a pathway for further professionalization of the CHW workforce by establishing a standard definition and set of core competencies. Voluntary certification also provides guidance to organizations in developing appropriate training and job activities, as well as ongoing professional development opportunities. In developing certification with CHWs representing different populations, and in particular Tribal Nations, it is essential to assure that the CHW definition is in alignment with all groups and that the scope of practice reflects CHW roles in both clinic and community-based settings. The Arizona experience underscores the benefits of a flexible approach that leverages existing strengths in organizations and the population served.

BMC Public Health ; 19(1): 399, 2019 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-30975126


BACKGROUND: Latinos are currently the largest and fastest growing racial/ethnic group in the United States and have the lowest rates nationally of regular sources of primary care. The changing demographics of Latino populations have significant implications for the future health of the nation, particularly with respect to chronic disease. Community-based agencies and clinics alike have a long history of engaging community health workers (CHWs) to provide a broad range of tangible and emotional support strategies for Latinos with chronic diseases. In this paper, we present the protocol for a community intervention designed to evaluate the impact of CHWs in a Community-Clinical Linkage model to address chronic disease through innovative utilization of electronic health records (EHRs) and application of mixed methodologies. Linking Individual Needs to Community and Clinical Services (LINKS) is a 3-year, prospective matched observational study designed to examine the feasibility and impact of CHW-led Community-Clinical Linkages in reducing chronic disease risk and promoting emotional well-being among Latinos living in three U.S.-Mexico border communities. METHODS: The primary aim of LINKS is to create Community-Clinical Linkages between three community health centers and their respective county health departments in southern Arizona. Our primary analysis is to examine the impact of the intervention 6 to 12-months post program entry. We will assess chronic disease risk factors documented in the EHRs of participants versus matched non-participants. By using a prospective matched observational study design with EHRs, we have access to numerous potential comparators to evaluate the intervention effects. Secondary analyses include modeling within-group changes of extended research-collected measures. This approach enhances the overall evaluation with rich data on physical and emotional well-being and health behaviors of study participants that EHR systems do not collect in routine clinical practice. DISCUSSION: The LINKS intervention has practical implications for the development of Community-Clinical Linkage models. The collaborative and participatory approach in LINKS illustrates an innovative evaluation framework utilizing EHRs and mixed methods research-generated data collection. TRIAL REGISTRATION: This study protocol was retrospectively registered, approved, and made available on by NCT03787485 as of December 20, 2018.

Servicios de Salud Comunitaria/organización & administración , Agentes Comunitarios de Salud/organización & administración , Promoción de la Salud/métodos , Hispanoamericanos/estadística & datos numéricos , Arizona , Enfermedad Crónica/prevención & control , Centros Comunitarios de Salud/organización & administración , Femenino , Humanos , Masculino , México , Atención Primaria de Salud/organización & administración , Estudios Prospectivos , Conducta de Reducción del Riesgo , Estados Unidos , Adulto Joven
J Ambul Care Manage ; 38(3): 225-35, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26049652


This mixed-methods study explores community health worker (CHW) engagement in professional advocacy. Data from the National Community Health Worker Advocacy Survey (n = 1661) assessed the relationship between CHW professional advocacy and CHW demographics, and work characteristics. Qualitative data articulated the quality of professional advocacy efforts. Approximately, 30% of CHW respondents advocated for professional advancement or collaborated with other CHWs to advance the workforce. Advocacy was more prevalent among CHWs affiliated with a professional network. CHW advocacy targeted recognition of the field, appropriate training and compensation, and sustainable funding. CHW professional advocacy is imperative to advancement of the field.

Agentes Comunitarios de Salud , Formulación de Políticas , Rol Profesional , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Encuestas y Cuestionarios , Estados Unidos
J Immigr Minor Health ; 16(6): 1176-82, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23813347


This study examines factors relating to farmworkers' health status from sociocultural factors, including stress embedded within their work and community contexts. A cross-sectional household survey of farmworkers (N = 299) included social-demographics, immigration status descriptors, and a social-ecologically grounded, community-responsive, stress assessment. Outcomes included three standard US national surveillance measures of poor mental, physical, and self-rated health (SRH). Logistic regression models showed that higher levels of stress were significantly associated (Ps < .001) with increased risk for poor mental health and poor physical health considering all variables. Stress was not associated with SRH. Regarding two of the three outcomes, mental health and physical health, stress added explanatory power as expected. For poor SRH, a known marker for mortality risk and quite high in the sample at 38%, only age was significantly associated. Clinical and systems-level health promotion strategies may be required to mitigate these stressors in border-residing farmworkers.

Agricultores/psicología , Americanos Mexicanos/psicología , Estrés Psicológico/epidemiología , Adulto , Factores de Edad , Anciano , Arizona/epidemiología , Estudios Transversales , Agricultores/estadística & datos numéricos , Femenino , Estado de Salud , Humanos , Masculino , Americanos Mexicanos/estadística & datos numéricos , México/etnología , Persona de Mediana Edad , Factores de Riesgo , Factores Socioeconómicos , Estrés Psicológico/etiología , Estrés Psicológico/psicología , Adulto Joven
J Immigr Minor Health ; 15(2): 427-36, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22430894


Understanding contemporary socio-cultural stressors may assist educational, clinical and policy-level health promotion efforts. This study presents descriptive findings on a new measure, the border community and immigration stress scale. The data were from two community surveys as part of community based participatory projects conducted in the Southwestern US border region. This scale includes stressful experiences reflected in extant measures, with new items reflecting heightened local migration pressures and health care barriers. Stressors representing each main domain, including novel ones, were reported with frequency and at high intensity in the predominantly Mexican-descent samples. Total stress was also significantly associated with mental and physical health indicators. The study suggests particularly high health burdens tied to the experience of stressors in the US border region. Further, many of the stressors are also likely relevant for other communities within developed nations also experiencing high levels of migration.

Emigrantes e Inmigrantes/psicología , Americanos Mexicanos/psicología , Estrés Psicológico/psicología , Adulto , Anciano , Arizona , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
J Prim Prev ; 31(1-2): 69-83, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20140646


Diabetes health disparities among Hispanic populations have been countered with federally funded health promotion and disease prevention programs. Dissemination has focused on program adaptation to local cultural contexts for greater acceptability and sustainability. Taking a broader approach and drawing on our experience in Mexican American communities at the U.S.-Mexico Border, we demonstrate how interventions are adapted at the intersection of multiple cultural contexts: the populations targeted, the community- and university-based entities designing and implementing interventions, and the field team delivering the materials. Program adaptation involves negotiations between representatives of all contexts and is imperative in promoting local ownership and program sustainability.

Diabetes Mellitus Tipo 2/prevención & control , Educación en Salud/organización & administración , Promoción de la Salud/organización & administración , Disparidades en el Estado de Salud , Americanos Mexicanos , Arizona/epidemiología , Relaciones Comunidad-Institución , Diabetes Mellitus Tipo 2/etnología , Salud de la Familia/etnología , Educación en Salud/métodos , Promoción de la Salud/métodos , Humanos , Desarrollo de Programa/métodos , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa