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Community Health Worker Research Materials

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This page provides a selected list of current articles from the research literature of interest to stakeholders in the Promotor(a) or Community Health Worker Training and Certification Program.  A promotora/community health worker is defined here as a person who, with or without compensation:

  • provides cultural mediation between their communities and health and human service systems; 
  • provides informal counseling and social support; 
  • provides culturally and linguistically appropriate health education; 
  • advocates for individual and community needs; 
  • assures people get the services they need; 
  • builds individual and community capacity; 
  • or provides referral and follow-up services.

For further information on the following articles contact the Medical and Research Library at library@dshs.state.tx.us or call 512-776-7559. For further information on promotoras/es and community health workers in Texas, contact chw@dshs.state.tx.us, (512) 776-2570 or (512) 776-2624, or visit the Promotor(a) or Community Health Worker Training and Certification Program website, part of the Office of Title V and Family Health, at http://www.dshs.state.tx.us/mch/chw.shtm.

External links to other sites are intended to be informational and do not have the endorsement of the Texas Department of State Health Services. These sites may also not be accessible to people with disabilities. The links were working at the time they were created.


mrl-diamond Selected Current Journal Articles and Reports

[See a more comprehensive bibliography of articles on community health workers.]

CHW-roles and opportunities in healthcare delivery system reform by John e. Snyder, ASPE Issue Brief, January 2016.
Community Health Workers (CHWs) are an emerging group of health professionals that have recently drawn increased national attention because of their potential to deliver cost-effective, high quality, and culturally competent health services within team-based care models. The apparent benefits of integrating CHWs into health care teams seem to depend on context. The strongest evidence of these benefits supports utilizing CHWs to deliver certain specific, high-value, preventive services – focused on reducing risk factors for cardiovascular disease and other chronic conditions – to low-income, minority, or other underserved populations. Despite growing interest in engaging CHWs in national delivery system reform efforts, there are several uncertainties about how to best proceed with this. Questions remain around standardizing CHW training, certification, and licensure; establishing strong economic and other evidence to support their use; and securing reimbursement for their services to ensure financial sustainability of CHW programs. https://aspe.hhs.gov/sites/default/files/pdf/168956/CHWPolicy.pdf

New Map on Community Health Worker Models
This new NASHP map and chart makes it easy for you to find information about various activities related to CHWs in the states. http://www.nashp.org/state-community-health-worker-models/

New Community Health Worker Toolkit
The Division for Heart Disease and Stroke Prevention has compiled evidence-based research that supports the effectiveness of CHWs in a Community Health Worker (CHW) Toolkit. The toolkit also includes information that state health departments can use to train and further build capacity for CHWs in their communities as well as helpful resources that CHWs can use within their communities (http://www.cdc.gov/dhdsp/pubs/chw-toolkit.htm).

Community Health Worker (CHW) Resources

    - State Community Health Worker Models (from State Refor(u)m Webinar 2/23/15) https://www.statereforum.org/state-community-health-worker-models
    - Community Health Workers (CHWs) Training/Certification Standards Current Status http://www.astho.org/Public-Policy/Public-Health-Law/Scope-of-Practice/CHW-Certification-Standards/
    - Strategies for Supporting Expanded Roles for Non-Clinicians on Primary Care Teams, National Academy for State Health Policy http://www.nashp.org/sites/default/files/NOSOLO-new3.pdf

States Implementing Community Health Worker Strategies
This new technical assistance guide summarizes the successful work of organizations as it relates to Domains 3 and 4 (Health Systems Interventions and Community-Clinical Linkages, respectively) of CDC’s State Public Health Actions program (CDC-RFA-DP13-1305).  It also offers insights for states that are implementing CHW strategies.  Recommendations were developed by compiling interviews with 9 organizations experienced in integrating CHWs into healthcare teams and engaging CHWs in promoting linkages between the health care system and community resources.  Additional findings from a review of evidence-based literature are also included.
http://www.cdc.gov/dhdsp/programs/spha/docs/1305_ta_guide_chws.pdf

Albarran CR, Heilemann MV, Koniak-Griffin D. Promotoras as facilitators of change: Latinas' perspectives after participating in a lifestyle behaviour intervention program. J Adv Nurs. 2014 Oct;70(10):2303-13.
Aim: To describe immigrant Latinas' perspectives of a lifestyle behaviour intervention, focusing on their interactions with and perceptions of the promotoras who delivered the program in the USA. Background: Immigrant Latinas in the USA have high obesity rates, which contribute to increased risk for cardiovascular disease and other long-term diseases. Interventions using the promotora model appear to be effective in reducing cardiovascular disease risk by improving dietary habits, physical activity and selected clinical variables among Latinas. However, there has been very limited enquiry into what it is about these interventions and promotoras that facilitates behaviour change, from the perspective of participants. Design: Grounded theory methodology guided the data collection and analysis. Methods: This qualitative study was completed in 2012 in California, after the end of a lifestyle behaviour intervention. Four focus groups and seven one-on-one interviews were conducted with a total of 18 immigrant Latina intervention participants. Results: Women described promotoras as helping them change by motivating them through three interconnected elements: tools, support and knowledge. Latinas viewed their ability to make lifestyle changes as connected with their emotional and psychological health and saw promotoras as counsellors who gave emotional and social support. In this respect, the intervention was emotionally therapeutic for this sample of Latinas, although this was not the original intention of the program. Conclusion: Promotoras gave the backbone of the intervention and were crucial in motivating Latinas to implement lifestyle changes. Future lifestyle behaviour interventions should include a strong component of mental and emotional well-being.

Calderon V, Mejia Y, del Carmen Lara-Muñoz M, et al. Towards the sustainability of information campaigns: training Promotores to increase the psychosis literacy of Spanish-speaking communities. Soc Psychiatry Psychiatr Epidemiol. 2015 Apr;50(4):665-9.
Purpose: To assess the acceptability and efficacy of training community health workers (promotores) in Mexico to both recognize psychosis and to teach others to recognize psychosis. Methods: Two studies were carried out utilizing a single-group design. In Study 1, promotores watched a DVD-based psychosis literacy training. In Study 2, promotores were trained to administer a flip-chart version of the program and they then administered it to community residents. Results: Significant increases in the post-training assessment of psychosis literacy were observed. Conclusion: Promotores can be an important resource in identifying psychosis early and enhancing the sustainability of psychosis literacy information campaigns.

Campbell JD, Brooks M, Hosokawa P, et al. Community health worker home visits for medicaid-enrolled children with asthma: effects on asthma outcomes and costs. Am J Public Health. 2015 Nov;105(11):2366-72.
Objectives: We sought to estimate the return on investment of a streamlined version of an evidence-based community health worker (CHW) asthma home visit program. Methods: We used a randomized parallel group trial of home visits by CHWs to Medicaid-enrolled children with uncontrolled asthma versus usual care. Results: A total of 373 participants enrolled in the study (182 in the intervention group and 191 in the control group, of whom 154 and 179, respectively, completed the study). The intervention group had greater improvements in asthma symptom-free days (2.10 days more over 2 weeks; 95% CI =  1.17, 3.05; P < .001) and caretakers' quality of life (0.43 units more; 95% CI = 0.20, 0.66; P < .001) and a larger reduction in urgent health care utilization events (1.31 events fewer over 12 months; 95% CI = -2.10, -0.52; P = .001). The intervention arm compared with the control arm saved $1340.92 for the $707.04 additional costs invested for the average participant. The return on investment was 1.90. Conclusions: A streamlined CHW asthma home visit program for children with uncontrolled asthma improved health outcomes and yielded a return on investment of 1.90.

Daaleman TP, Fisher EB. Enriching patient-centered medical homes through peer support. Annals of Family Medicine. 2015;13(suppl. 1):S73-S78.
Peer supporters are recognized by various designations-community health workers, promotores de salud, lay health advisers-and are community members who work for pay or as volunteers in association with health care systems or nonprofit community organizations and often share ethnicity, language, and socioeconomic status with the mentees that they serve. Although emerging evidence demonstrates the efficacy of peer support at the community level, the adoption and implementation of this resource into patient-centered medical homes (PCMHs) is still under development. To accelerate that integration, this article addresses three major elements of peer support interventions: the functions and features of peer support, a framework and programmatic strategies for implementation, and fiscal models that would support the sustained viability of peer support programs within PCMHs.Key functions of peer support include assistance in daily management of health-related behaviors, social and emotional support, linkage to clinical care, and longitudinal or ongoing support. An organizational model of innovation implementation provides a useful framework for determining how to implement and evaluate peer support programs in PCMHs. Programmatic strategies that can be useful in developing peer support programs within PCMHs include peer coaching or mentoring, group self-management training, and programs designed around the telephone and information technology. Fiscal models for peer support programs include linkages with hospital or health care systems, service- or community-based nonprofit organizations, and partnerships between health care systems and community groups. Peer support promises to enrich PCMHs by activating patients in their self-care, providing culturally sensitive outreach, and opening the way for partnerships with community-based organizations.
http://annfammed.org/content/13/Suppl_1/S73.full?utm_source=Patient+Centered+Primary+Care+Collaborative+List&utm_campaign=8020a989d4-Month_in_Review_Sept_24_2015&utm_medium=email&utm_term=0_56f71f22aa-8020a989d4-250334441

Johnson SL, Gunn VL. Community health workers as a component of the health care team. Pediatr Clin North Am. 2015 Oct;62(5):1313-28.
In restructuring the delivery of primary care to improve the wellness of a community, every community must review its own circumstances for factors such as resources and capacities, health concerns, social and political perspectives, and competing priorities. Strengthening the health care team with community health workers to create a patient-centered medical home can enhance health care access and outcomes. Community health workers can serve as critical connectors between health systems and communities; they facilitate access to and improve quality and culturally sensitive medical care, emphasizing preventive and primary care. 

Kenya S, Lebron C, Reyes Arrechea E, Li H. Glucometer use and glycemic control among Hispanic patients with diabetes in southern Florida. Clin Ther. 2014 Apr 1;36(4):485-93.
Background: Self-monitoring of blood glucose (SMBG) has been deemed a critical component of diabetes care in the United States. To be effective, patients must have some diabetes knowledge, glucometer proficiency, and an ability to take appropriate actions when certain readings are obtained. However, most patients take no action in response to out-of-range glucometer readings, and in many populations, SMBG practices are not associated with improved glycemic control. Thus, SMBG utilization is being reconsidered in other countries. Nonetheless, SMBG behaviors are increasingly recommended in the United States, where the Hispanic population represents the fastest-growing minority group and is disproportionately affected by suboptimal diabetes outcomes. Because a growing number of interventions aim to reduce diabetes disparities by improving glycemic control among minorities, it is essential to determine whether efforts should focus on SMBG practices. We present data on SMBG behaviors and glycemic control among participants from the Miami Healthy Heart Initiative (MHHI), a National Institutes of Health/National Heart, Lung, and Blood Institute-sponsored trial assessing a community health worker (CHW) intervention among Hispanic patients with poorly controlled diabetes. Objective:  This study examined the effects of a CHW intervention on SMBG practices, glycosylated hemoglobin (HbA1c), and knowledge of appropriate responses to glucometer readings among Hispanic patients with diabetes. Methods: This study was an ancillary investigation within MHHI, a randomized, controlled trial in 300 Hispanic patients. Participants were intervention-group members who received 12 months of CHW support. Assessments were administered at baseline and poststudy to determine potential barriers to optimal health. Items from validated instruments were used to determine knowledge of appropriate responses to different glucose readings. These data were linked to HbA1c values. Means and frequencies were used to describe population characteristics and glucometer proficiency. Paired-sample t tests examined potential differences in HbA1c outcomes and SMBG practices. Qualitative data were collected from the CHWs who worked with study participants. Results:
Our population was diverse, representing several countries. Mean HbA1c improved significantly, from 10% to 8.8% (P ≤ 0.001). SMBG practices did not change. At baseline, 96% of patients reported owning a glucometer and 94% reported knowing how to use it. However, quantitative assessments and qualitative data suggested that participants had suboptimal knowledge regarding actions that could cause an out-of-range reading or how to respond to certain readings. Conclusions: SMBG behaviors were not associated with glycemic control in our sample. We conclude that a CHW intervention may improve glycemic control without improving SMBG practices. Future interventions may reconsider whether efforts should be directed toward improving SMBG behaviors.

Luque JS, Tarasenko YN, Reyes-Garcia C, et al.  Salud es Vida: a Cervical Cancer Screening Intervention for Rural Latina Immigrant Women. J Cancer Educ. 2016 Jan 12. [Epub ahead of print]
This study examined the feasibility and efficacy of Salud es Vida-a promotora-led, Spanish language educational group session on cervical cancer screening (Pap tests)-self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among immigrant Hispanic/Latina women from farmworker backgrounds. These women are disproportionately burdened with cervical cancer, with mortality rates significantly higher than non-Hispanic whites. The two-arm, quasi-experimental study was conducted in four rural counties of Southeast Georgia in 2014-2015. Hispanic/Latina immigrant women aged 21-65 years and overdue for a Pap test were included as intervention (N = 38) and control (N = 52) group participants. The intervention was developed in partnership with a group of promotoras to create the toolkit of materials which includes a curriculum guide, a brochure, a flipchart, a short animated video, and in-class activities. Twelve (32 %) intervention group participants received the Pap test compared to 10 (19 %) control group participants (p = 0.178). The intervention group scored significantly higher on both cervical cancer knowledge recall and retention than the control group (p < 0.001). While there was no statistically significant difference in cervical cancer screening self-efficacy scores between the group participants, both groups scored higher at follow-up, adjusting for the baseline scores. The group intervention approach was associated with increased cervical cancer knowledge but not uptake of Pap test. More intensive interventions using patient navigation approaches or promotoras who actively follow participants or conducting one-on-one rather than group sessions may be needed to achieve improved screening outcomes with this population.

Messias DK, Parra-Medina D, Sharpe PA, et al. Promotoras de Salud: roles, responsibilities, and contributions in a multisite community-based randomized controlled trial. Hisp Health Care Int. 2013;11(2):62-71.
There is widespread recognition of the cultural and linguistic appropriateness of promotoras (a Spanish term for community health workers) in health education and outreach among Hispanic communities. Yet, there are significant gaps in the literature regarding the preparation, implementation, and evaluation of promotoras’ engagement in research. To address this gap, we examine promotoras’ research-related training, roles, responsibilities, and contributions in a community-based participatory research project involving a multisite randomized controlled trial of a physical activity intervention for Mexican-origin women in Texas and South Carolina. We identify both benefits and challenges associated with promotoras’ engagement as community researchers; examine variations and differences in roles and responsibilities related to the research contexts, sites, settings, and individual characteristics; and discuss implications for research and practice.

Molokwu J, Penaranda E, Flores S, Shokar NK. Evaluation of the effect of a promotora-led educational intervention on cervical cancer and human papillomavirus knowledge among predominantly Hispanic primary care patients on the US-Mexico Border. J Cancer Educ. 2015 Oct 27. [Epub ahead of print]
Despite declining cervical cancer rates, ethnic minorities continue to bear an unequal burden in morbidity and mortality. While access to screening is a major barrier, low levels of knowledge and cultural influences have been found to play a part in underutilization of preventive services. The aim of our study was to evaluate the effect of a promotora-led educational intervention on cervical cancer and human papillomavirus knowledge in mainly Hispanic females attending a primary care clinic. One hundred ten females were recruited from the waiting room of a busy primary care clinic and invited to attend individual or small group educational sessions. Participants completed knowledge surveys pre- and post-intervention. An overall evaluation of the educational session was also completed. Following the educational intervention, participants showed an improvement in knowledge scores from a mean score of 10.8 (SD 3.43) out of a possible score of 18 to a mean score of 16.0 (SD1.51) (p < 0.001). 94.5 % of participants rated as excellent, the presentation of information in a way that was easy to understand, most reported that it was a good use of their time and that it lowered their anxiety about testing for early detection of cervical cancer. An educational intervention delivered by well-trained Promotora/Lay health care worker significantly improves patient's cervical cancer and HPV knowledge and can be a useful tool in patient education in the clinical setting especially with high risk populations.

Moore AA, Karno MP, Ray L, et al. Development and preliminary testing of a promotora-delivered, Spanish language, counseling intervention for heavy drinking among male, Latino day laborers. J Subst Abuse Treat. 2016 Mar;62:96-101.
This study developed and then tested the feasibility, acceptability and initial efficacy of a 3-session, culturally adapted, intervention combining motivational enhancement therapy (MET) and strengths-based case management (SBCM) delivered by promotoras in Spanish to reduce heavy drinking among male, Latino day laborers. A pilot two-group randomized trial (N=29) was conducted to evaluate the initial efficacy of MET/SBCM compared to brief feedback (BF). Alcohol-related measures were assessed at 6, 12 and 18 weeks after baseline. Most intervention group participants (12/14) attended all counseling sessions and most participants (25/29) remained in the study at 18 weeks. Alcohol related measures improved in both groups over time with no statistically significant differences observed at any of the time points. However the comparative effect size of MET/SBCM on weekly drinking was in the large range at 6-weeks and in the moderate range at 12-weeks. Post hoc analyses identified a statistically significant reduction in number of drinks over time for participants in the intervention group but not for control group participants. Despite the extreme vulnerability of the population, most participants completed all sessions of MET/SBCM and reported high satisfaction with the intervention. We feel our community partnership facilitated these successes. Additional studies of community-partnered and culturally adapted interventions are needed to reduce heavy drinking among the growing population of Latinos in the U.S.

Morgan K, Lee J, Sebar B. Community health workers: a bridge to healthcare for people who inject drugs. Int J Drug Policy. 2015 Apr;26(4):380-7.
Background: Although people who inject drugs (PWIDs) have increased healthcare needs, their poor access and utilisation of mainstream primary healthcare services is well documented. To address this situation, community health workers (CHWs) who have personal experience of drug injecting in addition to healthcare training or qualifications are sometimes utilised. However, the role peer workers play as members of clinical primary healthcare teams in Australia and how they manage the healthcare needs of PWID, has been poorly documented. Methods: A qualitative ethnomethodological approach was used to study the methods used by CHWs. Data was collected using participant observation of CHWs in a PWID-targeted primary healthcare centre. CHW healthcare consultations with PWID were audio-recorded and transcribed verbatim. Transcripts along with field notes were analysed using membership categorisation and conversation analysis techniques to reveal how CHWs' personal and professional experience shapes their healthcare interactions with PWID clients. Results: CHWs' personal experience of injecting drug use is an asset they utilise along with their knowledge of clinical practice and service systems. It provides them with specialised knowledge and language--resources that they draw upon to build trust with clients and accomplish transparent, non-judgmental interactions that enable PWID clients to be active participants in the management of their healthcare. Existing literature often discusses these principles at a theoretical level. This study demonstrates how CHWs achieve them at a micro-level through the use of indexical language and displays of the membership categories 'PWID' and 'healthcare worker'. Conclusion: This research explicates how CHWs serve as an interface between PWID clients and conventional healthcare providers. CHWs deployment of IDU-specific language, membership knowledge, values and behaviours, enable them to interact in ways that foster transparent communication and client participation in healthcare consultations. The incorporation of community health workers into clinical healthcare teams working with IDU populations is a possible means for overcoming barriers to healthcare, such as mistrust and fear of stigma and discrimination, because CHWs are able to serve as an interface between PWID and other healthcare providers.

Najafizada SA, Bourgeault IL, Labonte R, Packer C, Torres S. Community health workers in Canada and other high-income countries: A scoping review and research gaps. Can J Public Health. 2015 Mar 12;106(3):e157-64.
Objectives: Community health workers (CHWs) have been deployed to provide health-related services to their fellow community members and to guide them through often complex health systems. They help address concerns about how marginalized populations in many countries experience health inequities that are due, in part, to lack of appropriate primary health care services, possibly resulting in inappropriate use of higher-cost health services or facilities. This paper reviews studies on CHW interventions in a number of high-income countries, including Canada, to identify research gaps on CHW roles. Methods:  A scoping review using 68 sources of interventions involving CHWs was undertaken. The five-step Arksey and O'Malley model guided this review with the aim of summarizing research findings and identifying research gaps in the existing literature on CHWs in Canada (23 sources). A standardized extraction tool was employed to synthesize the literature. Synthesis: We found that CHWs provide a wide range of health-related services but in a manner that, in Canada, is unrecognized and unregulated. In high income countries, CHW interventions have contributed to health-related issues in communities and demonstrated potential to both reduce health inequity in marginalized populations and reduce the cost of medical services. Conclusion:  CHWs are an under-recognized, and therefore underutilized, public health workforce, which has a promising capacity to reduce health inequities in marginalized populations in Canada. There is growing support to suggest that CHW roles need to be better integrated within the broader health and social services systems to enable their full potential to be realized.

Nguyen BH, Stewart SL, Nguyen TT, et al. Effectiveness of lay health worker outreach in reducing disparities in colorectal cancer screening in Vietnamese Americans. Am J Public Health. 2015 Oct;105(10):2083-9.
Objectives: We conducted a cluster randomized controlled study of a lay health worker (LHW) intervention to increase colorectal cancer (CRC) screening rates among Vietnamese Americans, who typically have lower rates than do non-Hispanic Whites. Methods: We randomized 64 LHWs to 2 arms. Each LHW recruited 10 male or female participants who had never had CRC screening (fecal occult blood test, sigmoidoscopy, or colonoscopy). Intervention LHWs led 2 educational sessions on CRC screening. Control LHWs led 2 sessions on healthy eating and physical activity. The main outcome was self-reported receipt of any CRC screening at 6 months after the intervention. We conducted the study from 2008 to 2013 in Santa Clara County, California. Results: A greater proportion of intervention participants (56%) than control participants (19%) reported receiving CRC screening (P < .001). When controlling for demographic characteristics, the intervention odds ratio was 5.45 (95% confidence interval = 3.02, 9.82). There was no difference in intervention effect by participant gender. Conclusions: LHW outreach was effective in increasing CRC screening in Vietnamese Americans. Randomized controlled trials are needed to test the effectiveness of LHW outreach for other populations and other health outcomes.

Rashid S, Carcel C, Morphew T, Amaro S, Galant S. Effectiveness of a promotora home visitation program for underserved Hispanic children with asthma. J Asthma. 2015 Jun;52(5):478-84.
Objective: Retention in a mobile asthma clinic, the Breathmobile™, of ≥3 visits has previously been shown to be essential for attaining asthma control in underserved children. The objective of this study in primarily Hispanic-American children was to determine the difference in retention between those seen in the Breathmobile™ compared to those receiving an additional promotora-based home visit (HV). Methods: Children with asthma in the Breathmobile™ program were evaluated for asthma status and aeroallergen sensitivity. Indication for HV included poor asthma control, educational and environmental control needs. An initial visit consisted of environmental assessment as well as a 3-h interactive educational session covering asthma basics. A follow-up visit 1 month later assessed implementation. The primary outcome measure of retention was ≥6 months in the Breathmobile™ program. Results: Of the 1007 asthmatic children seen between April 2002 and June of 2005, 136 received HV. These children showed significantly greater retention compared to those without HV with a median number of visits (5 visits versus 2 visits), ≥3 Breathmobile™ visits (86.0% versus 38.8%), median number of days in the program (299 versus 63 days) and percentage of patients in the program ≥6 months (67.8% versus 31.3%) p < 0.001. HV and asthma severity were each independent predictors of retention. Conclusions: The addition of a promotora HV program proved effective in providing greater retention in the Breathmobile™ program essential for asthma control. Randomized clinical trials will be needed to show the impact on health care utilization and asthma control.

Rios-Ellis B, Nguyen-Rodriguez ST, Espinoza L, et al. Engaging community with promotores de salud to support infant nutrition and breastfeeding among Latinas residing in Los Angeles County: Salud con Hyland's. Health Care Women Int. 2015;36(6):711-29.
The Salud con Hyland's Project: Comienzo Saludable, Familia Sana [Health With Hyland's Project: Healthy Start, Healthy Family],was developed to provide education and support to Latina mothers regarding healthy infant feeding practices and maternal health. The promotora-delivered intervention was comprised of two charlas (educational sessions) and a supplemental, culturally and linguistically relevant infant feeding and care rolling calendar. Results indicate that the intervention increased intention to breastfeed exclusively, as well as to delay infant initiation of solids by 5 to 6 months. Qualitative feedback identified barriers to maternal and child health education as well as highlighted several benefits of the intervention.

Rios-Ellis B, Becker D, Espinoza L, et al. Evaluation of a community health worker intervention to reduce HIV/AIDS stigma and increase HIV testing among underserved Latinos in the southwestern U.S. Public Health Rep. 2015 Sep-Oct;130(5):458-67.
Objectives: Latinos are at an elevated risk for HIV infection. Continued HIV/AIDS stigma presents barriers to HIV testing and affects the quality of life of HIV-positive individuals, yet few interventions addressing HIV/AIDS stigma have been developed for Latinos. Methods: An intervention led by community health workers (promotores de salud, or promotores) targeting underserved Latinos in three southwestern U.S. communities was developed to decrease HIV/AIDS stigma and increase HIV knowledge and perception of risk. The intervention was led by HIV-positive and HIV-affected (i.e., those who have, or have had, a close family member or friend with HIV/AIDS) promotores, who delivered interactive group-based educational sessions to groups of Latinos in Spanish and English. To decrease stigma and motivate behavioral and attitudinal change, the educational sessions emphasized positive Latino cultural values and community assets. The participant pool comprised 579 Latino adults recruited in El Paso, Texas (n=204); San Ysidro, California (n=175); and Los Angeles, California (n=200). Results: From pretest to posttest, HIV/AIDS stigma scores decreased significantly (p<0.001). Significant increases were observed in HIV/AIDS knowledge (p<0.001), willingness to discuss HIV/AIDS with one's sexual partner (p<0.001), and HIV risk perception (p=0.006). Willingness to test for HIV in the three months following the intervention did not increase. Women demonstrated a greater reduction in HIV/AIDS stigma scores when compared with their male counterparts, which may have been related to a greater increase in HIV/AIDS knowledge scores (p=0.016 and p=0.007, respectively). Conclusion: Promotores interventions to reduce HIV/AIDS stigma and increase HIV-related knowledge, perception of risk, and willingness to discuss sexual risk with partners show promise in reaching underserved Latino communities.

Siemon M, Shuster G, Boursaw B. The impact of state certification of community health workers on team climate among registered nurses in the United States. J Community Health. 2015 Apr;40(2):215-21.
A number of states have adopted certification programs for community health workers (CHWs) to improve recognition of CHWs as members of health care teams, increase oversight, and to provide sustainable funding. There has been little research into the impact of state CHW certification on the diffusion and adoption of CHWs into existing health care systems. This study examined the impact of state CHW certification on the perceptions of team climate among registered nurses (RNs) who work with CHWs in states with and without CHW certification programs. The study recruited RNs using a purposeful sampling method and used an online survey, which included the Team Climate Inventory (TCI), and compared the perceptions of team climate between the two groups. The study found no significant differences in the overall mean TCI score or TCI subscale scores between RNs who work in states with CHW certification programs (n = 81) and those who work in states without CHW certification programs (n = 115). There was a statistically significant difference on one survey question regarding whether RNs believe state certification of CHWs improved the ability of their health care team to deliver quality care. More research is needed to assess impact of state certification of CHWs and other factors that influence the diffusion and adoption of CHWs into the current health care system.

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Last updated February 11, 2016