A Systematic Review of Health-Related Outcomes from Community Health Worker Interventions in Health Promotion, Disease Prevention and Chronic Disease Management
Creators: name: Kraschnewski, Jennifer L., MD
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2009

description: Community health workers (CHWs) can serve as a bridge to the health care system for both disease prevention and management. We aimed to conduct a systematic review of the effectiveness of CHW interventions in the areas of health promotion, disease prevention and chronic disease management. Methods: We searched Medline, the Cochrane Database, and CINAHL from their inception through October 2008 using 12 different terms for CHWs including the MESH term community health aides. We included studies with a comparison group that were conducted in the United States, published in English, and included at least 40 participants. Two reviewers independently assessed each abstract and full text articles for inclusion. Disagreements were resolved by consensus. Data was extracted onto a standard form by one reviewer and checked for completeness and accuracy by a second reviewer. Trained reviewers abstracted data and assessed the methodologic quality (internal validity) of studies using predefined criteria based on the U.S. Preventive Services Task Force and the National Health Service Centre for Reviews and Dissemination (U.K.) criteria. Results: Our initial search identified 992 articles. Of these, 24 studies met the inclusion criteria and addressed disease prevention or management. Identified studies were diverse in terms of target population, intervention design, and condition of interest. All of the studies focused on low income or minority populations. Trial duration ranged from 3 months to 4 years. Nineteen studies were randomized controlled trials and 5 were observational. Of the 24 studies, 2 were rated good quality, 14 fair, and 8 poor. Heterogeneity of study designs, conditions of interest and outcomes precluded quantitative synthesis of the results. Eleven studies addressed disease prevention, including pediatric immunizations (3), cardiovascular disease (2), diabetes prevention (1), HIV prevention (1), second-hand smoke exposure (1), colorectal cancer prevention (1), and general preventive care (2). Eight of eleven studies found that CHW interventions were more effective than usual care in either changing knowledge (2 of 2), behavior (4 of 6), health outcomes (2 of 4) or health care utilization (2 of 2). Thirteen studies addressed disease management, including diabetes mellitus (4), hypertension (4), asthma (2), back pain (1), tuberculosis (1), and mental health (1). In diabetes management, two of four studies found that a CHW intervention was more effective than usual care in decreasing HgbAlc. Studies addressing hypertension management (4) did not show a significant difference in blood pressure control between groups, although participants in the CHW groups improved when compared to baseline values. Both asthma studies demonstrated that CHW interventions were effective in reducing unscheduled health care services, but no more effective than comparisons for improving symptoms. Conclusions: CHWs have been used in many different health conditions, largely targeting low income and minority populations. CHW interventions in the area of disease prevention show promising benefits in improving patient knowledge and health care utilization, when compared to usual care. For chronic disease management, the majority of CHW interventions failed to show greater improvement in health outcomes than usual care except in asthma.