Impact of Community Health Worker Certification on Workforce and Service Delivery for Asthma and Other Selected Chronic Diseases

Background Community Health Worker (CHW) certification has been proposed to promote the diffusion of the CHW model in healthcare organizations. However, the extent to which health outcomes vary as a function of CHW certification is unclear. There is also a need to clarify the landscape of CHW certification efforts in the United States. Objectives The objectives were to (1) determine the effects of certification on CHW recruitment, retention, scope of practice, reimbursement or employer liability; (2) ascertain the effects of certification on quality or consistency of care, health outcomes, or patient/family acceptance, trust, and use of community health workers; (3) elucidate the context of certification requirements and implementation in the United States; (4) identify potential positive and negative implications of requiring certification; and (5) identify future research needs. Methods We searched PubMed and CINAHL through October 2019 and handsearched relevant reviews. Our grey literature search focused on reports and presentations by national organizations, foundations, and institutes. We also reviewed the websites of State health departments which have CHW certification programs. We conducted interviews with Key Informants representing stakeholders in the CHW certification enterprise. We used these interviews to identify themes to contextualize findings from the published and grey literature searches. Results The evidence base for community health worker certification is sparse. Our published literature search identified a handful of studies examining correlates of certification (i.e., training, recruitment, and scope of practice) with health outcomes, but these were not linked to the broader issue of certification (n=4, 0 about asthma). We did not find any studies that evaluated the relationship between CHW certification and CHW retention, reimbursement, employer liability, or patients’ and families’ trust in and receptivity to CHWs. We did not find any studies suggesting that patients’ outcomes differ as a function of intervention from a certified versus non-certified CHW, or that certification influences the quality or consistency of CHW-delivered interventions. We identified 37 documents through our grey literature search. Interviews with Key Informants identified four overarching themes: (1) the perceived utility of certification, (2) the philosophical/ethical considerations influencing certification, (3) its potential effects, and (4) recommended components and approaches. The majority of participants asserted that certification does not affect health outcomes. There were diverging opinions about the perceived and actual impact of certification on the CHW workforce, including recruitment, retention, career advancement, composition, and the financial viability of the CHW model. Conclusions In the absence of evaluations of the relationship between certification and outcomes related to patients’ and families’ health, and dimensions of CHWs’ workforce development, the impact of CHW certification is more speculative than conclusive. Further research is needed to determine if certification is linked to improved outcomes for people with asthma and other chronic illness outcomes.