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

ABSTRACT

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.

KEYWORDS:

• Care teams
• community health worker
• healthcare
• hospital systems
• integration
• United states

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.

Notes on contributors

Erin McCarville

Erin McCarville, DrPH, MPH, is a Senior Technical Specialist with Ariadne Labs, a joint center for health systems innovation at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. Dr. McCarville’s research interests include implementation science, systems thinking, and health system integration, especially as it relates to community health workers.

Molly A. Martin

Molly A. Martin, MD, MAPP, is a Professor of Pediatrics at the University of Illinois Chicago. Dr. Martin is an established leader in the fields of implementation science and behavioral intervention design and testing, especially as they relate to community health workers. She is also active in local and national policy efforts that target health disparities. Her research focuses on community models to improve health.

Preethi Pratap

Preethi Pratap, PhD, is an Assistant Professor in the Division of Environmental and Occupational Health Sciences at the University of Illinois at Chicago, School of Public Health. Dr. Pratap’s current research focuses on application of systems thinking and participatory action approaches to engage stakeholders across the work ecosystem (academia, healthcare, corporations, government, community organizations) to co-create knowledge and inclusive evidence for broader policy, systems and environment (PSE) change initiatives to promote and support workforce health and well-being for ALL workers.

Eve Pinsker

Eve C. Pinsker, PhD, is a cultural anthropologist (University of Chicago 1997) who has applied social theory, ethnographic methods, and systems thinking to evaluation research on multi-sectoral and collaborative public health, community development, and leadership training programs. She has been a core faculty member of the DrPH in Leadership program at the University of Illinois at Chicago School of Public Health since 2012.

Steven M. Seweryn

Steven M. Seweryn, EdD, MPH, is a Clinical Assistant Professor in the Epidemiology and Biostatistics Division. He currently serves as the Associate Director of the DrPH Program. Dr. Seweryn has 30 years of experience in local and state public health practice. He has extensive experience in communicable disease control, public health surveillance and community health assessment and planning.

Karen E. Peters

Karen E. Peters, DrPH, is a Clinical Assistant Professor in the Division of Community Health Sciences at the UIC School of Public Health. Her research and teaching interests include health workforce development, global health, rural healthcare delivery, and public policy. Dr. Peters focuses her research approaches using a community-based participatory action research (CBPAR) methodology, including the use of Photovoice she developed with partners in Colombia and Senegal.