State of evaluation: community health workers

Disparity groups, especially racial and ethnic minority groups, are at greater risk for poor health yet experience numerous obstacles in accessing health care. Community health workers (CHWs) are indigenous, trusted, and respected members of the underserved community. They can serve as a bridge between peers and health professionals. Use of CHWs has fluctuated since the federal government first endorsed their use for expanded health access to the underserved in the 1960s. National demands to eliminate health disparities and recent socioeconomic pressures have focused attention on use of CHWs to improve community health. Still, underutilization exists due to, in part, a lack of understanding of the CHW concept and a dearth of evaluation literature on CHWs. This article describes the CHW concept, provides a summary of CHW evaluation literature, and suggests quality care indicators to strengthen evaluation. The review of evaluation research relating to CHWs provides a preliminary state of the science for nurses to begin building an evidence-based practice. Quality of care indicators pertinent to CHW are summarized from the existing evaluation literature. The three best practice domains (therapeutic alliance, risk reduction and health care utilization) are proposed along with suggestions for using quality indicators to improve evaluation. A reduction in health disparities can occur with enhanced CHW utilization.