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Evaluating a Community-Placed and Clinically Integrated Community Health Worker Program: A Realist Approach
Jane W Njeru1, Jennifer L Ridgeway, Gladys B Asiedu
1Division of Primary Care Internal Medicine (Drs Njeru, Quirindongo-Cedeño, and Wieland), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Drs Ridgeway and Asiedu), Division of Health Care Policy and Research (Dr Radecki Breitkopf), and Department of Internal Medicine (Dr Gunderson and Ms Nelson and Mr O'Brien), Mayo Clinic, Rochester, Minnesota; and Intercultural Mutual Assistance Association (Ms Nelson and Mr Buzard), Rochester, Minnesota.
Community health worker (CHW) programs improve patient care by building trust and empowerment. Successful implementation relies on home visits, clear roles, and effective team communication for better patient outcomes.
Area of Science:
- Public Health
- Health Services Research
- Community Health
Background:
- Community health worker (CHW) programs are vital links between patients and healthcare teams.
- Evaluating CHW programs is challenging due to complex components and varied outcomes.
Purpose of the Study:
- To identify mechanisms and contextual factors for successful CHW program implementation using a realist evaluation approach.
- To understand how CHW programs enhance patient-centered outcomes and experiences.
Main Methods:
- A realist evaluation framework was applied to a community-placed CHW program in the Midwest US.
- Analysis focused on context-mechanism-outcome configurations.
Main Results:
- Key mechanisms identified include building trust, self-efficacy, and empowerment among stakeholders.
- Essential contextual factors include CHW home visits, inter-team communication, and role clarity.
Conclusions:
- Realist evaluation effectively elucidates CHW program success factors.
- Recommendations for program improvement should be context-specific to maximize impact.
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