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Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary
Savanna L Carson1, Clemens Hong, Heidi Behforouz
1Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles (Drs Carson, Chang, and Brown and Mss Morales, Porter, and Vassar); Los Angeles County, Department of Health Services, Los Angeles, California (Drs Hong and Behforouz and Ms Shah); Health Science Program, California State University Channel Islands, Camarillo, California (Dr Dixon); Worker Education & Resource Center, Inc, Los Angeles, California (Mss Factor and Porter); Department of Urban Public Health, Charles R Drew University of Medicine and Science, College of Science and Health, Los Angeles, California (Dr George); USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California (Ms Lewis); Department of Psychological Science, University of California Irvine, Irvine, California (Ms Majeno); and Olive View-UCLA Medical Center, Sylmar, California (Ms Vassar and Dr Brown).
Community health workers (CHWs) help complex patients overcome primary care barriers. They provide social support, improve communication, and advocate for equitable treatment, addressing multilevel challenges.
Area of Science:
- Health Services Research
- Social Determinants of Health
- Patient Advocacy
Background:
- Medically and socially complex patients face significant barriers to primary care access.
- These barriers contribute to health inequities and increased healthcare expenditures.
- Understanding the role of community health workers (CHWs) is crucial for addressing these challenges.
Purpose of the Study:
- To explore patient and CHW perspectives on how CHWs address barriers to primary care.
- To identify the mechanisms through which CHWs intervene at patient and system levels.
- To examine the implications for existing conceptual models of CHW practice.
Main Methods:
- Qualitative study utilizing focus groups.
- Involved 25 patients with complex medical and social needs.
- Included 17 community health workers.
Main Results:
- CHWs addressed patient-level barriers through social support, empowerment, and creating linkages to resources.
- CHWs mitigated system-level barriers by increasing care team awareness, improving communication, and advocating for patients.
- CHWs' influence on entrenched community-level barriers was limited.
Conclusions:
- CHWs play a vital role in intervening on multilevel barriers to primary care for complex patients.
- CHW interventions focus on patient preferences, motivators, and circumstances, including advocating for equitable treatment.
- Findings offer insights for refining conceptual models of CHW effectiveness.
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