Integrating Community Health Workers' Dual Clinic-Community Role in Safety-Net Primary Care: Implementation Lessons...

Area of Science:

• Public Health
• Health Services Research
• Diabetes Prevention

Background:

• Over a third of US adults have prediabetes, with a high risk of progressing to type 2 diabetes.
• Community Health Workers (CHWs) are vital in promoting healthy behaviors for diabetes prevention.
• Limited guidance exists for integrating CHWs into primary care, especially regarding their dual roles.

Purpose of the Study:

• To examine CHW adaptations of a diabetes-prevention intervention in safety-net hospitals.
• To analyze the impact of CHW actions on program fidelity and patient outcomes.
• To propose strategies for effective CHW integration into primary care settings.

Main Methods:

• A case study utilizing the Model for Adaptation Design and Impact (MADI).
• Analysis of the Community Health Outreach to Reduce Diabetes (CHORD) trial (2017-2022).
• Semi-structured interviews and focus groups with CHWs (n=4) and clinicians (n=17).

Main Results:

• CHW adaptations expanded interventions to include social assistance, healthcare access, and operational tasks.
• Adaptations aimed to improve intervention fit, reach, and retention, but had potential ripple effects.
• CHWs' focus on complex social needs may divert attention from core health-coaching responsibilities.

Conclusions:

• CHWs' community knowledge enhances patient engagement, but overextension can detract from health goals.
• Primary care CHW programs need explicit delineation of non-health support roles.
• Integration requires multiprofessional teams, community partnerships, clear communication, and iterative review mechanisms.