Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model

Area of Science:

• Implementation science
• Public health
• Health equity

Background:

• Community health worker (CHW) programs show potential for improving health outcomes and reducing healthcare costs.
• Limited knowledge exists on barriers and facilitators for scaling evidence-based CHW programs effectively.

Purpose of the Study:

• To identify barriers and facilitators to implementing an evidence-based CHW model, specifically the Individualized Management of Person-Centered Targets (IMPaCT) program.
• To inform strategies for successful scaling and sustainability of CHW initiatives.

Main Methods:

• Qualitative study using interviews with program staff and patients involved in the IMPaCT model across diverse US health systems.
• Data collected between March 2020 and July 2021, analyzed using a rapid qualitative analytic technique informed by the Consolidated Framework for Implementation Research.

Main Results:

• Key barriers included economic/policy constraints (funding, clinical integration) and program-specific issues (tailored materials, costs).
• Facilitators comprised CHW interpersonal skills, program evidence base, supportive teams, and relationship-building design.
• The COVID-19 pandemic, leadership, training, and fidelity were cited as both barriers and facilitators.

Conclusions:

• Findings underscore the growing importance of CHWs in advancing health equity and population health.
• Addressing identified barriers requires policy and practice changes, focusing on improved clinical integration and sustainable financing for CHW programs.
• Continued attention to these factors is crucial for the long-term success and impact of the CHW workforce.