Colorado's Health Extension Response to the COVID-19 Pandemic: A Multi-method Evaluation

The purpose of this study was to evaluate the activities and impact of Colorado's health extension agents' Regional Health Connectors (RHC) in response to the COVID-19 pandemic. Health extension is gaining momentum across the U.S. with a focus on primary care practice transformation, quality improvement, and broader community health. RHCs aim to increase clinical-community alliances, particularly related to the social determinants of health. During the COVID-19 pandemic, RHC roles drastically shifted, prompting quick responses to address community needs in a public health crisis. We conducted longitudinal, twice-monthly surveys with both quantitative and qualitative responses to better understand which needs RHCs were responding to and how they were responding in communities, primary care practices, and public health organizations. Nine electronic surveys were sent to RHCs from April to August 2020: eight standardized questionnaires administered every two weeks and one final retrospective questionnaire. Analyses using mixed effects logistic model and grounded theory approaches explored the nature of RHC-partner interactions and perceived impacts. Within each region, RHCs worked with primary care practices, local public health agencies, and community organizations to help coordinate the COVID-19 response. Broadly speaking, RHCs assisted with COVID-19 testing and contact tracing, communicated the latest information and recommendations to numerous partners, assisted practices and organizations in addressing social needs, and worked to enhance access to mental health and telehealth services. Partner needs were significantly related to the RHCs host organization. This highlights the roles that health extension programs may play during a public health emergency, such as the COVID-19 pandemic.