A Scoping Review of RCT Studies on Community Health Worker Effectiveness

Community health workers (CHW) play a unique role as trusted frontline public health workers who connect underserved populations with health and social services. In addition, CHWs have local insights on underserved patients and families, which can help to reduce information gaps and enhance the capacity of health care systems to understand health-related social needs. However, prior reviews have included studies of varying quality, which makes it difficult to assess rigorous evidence from randomized control trial (RCT) studies. Also, many CHW intervention studies do not clearly specify in which organizational setting a CHW is employed. This scoping review of US studies published in the peer-reviewed literature from 2000 to 2023 focuses on RCT studies of CHW interventions by type of organization. A total of 39 studies met all inclusion criteria. Most RCT studies were conducted in health care systems and among safety-net providers, including community health centers. However, only a handful of rigorous RCT studies of CHW interventions were conducted in public health agencies or payer settings (managed care organizations). Overall, most RCT studies of CHW interventions found consistent evidence of improved outcomes. Health care organizations can enhance their efforts to address resource gaps by hiring CHWs or partnering with organizations that employ CHWs. Finally, future RCT studies on CHWs employed by health plans (payers) or public health agencies are needed to bolster the growing body of rigorous evidence that CHWs are highly effective in improving patient outcomes across multiple organizational settings.