Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting

Authors: Savanna L. Carson, PhD; Clemens Hong, MD, MPH; Heidi Behforouz, MD; Emily Chang, MD; Lydia Z. Dixon, PhD; Diane Factor, MS; Sheba M. George, PhD; Jenebah Lewis, MSW, LCSW; Angelina Majeno, MPH; Maria Morales, BA; Courtney Porter, BS; Ami Shah, MPH; Stefanie D. Vassar, MS; Arleen F. Brown, MD, PhD
Year: 2022
State: NatDoc: National Document
Website link:
Publicly Available: Yes
Certification: CHW role scope of practice, Competencies
Evidence Generation: Documentation of how CHWs can work within care teams, Surveys and assessment tools to define and develop workforce
Sustainable Financing: Surveys and assessment tools to define and develop workforce

Medically and socially complex patients disproportionately face barriers to primary care, contributing to health inequities and higher health care costs. This study elicited perspectives on how community health workers (CHWs) act upon barriers to primary care in 5 patient and 3 CHW focus groups. Participants described how CHWs acted on patient-level barriers through social support, empowerment, and linkages, and system-level barriers by enhancing care team awareness of patient circumstances, optimizing communication, and advocating for equitable treatment. Limitations existed for influencing entrenched community-level barriers. CHWs, focusing on patient preferences, motivators, and circumstances, intervened on multilevel barriers to primary care, including advocacy for equitable treatment. These mechanisms have implications for existing CHW conceptual models.

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