Toward A Scalable, Patient-Centered Community Health Worker Model: Adapting the IMPaCT Intervention for Use in the Outpatient Setting.

Community health worker (CHW) programs are an increasingly popular strategy for patient-centered care. Many health care organizations are building CHW programs through trial and error, rather than implementing or adapting evidence-based interventions. This study used a qualitative design-mapping process to adapt an evidence-based CHW intervention, originally developed and tested in the hospital setting, for use among outpatients with multiple chronic conditions. The study involved qualitative in-depth, semi-structured interviews with chronically ill, uninsured, or Medicaid outpatients from low income zip codes (n = 21) and their primary care practice staff (n = 30). Three key themes informed adaptation of the original intervention for outpatients with multiple conditions. First, outpatients were overwhelmed by their multiple conditions and wished they could focus on 1 at a time. Thus, the first major revision was to design a low-literacy decision aid that patients and providers could use to select a condition to focus on during the intervention. Second, motivation for health behavior change was a more prominent theme than in the original intervention. It was decided that in addition to providing tailored social support as in the original intervention, CHWs would help patients track progress toward their chronic disease management goals to motivate health behavior change. Third, patients were already connected to primary care; yet they still needed additional support to navigate their clinic once the intervention ended. The intervention was revised to include a weekly clinic-based support group. Structured adaptation using qualitative design mapping may allow for rapid adaptation and scale-up of evidence-based CHW interventions across new settings and populations.