COMMUNITY HEALTH WORKERS: A SCOPING REVIEW

OF HICSMaisam Najafizada, Ivy Bourgeault, Ronald Labonté ,

Sara Torres, Corinne Packer

Institute of Population HealthUniversity of Ottawa

snaja100@uottawa.ca

The marginalized vs the health system

The problem

• Health inequities among marginalized populations (Immigrants, aboriginals, and low-income and homeless populations)

Meaning– Inappropriate utilization of health care services• A lack of access to or underutilization of primary

health care services• An overutilization of emergency departments, and

professional services

The grassroots solution

• Individuals with good knowledge of communities (mostly one of their members) who has good knowledge of the health system– Health Navigators– Promotoras (Spanish Population)– Community Health Representatives (Aboriginals)– Peer Health Educator– Health Trainers (UK)

The question

• What do we know about CHWs in Canada?• What is there to know about CHWs in

countries like Canada i.e. the United States, the UK, Europe, Australia?

• Comparing the two, where is the research gap in Canada?

Arksey and O’Malley Method of Scooping review: - Identifying research question- Identifying relevant studies- Study selection- Charting data- Collating, summarizing and

reporting the results

How is the study conducted?

Flow

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Electronic Database Search (n=409 articles)Gross number of articles in each sourceMedline (n= 121)Embase (n= 126)CINAHL 9 (n=142)Grey Literature (n=20)

Abstract review (n=409)

Articles excluded based on abstract review(n=294)

Reason for exclusion: Did not have CHWs as the main focus  

Full screening (n=115)

Articles excluded based on full screening(n=58)

Reason for exclusion: Does not focus on health promotion, disease prevention, social determinants of health

Data extraction (n=64)

Who are they & what do they do?• A frontline public health worker • Trusted member of and/or has an unusually close

understanding of the community served. • Serves as a liaison/link/intermediary between health/social

services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.

• Builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counselling, social support, and advocacy.

Typology of CHWs in Canada

• Community Health Representatives: Aboriginal population• Community Facilitator and Community Support Workers:

CancerCare Manitoba:• Women Health Educators (WHEs): Hamilton• Community Health Brokers: Hamilton, Niagara, Brant, and

Haldimand Norfolk • Multicultural Health Brokers: Edmonton, Alberta; Sommerset

West Community Center, Ottawa. • Cross Cultural Health Brokers: British Columbia • Peer Leader (lay health educator): Toronto

Recruitment• Types of recruitment– Recruited by community organizations– Recruited by public health system in small projects– Recruited by communities (Rarely)

• Criteria – Community origin– Knowledge of the community

Education & Training• Type of training

– On-the-job training– Health organization training– Educational institution training– No training

• Content of training– Health promotion and disease prevention– Access to health system– Community development-related training– Disease-specific training– Administrative and research related

•

Accreditation & Recognition• Internationally

– CHW as a standard job classification in US in 2010– Minnesota and Massachusetts have integrated CHWs in their

health system– Health Trainer in the national health services of the UK

• Canada– Unregulated and unrecognized in Canada

• CHW as a career• Sustainability of CHW programs• Integration of CHW programs into the health system

Compensation

• Type of payment– Paid low wages– Not paid for the amount of time actually works – Employed/paid at intervals – when projects have funding

• Factors in payment– Training– Accreditation – Funding

Discussion

• What’s known– CHWs are a reality under

various titles

– Takes a holistic approach– a) Positive health impact

b) reduce health disparity, c) potential to control/reduce high costs of medical/hospital services

– A component of patient-centered health systems

• What’s not known in Canada

– No complete picture– No evidence on

• Their cost-effectiveness• Interaction with other

sectors• Enablers and barriers to

these roles– Identification and

recommendation for policy and program change

Conclusion

• CHWs are a grassroots reality in Canada, • Who needs to be identified and researched

nationally, • Who needs to be recognized by the governments,• Who needs to be regulated within the health care

system

Questions and comments