Introduction

Methods Future Directions • Create patient pathway flow charts • Partner with licensed individuals for reimbursement • Explore the hiring process at different types of

organizations• Build analytic capacity of safety net providers• Incorporate self-efficacy measures into EHRs• Provide initial comprehensive training • Incorporate team based approaches to training• Create safe spaces for communication to help improve

evidence-based service delivery• Provide opportunities for CHWs to maintain community

connection

Community Health Workers A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. The trusting relationship enables the CHW to serve 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.

American Public Health AssociationCommunity Health Worker Section, 2009

Research Questions1. How are CHWs integrated into their health care

organization?2. What organizational factors support CHWs in their

roles in hypertension self-management and hypertension medication adherence?

Results

Acknowledgments We would like to acknowledge and thank all of the CHW participants and CHWs around the nation working to reduce health disparities. We dedicate this work to Dr. David Callahan.

Time Spent with Patients

The Integration of Community Health Workers into Care Teams for Patients with Hypertension

Caitlin Allen, Cam Escoffery, Anamika Satsangi, J. Nell Brownstein | Rollins School of Public Health, Emory University

• Months of Interaction: 7.0 (SD=5.1)• Times per Month: 7.8 (SD=12.6)• Minutes per Visit: 39.7 (SD=25.7)

Other Member of Care Team• Nurse (49.7%)• Medical Director (46.2%)• Other CHWs (43.4%)• CHW Supervisors/Head CHW (42.1%)• Nurse Practitioner (38.6%)

“A lot of the nurse managers have made the referrals to us. The community health workers will communicate

with the nurse manager and let them know we're seeing this client, this is what we're seeing. We

coordinate back and forth and again, if we go to an appointment, we do follow back up.”

Construct Definitions ExamplesNetworks and communication

The nature and quality of formal and informal communications within an organization

Electronic Health Records Staff-meetings

Culture Norms, values and basic assumptions

Ability for CHWs to stay connected to community

Implementation climate

The absorptive capacity for change, shared receptivity of involved individuals to an intervention and the extend to which that intervention will be rewarded, supported, and expected within their organization

Training (learning climate) Being part of multidisciplinary care team

(compatibility, relative priority) Support and validation from patients

(relative priority) Resources to health education materials

(learning climate)

Readiness for implementation

Tangible and immediate indicators of organizational commitment to its decision to implement an intervention

Support from leadership or program champion (leadership engagement)

Training (available resources)

“But in fact, one our focus has always been that, whenever we go out, we always invite our clinic to go with us, so that way, they can have firsthand knowledge. Some of them have gone out, but you're still in a culture that's very entrenched and sometimes those who are at the top, they don't do it. They don't go out. And I think in order for people to really see the value of a community health worker, you have to go out – you have to be in the community and a lot of administrators have no idea about the community that they're serving.”

Inner Setting

CHW Learning Climate • Resources to health education materials (65.0%)• Training held outside of my organization (58.7%)• Training held at my organization (48.3%)

Communication

Outer Setting: Staying Connected to the Community Construct Definitions ExamplesCHW cosmopolitan

The degree to which CHWs are networked with external organizations

Networking with other CHWs and organizations; formal or informal

Organizational cosmopolitan

The degree to which an organization itself is networked with non-CHW organizations

Organization employing CHW is well networked with community based organizations; formal or informal

Peer pressure Mimetic or competitive pressure to implement an intervention

Attending meetings with other organizations who train CHWs to learn best practices

External policies and initiatives

Policy and regulations, external mandates, recommendation guidelines, pay-for-performance, collaborative, and public or benchmark reporting

CHWs are aware and connected with larger policies and initiatives that impact their work

“When I find a particular need that I don't know what to do, I know who to go to so that that person can come in and then

help me with that patient to get them where they need to be.”

“Training is really important, because if you provide adequate training for folks, then you facilitate both what they're able to

do and what and how useful it is for the community, and it takes a lot of the problems out of the things. It puts

parameters on it.”

• Recruited from survey takers• Semi-structured telephone interview• 21 questions in 5 domains

Data Analysis• Transcribed verbatim• Two coders (AKS and CGA)• Inductive thematic analysis• MaxQDA version 11

CHWs Play Key Roles in Hypertension Self-Management

Key roles including health education, coordinating with the care team members, helping patients overcome various barriers such as accessing health providers, reminding about appointments, and increasing medication adherence (through label reading, getting free or low-cost medication and medication refills).

Design

Role N (%)Educate on healthy diet 118 (83.7%)Educate on low-sodium diet 112 (79.4%)Help patients or clients understand that they should not stop taking their blood pressure medicine without talking to the doctors

104 (73.8%)

Help patients or clients with keeping doctor’s appointments 103 (73.1%)Provide referrals to other social services 94 (66.7%)Educate about shopping for and preparing healthy foods 93 (66.0%)Help patients or clients understand they should talk to their doctors about any side effects they think their blood pressure medicines may have

93 (66.0%)

Assist with goal setting 88 (62.4%)Offer or refer patients or clients to quit smoking programs (smoking cessation)

80 (56.7%)

Help patients or clients with remembering to take medication by using pill boxes or other reminders

79 (56.0%)

Help with patients or clients with insurance issues 79 (56.0%)