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Community Health Workers: A scoping review of HICs

Community Health Workers: A scoping review of HICs. Maisam Najafizada, Ivy Bourgeault , Ronald Labont é , Sara Torres, Corinne Packer Institute of Population Health University of Ottawa snaja100@uottawa.ca . The marginalized vs the health system. The problem.

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Community Health Workers: A scoping review of HICs

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  1. Community Health Workers: A scoping review of HICs Maisam Najafizada, Ivy Bourgeault, Ronald Labonté, Sara Torres, Corinne Packer Institute of Population Health University of Ottawa snaja100@uottawa.ca

  2. The marginalized vsthe health system

  3. 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

  4. 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)

  5. 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?

  6. How is the study conducted? • Arksey and O’Malley Method of Scooping review: • Identifying research question • Identifying relevant studies • Study selection • Charting data • Collating, summarizing and reporting the results

  7. Electronic Database Search (n=409 articles) Gross number of articles in each source Medline (n= 121) Embase (n= 126) CINAHL 9 (n=142) Grey Literature (n=20) Flowchart of articles included in the study 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)

  8. Who are they & what do they do? • A frontlinepublic 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.

  9. Typology of CHWs in Canada • Community Health Representatives: Aboriginal population • Community Facilitator and Community Support Workers: CancerCareManitoba: • 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. Questions and comments

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