Evaluating a Community-Placed and Clinically Integrated Community Health Worker Program: A Realist Approach. Issue 2 (April 2019)

• Record Type: Journal Article
• Authors: Njeru, Jane W.; Ridgeway, Jennifer L.; Asiedu, Gladys B.; Radecki Breitkopf, Carmen; Gunderson, Jean M.; Quirindongo-Cedeño, Onelis; O'Brien, Michael W.; Nelson, Tara M.; Buzard, Ron; Wieland, Mark L.
• Is Part Of: Journal of ambulatory care management. Volume 42:Issue 2(2019)
• Publication Date: 2019-04
• Subjects: community-based interventions -- patient-centered care -- program evaluation -- qualitative research -- realist evaluation; Ambulatory medical care -- Administration -- Periodicals; Ambulatory medical care -- United States -- Administration -- Periodicals; Community health services -- Administration -- Periodicals; Community health services -- United States -- Administration -- Periodicals; Health planning -- Periodicals; Health planning -- United States -- Periodicals; 362.12
• DOI: 10.1097/JAC.0000000000000268
• Languages: English
• ISSNs: 0148-9917

Abstract

Abstract : Community health worker (CHW) programs can act as bridges between patients and health care teams, but the complexity and variability of program components and outcomes make them difficult to evaluate. This evaluation used a realist approach to identify underlying mechanisms and contextual factors associated with successful implementation of a community-placed CHW program affiliated with a primary care practice in the Midwest United States. The analysis identified mechanisms by which stakeholders built trust, self-efficacy, and empowerment to improve patient-centered outcomes and experiences. It also identified conditions that support activation of these mechanisms, including the ability of CHWs to make home visits, effective communication between members of the care team across settings, and clarity about the role of the CHW relative to other support services for patients. This type of context-mechanism-outcome evaluation facilitated development of recommendations responsive to local context.