TY - JOUR
T1 - Community health workers and community advocacy
T2 - Addressing health disparities
AU - Ingram, Maia
AU - Sabo, Samantha
AU - Rothers, Janet
AU - Wennerstrom, Ashley
AU - De Zapien, Jill Guernsey
N1 - Funding Information:
Since the launch of Comienzo Sano in 1987, a prenatal outreach and education intervention in Yuma County, researchers in Southern Arizona have collaborated with Latino communities to develop, implement and evaluate programs utilizing the CHW model. This public health intervention was eventually sustained as a line item of the Arizona Department of Health Services budget and is now implemented in rural and underserved communities throughout Arizona [22, 23]. The pressure to sustain grant initiated programs influenced partners to focus evaluation efforts on documenting the effectiveness of CHW programs in improving health outcomes, in spite of the fact that CHW activities often included efforts to mobilize the community in creating an environment more conducive to health. One example is the Border Health Strategic Initiative funded by the Centers for Disease Control and Prevention from 2000 to 2003. Border Health ¡SI! was a comprehensive diabetes prevention and control program which centered around the use of CHWs to work across multiple domains of the community [24]. CHWs were crucial both in engaging the community to address environmental changes and in successfully mobilizing program participants to lobby local politicians for increased funding for recreational areas [25]. In Arizona, as CHWs have become increasingly recognized as an effective means to conduct community outreach, health care providers such as community health centers have incorporated the use of CHWs in their clinical programs. While clearly positive from the standpoint of sustainability for CHW programs and improving the cultural competence of clinical services, there is some question as to whether the role of the CHW has been limited in the context of specific program delivery.
PY - 2008/12
Y1 - 2008/12
N2 - The Community Health Worker model is recognized nationally as a means to address glaring inequities in the burden of adverse health conditions that exist among specific population groups in the United States. This study explored Arizona CHW involvement in advocacy beyond the individual patient level into the realm of advocating for community level change as a mechanism to reduce the structural underpinnings of health disparities. A survey of CHWs in Arizona found that CHWs advocate at local, state and federal political levels as well as within health and social service agencies and business. Characteristics significantly associated with advocacy include employment in a not for profit organization, previous leadership training, and a work environment that allows flexible work hours and the autonomy to start new projects at work. Intrinsic characteristics of CHWs associated with advocacy include their belief that they can influence community decisions, self perception that they are leaders in the community, and knowledge of who to talk to in their community to make change. Community-level advocacy has been identified as a core CHW function and has the potential to address structural issues such as poverty, employment, housing, and discrimination. Agencies utilizing the CHW model could encourage community advocacy by providing a flexible working environment, ongoing leadership training, and opportunities to collaborate with both veteran CHWs and local community leaders. Further research is needed to understand the nature and impact of CHW community advocacy activities on both systems change and health outcomes.
AB - The Community Health Worker model is recognized nationally as a means to address glaring inequities in the burden of adverse health conditions that exist among specific population groups in the United States. This study explored Arizona CHW involvement in advocacy beyond the individual patient level into the realm of advocating for community level change as a mechanism to reduce the structural underpinnings of health disparities. A survey of CHWs in Arizona found that CHWs advocate at local, state and federal political levels as well as within health and social service agencies and business. Characteristics significantly associated with advocacy include employment in a not for profit organization, previous leadership training, and a work environment that allows flexible work hours and the autonomy to start new projects at work. Intrinsic characteristics of CHWs associated with advocacy include their belief that they can influence community decisions, self perception that they are leaders in the community, and knowledge of who to talk to in their community to make change. Community-level advocacy has been identified as a core CHW function and has the potential to address structural issues such as poverty, employment, housing, and discrimination. Agencies utilizing the CHW model could encourage community advocacy by providing a flexible working environment, ongoing leadership training, and opportunities to collaborate with both veteran CHWs and local community leaders. Further research is needed to understand the nature and impact of CHW community advocacy activities on both systems change and health outcomes.
KW - Advocacy
KW - Community health worker
KW - Health disparities
KW - Leadership
KW - Policy
UR - http://www.scopus.com/inward/record.url?scp=53649110566&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=53649110566&partnerID=8YFLogxK
U2 - 10.1007/s10900-008-9111-y
DO - 10.1007/s10900-008-9111-y
M3 - Article
C2 - 18584315
AN - SCOPUS:53649110566
SN - 0094-5145
VL - 33
SP - 417
EP - 424
JO - Journal of Community Health
JF - Journal of Community Health
IS - 6
ER -