Developing the community health worker evidence base: Issues in research and evaluation

Community health workers (CHWs) have the potential to improve health and reduce health disparities. While the use of CHWs is increasing, further growth is hampered by lack of sustainable funding and broad policy support. A more robust body of evidence demonstrating their effectiveness to potential funders and policymakers is needed. Knowledge about effective methods of program implementation is also lacking. This session will discuss issues in developing this evidence, including: (1) What are appropriate measures of CHW effectiveness? Health measures may include intermediate measures such as self-efficacy and behaviors, or distal measures such as health outcomes. Other client-level domains might include client's social support and ability to create community change. Assessing impact on community capacity to change local determinants of health and impact on the determinants themselves are other potential domains. (2) How can cost-effectiveness analysis be incorporated into CHW research? (3) What types of evaluation design should be used? The roles of randomized controlled trials, time-series analysis, case studies and qualitative approaches need consideration. (4) How can participatory research methods be used to involve clients, CHWs, researchers and policy makers in CHW research? The session will also include case studies of how advocates have used research to generate support for CHWs from public health agencies, health systems and policy makers. We will discuss making the business case for CHWs. For example, the Health Department in Seattle/King County has both developed CHW programs and played a leading role in seeking Medicaid funding for CHW pilot programs.