Arizona Community Health Workers Advocate for Community Change: How can the CHW work environment foster leadership in advocating for community-wide change

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 CHWs involvement in advocacy beyond the individual patient level and into the realm of advocating for community level change as a mechanism to reduce the structural underpinnings of disparities in health outcomes. A cross sectional study among 86 Arizona CHWs. CHWs were found to advocate at local, state and federal political levels as well as within health and social service agencies and business. CHW work environment characteristics significantly associated with advocacy include employment in a not for profit organization, previous leadership training, flexibility in work hours as well as the flexibility and autonomy to start new projects at work. Intrinsic characteristics of CHWs associated with advocacy include CHW's knowledge of who to talk to in their community, the belief that they can influence community decisions and that they themselves are a leader. Community-level advocacy is considered a CHW core function among CHWs and community advocacy 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 CHWs 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