Community Health Workers in Washington, DC Healthy Start Programs: Perceived Barriers to Successful Home Visitation

Washington, DC has two federally-funded HS programs serving diverse populations of low-income pregnant women and their children through home visitation services by CHWs and nurses. This study sought to identify the perceptions of CHWs about their work, including perceived barriers to providing services to women in the program. The study design is qualitative semi-structured interviews with all of the HS-employed CHWs and nurses (n= 34).

Program 1 CHWs felt better prepared to serve clients because of personal characteristics and previous experiences but expressed a desire for a larger role and increased skills (i.e., basic clinical duties, education) to assist them in serving clients better, as well as a clearer delineation of expectations with the nurses. Program 2 CHWs expressed greater autonomy and independence in their roles as part of a care delivery team and felt well prepared to serve their clients because of the extensive training and supervisory support provided by their program.

Perceived barriers to serving clients included – in Program 1 - complex social issues (i.e., racism, poverty, inadequate housing, lack of transportation) and individual client behaviors (e.g., not being home for a scheduled visit), and - in Program 2 - cultural and language differences (i.e., social isolation, fear about citizenship), and inadequate time (e.g., due to clients' jobs).

Understanding the experience of CHWs, including their perceived strengths as well as their perceived barriers in delivering appropriate services to women and infants, can better inform supervisors, trainings and the design of home visitation programs such as HS.