Exploring the CHW Role: From Preparation to Practice

Background: The National Heart, Lung, and Blood Institute's (NHLBI) Community Health Workers (CHW) Initiative began in 1994 with a community-based Latino cardiovascular health education program. The model has been expanded and adapted to include other cultures. The CHW Initiative focuses on increasing the participation of CHWs to improve cardiovascular disease among low income and high risk communities.

Methods: NHLBI conducted formative research with thirty-five individuals representing CHWs, CHW leaders, CHW trainers and recruiters, training designers, decision-makers, and federal agencies with CHW programs. Telephone interviews were held using five protocols based on research questions. The purpose was to explore actual and perceived CHW preparation and roles, and the most effective way to effect positive change in both preparation and practice of CHWs.

Results: Interviewees suggested several needs. CHW preparation: Improved funding mechanisms, improved access to training; skill-based training in core competencies before specialized training; development of training standards and core competencies; more experientially taught CHW courses using adult learning methods; improved data on certification programs (implementation and outcomes); Practice: Increase CHW advocacy role; CHW training programs built on the unique nature of the CHW role; explore the advantages and disadvantages of credentialing; and document, track, and share activities and outcomes in order to demonstrate what CHWs can do.

Conclusions: Today CHWs have a unique and important role in health care that has increased due to several factors, including health care reform, financial constraints, increasingly diverse populations, and the increasing number of people living with chronic illnesses.