Community Health Workers: Giving voice over time

Community Health Workers are often defined as people who come from a vulnerable community and empower their neighbors to achieve better health outcomes. This role has been discussed in the literature for the past fifty years, and over time, the role has developed and changed to address a wide variety of public health concerns. The root of the concept is embedded in empowerment; however recent work suggests that CHWs are being seen as change agents and paraprofessionals. Data on the effectiveness of the role for health improvement is limited, however and much work has been focused on training of CHWs and having them work in a wide variety of interventions. The purpose of this paper is to describe the CHW movement over the past fifty years via an integrative literature review focusing on the CHW role, underlying theories for the role, sustainability of the role over time, and measures of empowerment and effectiveness for communities and CHWs. The integrative review of the literature from 1960-2010 will address questions of: how did the CHW role develop in the US? What theoretical frameworks have been used to support/explain the role; how has effectiveness of the CHW role been defined and how has this definition changed over time? Data analysis provides a description of how this role evolved over time, how current trends in CHW interventions and research relate to community empowerment, and directions for future research into the role and its impact on community health.