Predictors and a Framework for Fostering Community Advocacy as CHW Core Function to Eliminate Health Disparities

Community Health Workers (CHWs) are in the unique position of recognizing environmental and structural barriers facing marginalized populations. Their sense of identity with the communities they serve both compels and positions CHWs to take action in the face of these challenges. Objective: The National Community Health Workers Advocacy Study (NCHWAS) is a mixed-methods, community based participatory research (CBPR) project investigating the impact of CHW advocacy on community engagement to address the social determinants of health (SDH). Based on this study, we present a framework for conceptualizing and measuring ways in which CHWs engage in advocacy activities, and mechanisms to support CHW advocacy efforts beyond the individual client level. Methods: Cross sectional survey data for 371 CHWs, from 22 US states assessed socio demographic measures; CHW training experience, characteristics of CHW work environment and duties; and CHW leadership qualities on CHW civic, political and own agency advocacy. CHW advocacy stories further articulate CHW advocacy efforts at civic, political, and own agency levels. Results: 75% of CHWs respondents engaged in some type of advocacy. Factors that significantly contributed to CHW advocacy included leadership and advocacy training, work setting, job description, and CHW leadership qualities. Conclusions: CHWs recognized by their community, employer, and community leaders as a trusted member of community opinion can be supported by including community advocacy as central to CHW job description, delineating specific advocacy activities in line with institutional mission and project goals and identifying and providing skill building that prepare CHWs to organize and advocate effectively.