142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Empowerment-washing: A Critical Systematic Review of Community Health Worker Participation in Program Planning and Case Study of an Non-Governmental Organization's Experience

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 10:50 AM - 11:10 AM

Kris Coontz, MPH, MD , School of Medicine, Tulane University School of Medicine, Department of Internal Medicine, New Orleans, LA
José Albany Chavarría Picado , Teach For Health, San Ramon, Matagalpa, Nicaragua
Noah Hawthorne, MPH, MD , Department of Emergency Medicine, UCSF, San Francisco, CA
Sarah Nunn, MSN , Teach For Health, San Francisco, CA
Ivania del Carmen Escobar Sanchez , Teach for Health, Teach for Health, San Ramon, Matagalpa, Nicaragua
While many Community Health Worker (CHW) programs globally utilize the language of empowerment justified through “participation”, it is unclear how programs define, incorporate and measure participation. MeSH, CINAHL and PubMed were searched for publications in the last 20 years with terms related to participation and empowerment, cross-referenced with common descriptors for CHWs employed in the health and development literature. 382 articles met criteria, and 141 were selected for review. Two independent reviewers evaluated articles to analyze the type, extent and location of CHW participation.  Evaluation strategies and evidence of benefit were recorded and compiled, where possible.  “Model” participatory CHW programs were identified and separately reviewed through surveying 5 leaders in the field, and these programs were compared to the academic literature. The majority of surveyed programs had low participation in all program cycle areas except implementation, with minimal tracking of CHW participation. The vast majority lacked strategies to rigorously evaluate “participation” or its benefits, regardless of the type (“horizontal” vs. “vertical” programs) but not the organization of the program. Fewer still of the programs that utilized empowerment language attempted to define or measure empowerment. The presenters include the directors of a nonprofit in rural Nicaragua that has iteratively increased the involvement of CHWs in program planning and implementation. In the final part of this presentation, a Nicaraguan CHW who became the local Program Director of a non-profit collaboration between UCSF graduate students and local Nicaraguan organizations will present his experience and recommendations for maximizing meaningful participation.

Learning Areas:

Administration, management, leadership
Planning of health education strategies, interventions, and programs
Program planning

Learning Objectives:
Define Arnstein's "Ladder of Participation" and apply this concept in the framework of Community Health Worker program planning. Classify Community Health Worker programs based upon vertical and horizontal approaches along a spectrum of Community Health Worker participation. Review the types of participation, benefits cited, and measurement strategies found in a systematic literature review of Community Health Worker programs that use empowerment rhetoric. Review the evidence of benefit for involving Community Health Workers in various stages of program development, from planning to implementation. Provide practical suggestions for maximizing meaningful participation in Community Health Worker program planning.

Keyword(s): Community Health Workers and Promoters

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I originated and conducted the literature review to investigate participation strategies and measurement in Community Health Worker programs. My relevant background includes serving as the head of a non-profit organization that trains Community Health Workers and consulting for similar programs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.