CHWs Linking Primary Care and Public Health Services: A Community-Engaged Process for Developing the CHW Role

Although Community Health Workers (CHW) are effective at reaching underserved populations and promoting health, evidence is limited on how best to integrate CHWs within primary care and public health settings or to plan for broad scale implementation of the CHW role. Most notably, evidence is limited on CHW selection, training, scope and practice, and supervision. We address this gap by testing a novel, community-engaged strategy that employs CHWs to leverage and link the strengths and services of primary care and public health and thereby promote cardiovascular health in a rural county that ranks 94^th (of 100 NC counties) for healthy behaviors, and whose population is predominantly African American (60%) and low income (26% living in poverty). CHWs will be integrated as members of both primary care and public health teams and equipped with tablet computers designed to support delivery of an evidence-based health education intervention, referral of at-risk clients to community resources, and communication with clinic and public health teams. The 5-year project applies a community-engaged hybrid effectiveness-implementation trial design with three phases: (1) develop CHW role, (2) test impact on effectiveness and implementation outcomes, and (3) adapt and replicate in a second county and plan for taking the CHW role to scale. We will report findings from the project’s first phase: how we engaged community partners; formative data collected via focus groups, key informant interviews, windshield tours, GIS mapping, and team meetings; CHW job description, training and supervision plans; and practical measures to evaluate CHW implementation and impact.