Introduction: Chronic Kidney Disease (CKD) poses a significant health burden among patients of color, particularly among African American and Latinx communities in the US. Community Health Workers (CHWs) have emerged as pivotal actors in healthcare delivery, yet their integration into CKD care systems for these communities remained underexplored. This abstract examined the factors influencing the successful involvement of CHWs in CKD care systems for African American and Latinx communities in the US.

Methodology: The research team conducted a qualitative study using in-depth Zoom interviews with 66 experts, comprising clinicians, administrators, African American and Latinx CKD patients, and their family caregivers across 18 states in the US. The multidisciplinary research team analyzed the interview transcripts and identified emerging themes utilizing the thematic analysis method. Notably, the lead author has been working as a community aide for the University of Illinois's student communities on behalf of the University of Illinois at Urbana-Champaign.

Results: The team identified six themes as factors influencing the involvement of CHWs in CKD care teams for African American and Latinx communities. Theme 1 included "Training and certification" (This theme discussed how CHWs' limited training/certification could influence their acceptability and kidney care practices). Theme 2 was "Communications" (This theme delved into the importance of communication about CHWs' roles and scopes with clinicians to increase their acceptability in the kidney care model). Theme 3 included "Trust" (This theme demonstrated how building trust among patients would reduce proximity barriers and enable patients to share their sensitive health information with CHWs). Theme 4 delved into "Wage and incentives" (This theme explained how payment and provided benefits for CHWs could influence CHWs' interest in working in this extended role of caring for CKD patients). Theme 5 discussed "Logistics" (This theme explained the need to meet logistical needs for CHWs to work in the CKD care model). Finally, theme 6 demonstrated the importance of "Selection of an ideal candidate." (This theme discussed the necessary skills required to work as CHWs for these vulnerable populations and participants' suggestions on who could make ideal candidates as CHWs for CKD patients).

Conclusions: This study outlines the factors influencing the successful integration of CHWs in the CKD care model. It provides valuable guidance for the development and expansion of the CHW-led CKD care model and thus establishes kidney health equity

Equal Hope's Community Health Workers (CHWs) have been instrumental in addressing the halt of routine cancer screenings in communities of color. Following the pandemic, increased mistrust and safety concerns have led to a decline in cancer screenings among marginalized populations. In addition, as the communities of Chicago have grown so have their health needs. There is a need to address the gaps of care and CHWs are seen as trustworthy partners who ensure that communities are connected to resources. However, we have seen that encounters with the CHWs doesn't necessarily result in a sign-up. We have hypothesized that participants of community events such as health fairs are people who may already be plugged into the health system.

This challenging landscape prompted Equal Hope to pivot its outreach model and collaborate closely with CHWs to meet the evolving needs of the community. This presentation will highlight Equal Hope's innovative strategies, outcomes, and lessons learned in reimagining cancer screening access and engagement in underserved communities post-COVID-19.

Since 2020, our CHW team has grown from two to eight CHWs with four identifying as NH Black and four as Latinx. Our team now includes 50% that are bilingual and has allowed for unique and culturally appropriate ideas to engage the community. As a result, we have seen a 154% increase in those seeking Spanish navigation services.

As a result of our growth, between January 2022 to February 2024 we have conducted a total of 2,450 outreach events and educated 131,044 individuals, resulting in 2,521 new sign-ups. These outreach efforts have resulted in 3,940 navigated to services, with navigation to 4,580 breast cancer screenings, 547 cervical cancer screenings and 655 primary care appointments at an 83% completion rate.

In past years, we primarily focused on cancer screenings but recognize that the community we are targeting deals with many complex social needs such as housing, job, and food access. Our CHWs are now meeting the community where they are by targeting food pantries, shelters, and consulates by addressing the social determinants of health. We also engage clients in smaller group settings that include breast and cervical health presentations, sip & paint, sound bath meditation, and candle–making. All our events are intertwined with healing discussions. The CHWs have created these events based on their own personal experiences to create a safe space for open communication and discussion paired with a recreational activity.

Background/objectives: Access to quality education and healthcare significantly influences health outcomes making it especially essential for people experiencing homelessness (PEH), who face disproportionate health disparities. The COVID-19 pandemic exacerbated barriers to health information and resources, particularly heightening issues of mistrust and health literacy, and highlighted the urgency for interventions. Community health workers (CHWs) emerge as vital intermediaries to address these barriers to healthcare access, having the potential to inform and connect PEH. The objective of this study is to assess PEH knowledge and attitudes towards COVID-19 testing and vaccination, and the impact of CHW-led education within a homeless shelter in Indiana, while also identifying motivators, demotivators, and barriers to shelter-based COVID rapid testing and vaccination to inform future efforts in pandemic response.

Design/Setting: In partnership with a homelessness service agency, 15 CHW-led focus group-structured COVID-19 educational sessions were held, with a total of 78 PEH participants. Pre/post-tests were conducted to measure knowledge gains and attitude shifts among PEH. Guided by the socioecological model, thematic analysis of focus group transcripts identified key motivators and barriers to COVID-19 vaccination and testing. A CHW trained on research and ethics contributed to all aspects of this study, and led key aspects including intervention design, recruitment, data collection, analysis, and findings dissemination.

Results: Motivators and barriers to COVID-19 testing and vaccination were identified, including a desire to protect others and obstacles such as fear, mistrust, and misinformation. Completion of an educational session significantly increased knowledge scores (pre-test mean = 10.76/15, post-test mean = 13.58/15; p < 0.001), with most participants (91%) improving by 1 to 10 points. Significant knowledge gains were observed for misconceptions about vaccine fertility (pre-test: 38%, post-test: 87%, p < 0.001), COVID-19 vaccines causing the illness (pre-test: 42%, post-test: 85%, p < 0.001) and cost of COVID-19 tests (Pre-test: 54%, Post-test: 94%, p<.001). Attitudes toward testing and vaccination improved, with willingness to be vaccinated rising from 21% to 39%, and willingness to test after known exposure increasing from 83% to 92%. Feedback from the sessions revealed participant preferences towards health education format and topics.

Conclusion: CHW-led COVID-19 educational sessions increased knowledge gains and positively influenced attitudes towards vaccination and testing among PEH. Coupled with shared insights from PEH, our findings highlight the importance of tailored, community-driven interventions for pandemic response and emphasize the crucial role of education in building trust and promoting health literacy to improve health outcomes for vulnerable populations.

Background: Hearts in Action builds on a community-based participatory action project and is a collaboration between the Arizona statewide community health worker (CHW) association and a university partner. As part of the NIH Community Engagement Alliance Against COVID-19 Disparities (CEAL), Hearts in Action aims to (1) promote inclusion of disproportionately affected racial/ethnic minority and rural populations in research and (2) develop innovative strategies to promote prevention of health disparities. Previous research with Latino/e low-wage essential workers reveals that work-related stressors are compounded by non-work stressors creating a ‘double jeopardy’ scenario that is highly predictive of poor health outcomes, including chronic stress and cardiovascular disease.

Hearts in Action aims to evaluate a brief intervention delivered by CHWs to address work as a social determinant of health, safety, and quality of life among Latino/e essential workers in Arizona.

Methods: Six CHWs across three rural and urban cities in Arizona formed ten small groups of workers to reflect on work experiences related to labor rights and health. During four sessions, the CHWs co-learned with participants about the connection between work and health and strategies to change working conditions. All groups were completely in Spanish with Latino/e workers and CHWs.

The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was applied to evaluate the intervention. A pre-post survey measured changes in overall health status, work environment perceptions, and self-efficacy to advocate for improved work conditions. CHWs completed reflection logs to describe their perceptions about community engagement, intervention benefits, and recommendations to improve. Researchers attended several sessions and made detailed field observations to assess the needs and strengths of workers.

Results: Fifty Latino/e low wage workers participated, largely employed in farmwork, home or hotel housekeeping, and restaurants. Participants reported overall satisfaction with the intervention, increased self-efficacy to advocate in the workplace, improved knowledge about their rights as workers, and greater sense of connection to their community and available resources.

Conclusions: Hearts in Action is an acceptable and effective intervention for Latino/e workers that could be integrated into work and non-work settings to address work as a social determinant of health in a right-to-work state like Arizona.

Purpose: CDC's Community Health Workers for COVID Response and Resilient Communities (CCR) is a 3-year initiative to train, deploy, and engage community health workers (CHWs) in communities most affected by COVID-19. As part of the national evaluation of the CCR initiative, this study included interviews with CHWs and staff to examine barriers and facilitators to integrating CHWs within public health organizations and care teams. The results provide insights into best practices for CHW integration to improve COVID-19 response in priority communities, decrease impacts of COVID-19 on those at highest risk, and increase health equity and community resilience.

Methods: Virtual interviews were conducted with 12 CHWs and 13 program staff from 8 CCR recipient sites integrating CHWs into health departments, community health organizations, and clinics. Over 500 documents related to CHW integration were also collected and 1 site completed a Digital Storytelling workshop on CHW integration. Rapid qualitative analysis provided a multi-level approach to analyzing data, highlighting key themes through a comprehensive, systematic review of data sources. CHWs were involved in study design, execution, and analysis to provide insight and feedback. CHWs will also participate in presenting results.

Results: Facilitators and barriers to CHW integration include leadership, preparation, and role clarity. Leaders trained as CHWs or having knowledge of the CHW profession were better able to bridge gaps between teams and CHWs; leaders not including CHWs in decision-making or unable to communicate the importance of CHWs were less effective. Hiring CHWs without comprehensive pre-planning hindered integration whereas detailed preparation (training, education, planning meetings) set the stage for success. Lack of role clarity created challenges whereas detailed work plans, job descriptions, and frequent meetings between staff and CHWs helped ease integration into care teams.

Conclusions: Three major practice implications were identified. First, programs should invest time before integrating CHWs to ensure supportive policies, including clear job descriptions, onboarding procedures, and access to referral systems, are in place. Second, program leadership should ensure staff, community members, leadership and other constituents understand the history, value, and role of CHWs. Third, barriers to integration are often visible at the organizational level but are rooted in the systems level. Activating champions at the organizational, community, and state levels to support CHWs holds promise in addressing these systematic challenges. Understanding the challenges of integrating CHWs can guide future efforts to incorporate this vital workforce into existing systems and reduce social inequities experienced by marginalized populations.

Community health worker (CHW) surveys provide important information about the status of the CHW workforce from the perspectives of CHWs themselves. The 2023 Community Health Worker (CHW) Survey was conducted by the Michigan Community Health Worker Alliance (MiCHWA), statewide. It was created in collaboration with (EWG) and a small survey-focused subgroup, including CHW members. The subgroup reviewed other states’ CHW surveys, MiCHWA’s CHW employer survey and CHW topic recommendations. Drafts were reviewed by focus groups of CHWs, the EWG and MiCHWA’s CHW Network and piloted with CHW volunteers who received CE credits for their work. The online survey link was disseminated to MiCHWA’s CHW lists.

Our analyses of 262 responses found that CHWs are integral in bridging the gap between communities and health services, often engaging in an average of 16 sub-roles, including resource connection, motivation for care, and addressing basic needs. Despite their pivotal role, CHWs face significant challenges, notably low pay, perceptions of limited upward mobility, and emotional burnout. With CHW compensation ranging from $14.05 to $38.00 per hour, over half of the CHWs expressed concerns over financial security. The large variance in pay, coupled with the emotional toll of their work, contributes to burnout among CHWs. The survey highlighted substantial variation in CHW roles, number and geographic dispersion of clients served across different organization settings pointing to the need for targeted interventions to support CHWs in their multifaceted roles. In addressing the APHA meeting's theme, "Rebuilding Trust in Public Health and Science," our findings advocate for the recognition of CHWs as crucial agents in public health, necessitating adequate compensation, career advancement opportunities, and systemic support to mitigate burnout and turnover.

The involvement of CHWs in the survey's development emphasizes the importance of their leadership and firsthand experiences in shaping public health strategies. Such engagement not only enhances the survey's impact but also aligns with our commitment to elevating CHW voices in public health discourse, thereby contributing to the broader goal of rebuilding trust and advancing health equity.

Community health workers (CHWs) are a vital part of the local public health workforce’s aims to promote and protect the health of local communities. But the extent that CHWs work with local health departments (LHDs) that serve jurisdictions across the U.S., is largely unknown. This integration between the local governmental public health system and CHWs may support better and coordinated programming, provide stronger reach in communities, and more.

It is critical to understand whether and how LHDs work with CHWs, and if so, what functions CHWs support LHDs in doing across their communities. In 2023, the National Association of County and City Health Officials (NACCHO) conducted the Forces of Change study (FOC), a periodic nationally representative survey that examines emerging topics across workforce, programs, and infrastructure and their impact on the changing public health landscape. In 2023 the study captured information from LHDs about their coordination with CHWs, challenges, and opportunities.

Overall, results suggest that almost half of LHDs are not working with CHWs, with just over a fourth indicating they hire CHWs; about one in ten have CHWs as volunteers. Among the LHDs that directly work with CHWs, the most common functions that CHWs supported were connecting community residents with resources and providing public health education. LHDs were less likely to report CHWs supporting provision of clinical services or disease intervention work in the community.

Stronger integration of CHWs with LHDs poses an opportunity to better serve and promote health within local communities, especially in a time when rebuilding trust and bolstering local public health systems is needed. Results also suggested that supporting LHDs by identifying funding and LHDs’ ability to pay competitively, as well as building knowledge regarding CHWs’ roles related to programming and service planning in LHDs, will be necessary before this integration can be leveraged.

This session will cover not only data highlights but will also allow space for discussion about how, why, and in what capacity LHDs and CHWs can work together moving forward and how this integration may support bolstering community trust in and their engagement with the local governmental public health system.

The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded nutrition education program that uses a community health worker (CHW) education model to improve the nutrition security of adults and youth from low-income households (Roe et al., 2023). EFNEP is administered through Land Grant Universities nationwide, and at the University of Minnesota Extension, EFNEP CHWs are called paraprofessionals. The EFNEP model which has been mandated by congress since 1969 doesn’t require a degree, but instead relies on the lived experience and community expertise of staff in order to achieve behavioral change. EFNEP’s model is based on extensive research around CHWs, which are demonstrated to effectively reach populations that share socio/linguistic characteristics as the workers themselves. In a higher education system however, their lived experience is valued differently than academic degrees, resulting in low morale and poor retention of staff. Turnover among this category of workers across different industries continues to be a trend due to low pay, lack of support in their roles, limited autonomy and feeling undervalued. In order to improve staff retention as well as begin a ladder to promotion, Minnesota Extension created a Lead Paraprofessional role. In addition to improved job satisfaction and increased employee engagement, other outcomes were improved program participation, mentorship opportunities between lead paraprofessionals and less experienced staff, and more dynamic collaboration between paraprofessionals and department leadership that informed program priorities. This position included an increase in pay and responsibilities that fit within EFNEP national policy and provide opportunities for personal and professional growth.

This session will explore Minnesota Extension’s path to creating this new position. Steps included, multiple consultations with Extension and Central Human Resources, writing a new job description, determining job classification, and an appropriate pay structure. Driving this change is Minnesota EFNEP’s commitment to paying dignified and beyond-livable wages, as well as a desire to engage more authentically with paraprofessionals, and create buy-in for programming. Session participants will identify competencies necessary for creating more advanced CHW roles, support and advocacy needed at the supervisor and leadership levels, and best practices navigating organizational systems, structure, and policies.

Women residing in rural areas within the Appalachian region of the United States face a disproportionately higher burden of cancer compared to their counterparts in rural and urban non-Appalachian areas. This burden manifests in elevated cancer incidence rates, later diagnoses of breast cancer, and poorer survivorship outcomes. In response to the Breast and Cervical Cancer Mortality Prevention Act of 1990, the Centers for Disease Control and Prevention (CDC) established the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This program aims to assist individuals with low incomes and inadequate insurance in accessing timely breast and cervical cancer screening, diagnostic, patient navigation, and treatment services.
The Ohio Breast & Cervical Cancer Project (BCCP) initiated the first state-funded effort to enhance enrollment of African American and Appalachian women through Community Health Worker (CHW)-led initiatives in 2022. Supported by the Ohio University Heritage College of Osteopathic Medicine (OUHCOM), the project focuses on a nine-county region in Appalachia Ohio, employing five CHWs. The CHWs developed a three-step approach to augment BCCP enrollment: conducting environmental scans to assess existing resources and recruitment gaps, collaborating with providers and agencies to enhance enrollment, and increasing community awareness of BCCP services and eligibility criteria through participation in local events and programs.
The initiative collaborates closely with key community stakeholders, including agencies serving the target communities (Appalachian, African American, Amish), as well as nontraditional partners such as faith-based organizations, local businesses, and recreational establishments. Since its inception in July 2022, the CHWs have engaged with over 5,000 women, distributed more than 7,800 flyers, participated in 75 community events, and established over 1,000 organizational connections. Consequently, enrollment in BCCP within the nine-county region has seen a steady increase, particularly in areas with CHW support.
This session aims to discuss effective partnership engagement strategies employed by CHWs with healthcare providers, community agencies, and local businesses to address cancer disparities in rural and Appalachian regions. The abstract detailing these efforts has been developed and submitted for presentation by the program's CHWs.

Smoking represents a chronic, addictive, and recurring health concern. In Puerto Rico, a demographic analysis reveals that the typical smoker is male, aged between 35-44, earning less than $15,000 annually, possessing a high school education or less, divorced, unemployed, and lacking medical insurance, with a prevalence rate of 12.6%. Recognizing smoking as the leading preventable cause of death globally, Community Health Workers (CHW) have directed efforts towards addressing this pressing issue.

A CHW led initiative was devised to deliver educational workshops in schools and hospitals across the central region of the archipelago. The primary aim is to raise awareness regarding the adverse effects of tobacco use on both active and passive smokers, acquaint individuals with legislation in Puerto Rico, and promote the Smoking Cessation hotline operated by the Puerto Rico Department of Health. Additionally, the initiative seeks to prevent tobacco and vaping usage.

To date, A total of 16 workshops have been facilitated in community settings, by the same CHW who conceived the initiative, involving approximately 214 individuals collectively. Feedback from participants suggests that these educational sessions have successfully enhanced awareness regarding available services, as well as the risks and harms associated with smoking and exposure to second and third-hand smoke. Furthermore, the workshop was presented by the CHW that developed it to other CHWs and public health workers, enabling them to replicate this intervention in their future work. A total of 219 individuals received this training.

Through the trust of the community and the dedicated efforts of CHWs, significant strides have been made in educating individuals about smoking-related issues. By promoting access to available resources and advocating for prevention strategies, efforts are underway to reduce and prevent the impact of this treatable disease within the community.