Emory University School of Public Health, Atlanta, Georgia (Ms Allen); Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Barbero and Ms Moeti; and IHRC, Inc, Atlanta, Georgia (Ms Shantharam).
J Public Health Manag Pract. 2019 Nov/Dec;25(6):571-580. doi: 10.1097/PHH.0000000000000846.
Community health workers (CHWs) are becoming a well-recognized workforce to help reduce health disparities and improve health equity. Although evidence demonstrates the value of engaging CHWs in health care teams, there is a need to describe best practices for integrating CHWs into US health care settings. The use of existing health promotion and implementation theories could guide the research and implementation of health interventions conducted by CHWs. We conducted a standard 5-step scoping review plus stakeholder engagement to provide insight into this topic. Using PubMed, EMBASE, and Web of Science, we identified CHW intervention studies in health care settings published between 2000 and 2017. Studies were abstracted by 2 researchers for characteristics and reported use of theory. Our final review included 50 articles published between January 2000 and April 2017. Few studies used implementation theories to understand the facilitators and barriers to CHW integration. Those studies that incorporated implementation theories used RE-AIM, intervention mapping, cultural tailoring, PRECEDE-PROCEED, and the diffusion of innovation. Although most studies did not report using implementation theories, some constructs of implementation such as fidelity or perceived benefits were assessed. In addition, studies that reported intervention development often cited specific theories, such as the transtheoretical or health belief model, that helped facilitate the development of their program. Our results are consistent with other literature describing poor uptake and use of implementation theory. Further translation of implementation theories for CHW integration is recommended.
社区卫生工作者(CHWs)正在成为一种公认的劳动力,以帮助减少健康差距并提高健康公平性。尽管有证据表明让 CHWs 参与医疗保健团队具有价值,但仍需要描述将 CHWs 纳入美国医疗保健环境的最佳实践。使用现有的健康促进和实施理论可以指导 CHWs 进行的健康干预措施的研究和实施。我们进行了标准的 5 步范围审查加利益相关者参与,以深入了解这一主题。我们使用 PubMed、EMBASE 和 Web of Science ,确定了 2000 年至 2017 年间在医疗保健环境中发表的 CHW 干预研究。两名研究人员对这些研究的特征和报告的理论使用情况进行了摘要。我们的最终综述包括 2000 年 1 月至 2017 年 4 月期间发表的 50 篇文章。很少有研究使用实施理论来了解 CHW 整合的促进因素和障碍。那些纳入实施理论的研究使用了 RE-AIM、干预映射、文化定制、PRECEDE-PROCEED 和创新传播。尽管大多数研究没有报告使用实施理论,但也评估了实施的某些结构,例如保真度或感知收益。此外,报告干预措施发展的研究经常引用特定的理论,例如跨理论或健康信念模型,这些理论有助于促进其计划的发展。我们的结果与其他描述实施理论不良应用和使用的文献一致。建议进一步翻译 CHW 整合的实施理论。