Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
Department of Urology, Yale School of Medicine, New Haven, CT, USA.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720953673. doi: 10.1177/2150132720953673.
Community health workers (CHWs) are a critical part of the healthcare workforce and valuable members of healthcare teams. However, little is known about successful strategies for sustaining CHW programs. The aim of this study is to identify institutional and community factors that may contribute to the sustainability of CHW programs to improve maternal health outcomes.
We conducted focus groups and in-depth interviews with 54 CHWs, CHW program staff, and community partners involved in implementing three Merck for Mothers-funded CHW programs in the United States serving reproductive-age women with chronic health conditions. Additionally, a review of documents submitted by CHW programs during the evaluation process provided context for our findings. Data were analyzed using an inductive qualitative approach.
Three themes emerged in our analysis of factors that may influence the sustainability of CHW programs to improve maternal health: CHW support from supervisors, providers, and peers; relationships with healthcare systems and insurers; and securing adequate, continuous funding. Key findings include the need for CHWs to have strong supervisory structures, participate in regular care team meetings, and interact with peers; advantages of CHWs having access to electronic health records; and importance of full-cost accounting and developing a broad base of financial support for CHW programs.
Research should continue to identify best practices for implementation of such programs, particularly regarding effective supervisory support structures, integration of programs with healthcare systems, and long-term revenue streams.
社区卫生工作者（CHW）是医疗保健工作队伍的重要组成部分，也是医疗团队中有价值的成员。然而，对于维持 CHW 计划的成功策略知之甚少。本研究旨在确定可能有助于 CHW 计划可持续性以改善母婴健康结果的机构和社区因素。
我们对参与实施美国三项默克为母亲资助的 CHW 计划的 54 名 CHW、CHW 项目工作人员和社区合作伙伴进行了焦点小组和深入访谈，这些计划为患有慢性健康状况的育龄妇女提供服务。此外，我们对 CHW 项目在评估过程中提交的文件进行了审查，为我们的发现提供了背景。使用归纳定性方法对数据进行分析。
我们对可能影响 CHW 计划可持续性以改善母婴健康的因素进行分析后得出三个主题：主管、提供者和同行对 CHW 的支持；与医疗保健系统和保险公司的关系；以及确保充足、持续的资金。主要发现包括 CHW 需要有强大的监督结构、定期参加护理团队会议以及与同行互动；CHW 能够访问电子健康记录的优势；以及全面成本核算和为 CHW 计划开发广泛的财政支持基础的重要性。
应继续研究此类计划实施的最佳实践，特别是关于有效监督支持结构、计划与医疗保健系统的整合以及长期收入来源。
