Damian April Joy, Robinson Sarafina, Manzoor Faaiza, Lamb Mandy, Rojas Adriana, Porto Ariel, Anderson Daren
Weitzman Institute, 19 Grand Street, Middletown, CT 06457 USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Pilot Feasibility Stud. 2020 Sep 18;6:132. doi: 10.1186/s40814-020-00678-y. eCollection 2020.
Despite the positive effects of community health workers (CHWs) on addressing social determinants of health, improving patient health outcomes, and decreasing overall healthcare costs, there is a lack of standardization in training and certifying this workforce, resulting in different approaches to integrating this role into medical home models. The purpose of the current study is to evaluate the application of Project ECHO (Extension for Community Healthcare Outcomes) in enhancing CHWs' capacity to address health and social issues of vulnerable populations.
An explanatory sequential mixed methods design was applied in which all participants ( = 49) completed pre (January 2019) and post (July 2019) quantitative online surveys measuring changes in self-efficacy, behavior change intent, and knowledge. Virtual focus groups were conducted with a subset of participants ( = 20) in July 2019 to assess the feasibility, acceptability, and impact of Project ECHO.
There was a statistically significant difference of + 0.453 in the composite self-efficacy mean score pre- to post-series. For every 1 additional Project ECHO CHW session attended, there was a .05 improvement in participants' self-efficacy to perform CHW-related job duties and address social determinants of health (SDOH). Four major themes emerged from the qualitative focus group data: value in learning from other participants' caseloads, CHW-care team integration, availability of training and resources, and shared decision-making with patients.
This evaluation suggests that ECHO is a viable means of increasing access to training resources for CHWs. Future studies on the ECHO model as a means of educating and broadening implementation of CHWs are warranted. Programs such as Project ECHO can support CHWs by providing continuing education opportunities, as well as standardizing training content across large geographic areas.
尽管社区卫生工作者（CHWs）在解决健康的社会决定因素、改善患者健康结局以及降低总体医疗成本方面具有积极作用，但在培训和认证这支队伍方面缺乏标准化，导致将该角色融入医疗之家模式的方法各不相同。本研究的目的是评估社区医疗成果推广项目（ECHO）在增强社区卫生工作者应对弱势群体健康和社会问题能力方面的应用。
采用解释性序列混合方法设计，所有参与者（n = 49）完成了2019年1月（前期）和2019年7月（后期）的定量在线调查，测量自我效能、行为改变意向和知识的变化。2019年7月对一部分参与者（n = 20）进行了虚拟焦点小组访谈，以评估ECHO项目的可行性、可接受性和影响。
系列前后综合自我效能平均得分有统计学意义的差异，增加了0.453。每多参加一次ECHO社区卫生工作者培训课程，参与者履行社区卫生工作者相关工作职责和解决健康的社会决定因素（SDOH）的自我效能就提高0.05。定性焦点小组数据中出现了四个主要主题：从其他参与者的病例中学习的价值、社区卫生工作者 - 护理团队整合、培训和资源的可用性以及与患者共同决策。
该评估表明，ECHO是增加社区卫生工作者获得培训资源机会的可行手段。有必要对ECHO模式作为教育和扩大社区卫生工作者实施范围的手段进行进一步研究。像ECHO项目这样的计划可以通过提供继续教育机会以及在大地理区域内标准化培训内容来支持社区卫生工作者。
