Department of Psychology, University of Pennsylvania, Philadelphia.
Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Health Forum. 2024 Mar 1;5(3):e240034. doi: 10.1001/jamahealthforum.2024.0034.
Community health worker (CHW) programs may improve health outcomes, increase quality of life, and reduce hospitalizations and cost of care. However, knowledge is limited on the barriers and facilitators associated with scaling evidence-based CHW programs to maximize their public health outcomes.
To identify barriers and facilitators to implementing an evidence-based CHW model.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study examined perspectives of Individualized Management of Person-Centered Targets (IMPaCT) program staff (health system leaders, program managers, and community health workers) and patients receiving the intervention between March 9, 2020, and July 22, 2021, at 5 institutionally and geographically diverse health systems across the US. The collected data were analyzed between December 1, 2021, and April 27, 2022. Program staff were recruited via purposive sampling, and patients were recruited via convenience sampling.
The disease-agnostic IMPaCT CHW model includes a standardized implementation approach and a structured set of theory-informed intervention components to create and achieve individualized action plans.
Interview guides were informed by the Consolidated Framework for Implementation Research. A rapid qualitative analytic technique was used to identify key themes, which were categorized into barriers and facilitators associated with framework ecological domains.
Of a total 41 individuals invited, 39 agreed to participate (95% response rate; mean [SD] age, 45.0 [12.6] years; 30 women). General barriers included economic and policy constraints, including insufficient funding for CHW programs, clinical integration challenges, and CHW difficulty with maintaining boundaries. Program-specific barriers included insufficiently tailored materials for certain populations and upfront and ongoing program costs. General facilitators included CHWs' interpersonal skills and life experiences. Program-specific facilitators included the model's strong evidence base, supportive implementation team, and program design that enabled relationship building and engagement. Additional themes were cited as both barriers and facilitators, including the COVID-19 pandemic, organizational leadership, IMPaCT training, and program fidelity.
These findings suggest growing recognition of the importance of CHWs to improving health equity and population health. Barriers identified point to important policy and practice implications for CHW programs more broadly, including the need for continued attention to improving clinical integration and the need for sustainable program financing to preserve the longevity of this workforce.
社区卫生工作者（CHW）计划可以改善健康结果，提高生活质量，减少住院和医疗费用。然而，对于与扩大循证 CHW 计划相关的障碍和促进因素的了解有限，这些计划旨在最大限度地发挥其公共卫生效果。
确定实施循证 CHW 模式的障碍和促进因素。
设计、地点和参与者：这项定性研究调查了个体化管理以实现以人为中心的目标（IMPaCT）计划工作人员（卫生系统领导者、项目经理和社区卫生工作者）和接受该干预措施的患者的观点，这些患者是在 2020 年 3 月 9 日至 2021 年 7 月 22 日期间在美国 5 个机构和地理位置不同的卫生系统中招募的。收集的数据在 2021 年 12 月 1 日至 2022 年 4 月 27 日之间进行了分析。计划工作人员通过有针对性的抽样招募，患者通过方便抽样招募。
该无病 IMPaCT CHW 模式包括一种标准化的实施方法和一套结构化的、基于理论的干预组件，以制定和实现个体化行动计划。
访谈指南以实施研究综合框架为依据。采用快速定性分析技术来确定关键主题，这些主题被归类为与框架生态领域相关的障碍和促进因素。
在总共邀请的 41 个人中，有 39 人同意参与（95%的响应率；平均[SD]年龄 45.0[12.6]岁；30 名女性）。一般障碍包括经济和政策限制，包括 CHW 计划资金不足、临床整合挑战以及 CHW 维持边界的困难。特定于计划的障碍包括为某些人群提供的材料不够定制化以及计划的前期和持续成本。一般促进因素包括 CHW 的人际交往能力和生活经验。特定于计划的促进因素包括该模型强大的证据基础、支持性的实施团队以及能够建立关系和参与的计划设计。还引用了其他主题作为障碍和促进因素，包括 COVID-19 大流行、组织领导力、IMPaCT 培训和计划保真度。
这些发现表明，人们越来越认识到 CHW 在改善健康公平和人口健康方面的重要性。确定的障碍指出了 CHW 计划更广泛的重要政策和实践意义，包括需要继续关注改善临床整合以及需要可持续的计划资金来维持这一劳动力的长期存在。
