TY - JOUR
T1 - Evaluating a community-placed and clinically integrated community health worker program
T2 - A realist approach
AU - Njeru, Jane W.
AU - Ridgeway, Jennifer L.
AU - Asiedu, Gladys B.
AU - Radecki Breitkopf, Carmen
AU - Gunderson, Jean M.
AU - Quirindongo-Cedenõ, Onelis
AU - O'Brien, Michael W.
AU - Nelson, Tara M.
AU - Buzard, Ron
AU - Wieland, Mark L.
N1 - Funding Information:
This research was made possible in part by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The funders had no role in the data collection, interpretation, or reporting.
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Community health worker (CHW) programs can act as bridges between patients and health care teams, but the complexity and variability of program components and outcomes make them difficult to evaluate. This evaluation used a realist approach to identify underlying mechanisms and contextual factors associated with successful implementation of a community-placed CHW program affiliated with a primary care practice in the Midwest United States. The analysis identified mechanisms by which stakeholders built trust, self-efficacy, and empowerment to improve patient-centered outcomes and experiences. It also identified conditions that support activation of these mechanisms, including the ability of CHWs to make home visits, effective communication between members of the care team across settings, and clarity about the role of the CHW relative to other support services for patients. This type of context-mechanism-outcome evaluation facilitated development of recommendations responsive to local context.
AB - Community health worker (CHW) programs can act as bridges between patients and health care teams, but the complexity and variability of program components and outcomes make them difficult to evaluate. This evaluation used a realist approach to identify underlying mechanisms and contextual factors associated with successful implementation of a community-placed CHW program affiliated with a primary care practice in the Midwest United States. The analysis identified mechanisms by which stakeholders built trust, self-efficacy, and empowerment to improve patient-centered outcomes and experiences. It also identified conditions that support activation of these mechanisms, including the ability of CHWs to make home visits, effective communication between members of the care team across settings, and clarity about the role of the CHW relative to other support services for patients. This type of context-mechanism-outcome evaluation facilitated development of recommendations responsive to local context.
KW - community-based interventions
KW - patient-centered care
KW - program evaluation
KW - qualitative research
KW - realist evaluation
UR - http://www.scopus.com/inward/record.url?scp=85062688958&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062688958&partnerID=8YFLogxK
U2 - 10.1097/JAC.0000000000000268
DO - 10.1097/JAC.0000000000000268
M3 - Article
C2 - 30768430
AN - SCOPUS:85062688958
SN - 0148-9917
VL - 42
SP - 116
EP - 127
JO - Journal of Ambulatory Care Management
JF - Journal of Ambulatory Care Management
IS - 2
ER -