Peer Support and Community Health Workers (CHWs) Series:

“People with similar life experience”- A closer look at the unique role of CHWs and its implications for peer support

A recent article by Balcazar and colleagues discussed how community health workers known as CHWs can be a public health force for change in the United States (Balcazar et al., 20011). This article provided 3 action steps from CHWs that can help promote full participation in patient-centered primary care and the promotion of Community Wellness. Check out our previous blog posting highlighting this article. This has prompted a 3 part blog that will take a look at each one of these steps.

The first step is to Advocate for Inclusion of CHW Perspectives by promoting “awareness and appreciation of the uniqueness of CHWs and support their roles in bringing community perspectives and priorities into the process of improving health care systems.” This raises some interesting questions about CHWs including their history, where they work, how they are currently recognized and what unique skills they offer.

A review of the commentary by Balcazar and others helps answer these critical questions. CHWs have been around for more 60 years to increase engagement between community members and the US healthcare system (Balcazar et al., 20011). The federal government first endorsed their use for expanded health access for underserved populations in the 1960’s (Nemcek & Sabatier, 2003). They work in a variety of settings including individual and family services, social advocacy organizations, outpatient care centers, education programs, other ambulatory health care services and physicians’ offices (Brownstein et al., 2011). In 2003 the Institute of Medicine recommended that CHWs serve as members of health care teams, to improve the health of underserved communities (Rosenthal et al. 2011). The US Department of Labor recommended an occupational classification for community health workers in 2009 (Office of Management and Budget, 2008) and they were subsequently included in a provision of the 2010 National Health Reform Law (Rosenthal et al. 2011).

Throughout this time period different terms have been used to describe workers under the umbrella of the term CHW including outreach workers, promotores(as) de salud, community health representatives, and patient navigators (Rosenthal et al. 2010). In a more formal definition the American Public Health Association defined CHWs as “frontline public health workers who are trusted members of and/ or have an unusually close understanding of the community served. This trusting relationship enables CHWs to serve as a liaison. . . between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery” (Balcazar, 2011).

This definition underscores the unique role CHWs have compared to other health workers. As a result of their role in the community CHWs have commonalities of life experience with patients. This allows them to establish a trust and rapport that can elicit honest responses about patient’s symptoms and comprehension of health communications from their providers (Gilkey et al, 2011). Furthermore, this allows CHWs to communicate with other members of the healthcare system to ensure patient’s care is sensitive to cultural factors and community issues. This can impact issues of adherence to medications or healthy lifestyle recommendations (Balzacar et al 2011). CHWs can utilize these strengths through their involvement with community-based primary care services and community based participatory research to strengthen the health system and coordinate with other health professionals, health care administrators, and policymakers (Balzacar et al. 2011).

By looking into the roles and functions of CHWs, what would be the implications for peer support and its strategies? Here are two examples-
Effective peer support fundamentally relies on people with similar experience, who are therefore able to build a trusting relationship with those they serve. So think broadly in terms of identifying characteristics of peer supporters.
It is critical that peer support strategies help strengthen linkages to the resources both in communities and health care system.

We welcome you to share with us your thoughts on CHWs and peer support!

The second blog of this series will move forward with this definition in mind and discuss Balzacar’s second action step, promoting CHW’s integration into the work force.