Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting

Savanna L Carson; Clemens Hong; Heidi Behforouz; Emily Chang; Lydia Z Dixon; Diane Factor; Sheba M George; Jenebah Lewis; Angelina Majeno; Maria Morales; Courtney Porter; Ami Shah; Stefanie D Vassar; Arleen F Brown

doi:10.1097/JAC.0000000000000405

Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting

J Ambul Care Manage. 2022 Jan-Mar;45(1):22-35. doi: 10.1097/JAC.0000000000000405.

Authors

Savanna L Carson¹, Clemens Hong, Heidi Behforouz, Emily Chang, Lydia Z Dixon, Diane Factor, Sheba M George, Jenebah Lewis, Angelina Majeno, Maria Morales, Courtney Porter, Ami Shah, Stefanie D Vassar, Arleen F Brown

Affiliation

¹ Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles (Drs Carson, Chang, and Brown and Mss Morales, Porter, and Vassar); Los Angeles County, Department of Health Services, Los Angeles, California (Drs Hong and Behforouz and Ms Shah); Health Science Program, California State University Channel Islands, Camarillo, California (Dr Dixon); Worker Education & Resource Center, Inc, Los Angeles, California (Mss Factor and Porter); Department of Urban Public Health, Charles R Drew University of Medicine and Science, College of Science and Health, Los Angeles, California (Dr George); USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California (Ms Lewis); Department of Psychological Science, University of California Irvine, Irvine, California (Ms Majeno); and Olive View-UCLA Medical Center, Sylmar, California (Ms Vassar and Dr Brown).

Abstract

Medically and socially complex patients disproportionately face barriers to primary care, contributing to health inequities and higher health care costs. This study elicited perspectives on how community health workers (CHWs) act upon barriers to primary care in 5 patient (n = 25) and 3 CHW focus groups (n = 17). Participants described how CHWs acted on patient-level barriers through social support, empowerment, and linkages, and system-level barriers by enhancing care team awareness of patient circumstances, optimizing communication, and advocating for equitable treatment. Limitations existed for influencing entrenched community-level barriers. CHWs, focusing on patient preferences, motivators, and circumstances, intervened on multilevel barriers to primary care, including advocacy for equitable treatment. These mechanisms have implications for existing CHW conceptual models.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Community Health Workers*
Focus Groups
Humans
Primary Health Care*
Qualitative Research

Grants and funding

UL1 TR001881/TR/NCATS NIH HHS/United States