Background
Methods
Research design
Literature search
Inclusion and exclusion criteria
Study selection and data extraction
Risk of Bias
Results
Review of literature
Quality of studies
Characteristics of included studies
Study Design | Objective | Target Population/Eligibility Requirements | Intervention; Delivery Method | Outcomes Measured | Follow- Up | Comparison Group Treatment | Results | |
---|---|---|---|---|---|---|---|---|
Lopez 2017 (n = 370) | Non-randomized controlled quasi-experiment | To assess feasibility and effectiveness of CHW and health advocate initiative in public housing residents with high chronic disease burden | Low income, adults with either asthma (37.7%), hypertension, or diabetes recruited from 5 East Harlem public housing developments | 6 or more CHW visits as well as referrals to health advocates as needed; CHW and community based health advocate | BP, BMI, self reported physical activity, mental health status, self-efficacy, QOL, healthcare access, disease management | 3 months | Health advocate support alone | Improvement in self-reported physical activity (p = 0.005), change in insurance (11% vs 4%; p = 0.009), and change in primary doctor (14% vs 6%; p = 0.024); no between group difference in asthma self efficacy or general mental health |
Krieger 2014 (n = 366) | Randomized controlled trial | To assess whether CHW in home self-management support reduces asthma morbidity | Low-income adults with poorly controlled asthma primarily recruited from public health, community, and hospital-based clinics | 5 CHW home visits and as needed support via telephone, e-mail, or additional home visits, environmental trigger assessment and intervention; CHW | Asthma symptom free days, asthma related QOL, asthma-related unscheduled health care use; night symptoms, asthma exacerbations, medication use, pulmonary function, medication use, absenteeism, general health status | 12 months | Usual care plus community resource information and educational pamphlets | Increase in mean symptom free days per 2 weeks (2.02 d)(p < 0.001) and increase in asthma-related QOL (mean 0.50 points)(p < 0.001), fewer asthma attacks & night symptoms, improved asthma control and health status in intervention group; both had decreased urgent care use (1.3–1.5 fewer episodes)a; no change in PFT or absenteeism between groups |
Martin 2006 (n = 47) | Cross sectional and longitudinal analysis | To assess whether CHW home visits enabled changes in home asthma triggers | Inner-city, low-income, Latino adults with asthma recruited from community center | Initial visit for intervention followed by 3 home visits for data collection; CHW | ED and urgent care utilization, hospitalizations, asthma severity, albuterol use, home asthma triggers | 3, 6, and 12 months | NA | Decrease in home trigger score by 0.41(p < 0.01) with each home visit; no change in ED visit, urgent care visit, hospitalization at 3,6,12 m follow up; no change in daily albuterol use or asthma severity; improvement in individual home asthma triggers (chlorine, aerosols, use of air filter) at 12 m follow up |
Martin 2009 (n = 42) | Randomized pilot controlled trial | To assess whether CHW intervention improves asthma self-efficacy, clinical outcomes, and self-management behaviors | Low-income African American adults with asthma recruited from clinic | 4 group sessions led by a social worker at primary care clinics and 6 CHW in-home visits; CHW and social workers | Asthma self efficacy, asthma QOL, coping skills, self management behavior, use of steroids, symptoms | 3 and 6 months | Asthma education materials alone | Higher asthma self-efficacy at 3 months, improved asthma-related QOL and coping at 6 months; no change in use of inhaled steroids, number of symptomatic nights and days, use of a spacer, and asthma knowledge at 3 and 6 months |
Study design
Community health worker recruitment and training
Intervention description
Lopez 2017 | Krieger 2014 | Martin 2006 | Martin 2009 | ||
---|---|---|---|---|---|
Role of CHW | Goal Setting | X | X | X | |
Disease Management | X | X | X | X | |
Motivation | X | X | |||
Logistics | X | ||||
Education | X | X | X | X | |
Environment Assessment | X | X | X | ||
Medication Assistance | X | X | X | ||
Spirometry measurement | X | ||||
Direct communication of CHW with providers | X | ||||
Community Resource Referrals | X | X | X | X | |
Health insurance assistance | X | X | X | ||
Transportation Assistance | |||||
Additional telephone or email communication with CHW | X |