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Community health workers in Canada and other high-income countries: A scoping review and research gaps

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Abstract

Objectives

Community health workers (CHWs) have been deployed to provide health-related services to their fellow community members and to guide them through often complex health systems. They help address concerns about how marginalized populations in many countries experience health inequities that are due, in part, to lack of appropriate primary health care services, possibly resulting in inappropriate use of higher-cost health services or facilities. This paper reviews studies on CHW interventions in a number of high-income countries, including Canada, to identify research gaps on CHW roles.

Methods

A scoping review using 68 sources of interventions involving CHWs was undertaken. The five-step Arksey and O’Malley model guided this review with the aim of summarizing research findings and identifying research gaps in the existing literature on CHWs in Canada (23 sources). A standardized extraction tool was employed to synthesize the literature.

Synthesis

We found that CHWs provide a wide range of health-related services but in a manner that, in Canada, is unrecognized and unregulated. In high-income countries, CHW interventions have contributed to health-related issues in communities and demonstrated potential to both reduce health inequity in marginalized populations and reduce the cost of medical services.

Conclusion

CHWs are an under-recognized, and therefore underutilized, public health workforce, which has a promising capacity to reduce health inequities in marginalized populations in Canada. There is growing support to suggest that CHW roles need to be better integrated within the broader health and social services systems to enable their full potential to be realized.

Résumé

Objectifs

On déploie des travailleurs en santé communautaire (TSC) pour qu’ils offrent des services liés à la santé à leurs concitoyens et qu’ils les guident à travers les systèmes de santé souvent complexes. En effet, les populations marginalisées de nombreux pays sont victimes d’iniquités face à la santé, en partie à cause du manque de services de santé primaire adaptés, ce qui peut entraîner l’utilisation inappropriée des services ou des installations de santé plus chers. Notre article examine les études des interventions des TSC dans certains pays à revenu élevé, dont le Canada, afin de cerner les lacunes dans la recherche sur le rôle des TSC.

Méthode

Nous avons mené une étude de champ à l’aide de 68 sources d’interventions impliquant des TSC. Le modèle en cinq étapes d’Arksey et O’Malley a orienté cette étude dans le but de résumer les résultats de recherche et de cerner les lacunes dans la documentation existante sur les TSC au Canada (23 sources). Un outil d’extraction standardisé a servi à résumer la documentation.

Synthèse

Nous avons constaté que les TSC offrent un vaste éventail de services liés à la santé, mais d’une manière qui, au Canada, n’est ni reconnue, ni réglementée. Dans les pays à revenu élevé, les interventions des TSC jouent un rôle dans les dossiers de santé à l’échelle communautaire et ont le potentiel de réduire à la fois les iniquités face à la santé au sein des populations marginalisées et les coûts des services médicaux.

Conclusion

Les TSC sont une main-d’œuvre mal reconnue (et donc sous-utilisée) en santé publique, mais ils présentent la capacité prometteuse de réduire les iniquités face à la santé au sein des populations marginalisées au Canada. On appuie de plus en plus l’idée que le rôle des TSC devrait être mieux intégré dans les systèmes de la santé et des services sociaux en général pour que ces travailleurs puissent donner leur pleine mesure.

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Authors and Affiliations

  1. Institute of Population Health, University of Ottawa, 1 Stewart, Room 230, ON, K1 N 6N6, Ottawa, Canada

    Said Ahmad Maisam Najafizada MD (PhD Candidate) & Corinne Packer PhD

  2. Telfer School of Management and Institute of Population Health, University of Ottawa, ON, Ottawa, Canada

    Ivy Lynn Bourgeault PhD

  3. Faculty of Medicine and Institute of Population Health, University of Ottawa, ON, Ottawa, Canada

    Ronald Labonte PhD

  4. Institut de recherche en santé publique, de l’Université de Montréal, QC, Montréal, Canada

    Sara Torres PhD

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  1. Said Ahmad Maisam Najafizada MD
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Correspondence to Said Ahmad Maisam Najafizada MD.

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Najafizada, S.A.M., Bourgeault, I.L., Labonte, R. et al. Community health workers in Canada and other high-income countries: A scoping review and research gaps. Can J Public Health 106, e157–e164 (2015). https://doi.org/10.17269/CJPH.106.4747

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