8:45am - 9:00am (CDT) | 5013.0 - A community health worker (CHW) intervention to address social determinants of health (SDoH) through community-clinical linkages: A mixed methods evaluation.

Session: Programs/Services Addressing Determinants of Health

Program: Community Health Workers

Authors:

Katherine LaMonaca, MPH

Kathleen O'Connor Duffany, PhD, MEd

Abstract

Community health workers (CHWs) are increasingly being incorporated into the healthcare workforce to support individuals from underserved groups with access to health and social services. CHW-supported programs have the potential to address social determinants of health (SDoH) and advance health equity; however, rigorous evaluation is needed to assess impact, understand client experiences, and inform best practices.

Our community-academic partnership implemented a CHW program in New Haven, Connecticut. Individuals with unmet SDoH needs were identified via food pantry outreach and healthcare provider referrals, then offered tailored support and referrals to resources. We conducted a mixed-methods evaluation to assess program impact and facilitators/barriers to patient engagement. We used quantitative process tracking data to measure resource connections and SDoH need status, and qualitative in-depth interviews to understand client experiences. Data were analyzed using descriptive statistics (quantitative) and deductive coding with two independent coders (qualitative).

From 2018-2023, we enrolled 294 individuals. A full-time CHW served an average caseload of 40 clients. Clients were enrolled for six months with the option of renewal (mean enrollment=229 days). Clients predominantly identified as female (63%) and Hispanic/Latino (64%). Most had a non-English primary language (61%) and lacked healthcare coverage (61%). Clients had an average of two identified SDoH needs, most commonly food insecurity (85%), housing insecurity (37%), transportation (26%), and utilities (21%). The CHW made 923 referrals to community-based resources. Top referral categories were food assistance (44% of referrals), affordable housing (11%), utility payments (11%), clinical referrals (8%), and transportation (7%). Most clients were successfully connected to ≥1 resource (72%) and had ≥1 need met (78%). Food needs were nearly twice as likely to be met than other common needs.

Following program discharge, interviews were conducted with 20 clients (50% had all identified SDoH needs met; 50% had ≥1 unmet SDoH need). Interviewees identified several facilitators to meeting their SDoH needs, including having a positive, trusting relationship with the CHW and having the CHW’s support accessing resources. Barriers to meeting their SDoH needs included ineligibility for referred services, resource limitations (e.g., lack of affordable housing), stigma, and other external factors (e.g., time, cost, transportation). Clients had largely positive experiences, were highly satisfied with the CHW’s services, and reported improved health and increased self-efficacy accessing resources. Recommendations for future programming included longer enrollments and more intensive support (e.g., CHW accompaniment to appointments).

CHWs can serve as effective and trusted liaisons between community members, healthcare providers, and social service agencies.