C OMMUNITY H EALTH W ORKERS : A SCOPING REVIEW OF HIC S Maisam Najafizada, Ivy Bourgeault, Ronald Labont é, Sara Torres, Corinne Packer Institute of Population Health University of Ottawa

The marginalized vs the health system

The problem Health inequities among marginalized populations (Immigrants, aboriginals, and low-income and homeless populations) Meaning – Inappropriate utilization of health care services A lack of access to or underutilization of primary health care services An overutilization of emergency departments, and professional services

The grassroots solution Individuals with good knowledge of communities (mostly one of their members) who has good knowledge of the health system – Health Navigators – Promotoras (Spanish Population) – Community Health Representatives (Aboriginals) – Peer Health Educator – Health Trainers (UK)

The question What do we know about CHWs in Canada? What is there to know about CHWs in countries like Canada i.e. the United States, the UK, Europe, Australia? Comparing the two, where is the research gap in Canada?

Arksey and O’Malley Method of Scooping review: -Identifying research question -Identifying relevant studies -Study selection -Charting data -Collating, summarizing and reporting the results How is the study conducted?

Flowchart of articles included in the study Electronic Database Search (n=409 articles) Gross number of articles in each source Medline (n= 121) Embase (n= 126) CINAHL 9 (n=142) Grey Literature (n=20) Abstract review (n=409) Articles excluded based on abstract review (n=294) Reason for exclusion: Did not have CHWs as the main focus Full screening (n=115) Articles excluded based on full screening (n=58) Reason for exclusion: Does not focus on health promotion, disease prevention, social determinants of health Data extraction (n=64)

Who are they & what do they do? A frontline public health worker Trusted member of and/or has an unusually close understanding of the community served. Serves as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. Builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counselling, social support, and advocacy.

Typology of CHWs in Canada Community Health Representatives: Aboriginal population Community Facilitator and Community Support Workers: CancerCare Manitoba: Women Health Educators (WHEs): Hamilton Community Health Brokers: Hamilton, Niagara, Brant, and Haldimand Norfolk Multicultural Health Brokers: Edmonton, Alberta; Sommerset West Community Center, Ottawa. Cross Cultural Health Brokers: British Columbia Peer Leader (lay health educator): Toronto

Recruitment Types of recruitment – Recruited by community organizations – Recruited by public health system in small projects – Recruited by communities (Rarely) Criteria – Community origin – Knowledge of the community

Education & Training Type of training – On-the-job training – Health organization training – Educational institution training – No training Content of training – Health promotion and disease prevention – Access to health system – Community development-related training – Disease-specific training – Administrative and research related

Accreditation & Recognition Internationally – CHW as a standard job classification in US in 2010 – Minnesota and Massachusetts have integrated CHWs in their health system – Health Trainer in the national health services of the UK Canada – Unregulated and unrecognized in Canada CHW as a career Sustainability of CHW programs Integration of CHW programs into the health system

Compensation Type of payment – Paid low wages – Not paid for the amount of time actually works – Employed/paid at intervals – when projects have funding Factors in payment – Training – Accreditation – Funding

Discussion What’s known – CHWs are a reality under various titles – Takes a holistic approach – a) Positive health impact b) reduce health disparity, c) potential to control/reduce high costs of medical/hospital services – A component of patient- centered health systems What’s not known in Canada – No complete picture – No evidence on Their cost-effectiveness Interaction with other sectors Enablers and barriers to these roles – Identification and recommendation for policy and program change

Conclusion CHWs are a grassroots reality in Canada, Who needs to be identified and researched nationally, Who needs to be recognized by the governments, Who needs to be regulated within the health care system

Questions and comments