NADIA ISLAM, PHD SECTION FOR HEALTH EQUITY, DEPARTMENT OF POPULATION HEALTH NYU SCHOOL OF MEDICINE Community Health Worker Models in Asian American Communities

Asian Americans: The fastest growing minority AA population is projected to be 43.2 million in 2050 – or 10% of the entire U.S. population

WHO ARE CHWs ? CHWs are frontline public health professionals who have an unusually close understanding of the communities they serve through shared ethnicity, culture, language, and life experiences. Also referred to as … Promotor-es/-as Outreach Workers Community Health Representatives Patient Navigators/

Why CHWs?  Studies have demonstrated that CHW approaches improve:  Improve health outcomes across a range of conditions (Islam et al 2014; Ursua et al 2013; Tang et al 2014)  Reduce hospital re-admissions (Kangovi et al 2010)  Improve health promoting behaviors (Islam et al 2013)  Culturally and linguistically tailored approach that promotes community-clinical linkages and enhances community capacity

CHW

Testing the Efficacy of Community Health Workers to Improve Health Outcomes RCT to improve hypertension control among Filipino community members with uncontrolled hypertension Reduction in both systolic and diastolic blood pressure over a period of 8 months (P<.05) in treatment group Individuals receiving CHW services achieved more than twice the level of BP control as those receiving usual care RCT to improve diabetes management and physical activity among Bangladeshi community members with uncontrolled diabetes Significant reductions in mean weight & BMI (p<.0.05) in treatment group compared to control Significant increase in the proportion of individuals that achieved blood pressure control in treatment group compared to control Quasi-experimental trial to promote weight loss and improvements in health behaviors among South Asians at-risk for diabetes Significant reductions in mean weight, BMI, glucose, BP (p<0.01) in treatment group 25% of treatment group participants lost >5% weight compared to 15% in control group (P<.07)

CHW Levels of Intervention Policy Systems Community Individual

Individual-Level  Culturally tailored health education  Linguistically tailored access to care and patient navigation  Culturally tailored health promotion strategies  Empowerment & enhancing self-efficacy  Providing linkages to housing, immigration, and other services

Community level  Promoting positive health contexts  Increasing access to affordable physical fitness opportunities  Environmental changes in faith- based organizations, ethnic grocery stores, and restaurants  Building organizational capacity

Systems & Policy Level  Promoting cultural competency within healthcare systems  Advocating for responsive healthcare system & data disaggregation