Strengthening the Infrastructure to Support Community Health Workers of Arizona

Arizona CHW and CHW Employer Survey Results

The Arizona Community Health Worker Workforce Coalition is a network of organizations collaborating with the Arizona Community Health Worker Outreach Network (AzCHOW) to support the sustainability of the Arizona CHW workforce. The Coalition is comprised of CHWs, including Promotores de Salud, Community Health Representatives, Community Health Advisors and other related titles, and the University of Arizona, State, Local, Tribal Health Departments, Community Health Centers, and Area Health Education Centers.

RATIONALE:In light of today’s changing health care world we believe now is our opportunity to identify the road map to support this vital workforce in Arizona. This survey is our first step to paint a picture of Arizona’s CHW workforce and build consensus on the definition of CHWs and their scope of practice from the perspective of CHWs and their employers. The survey was comprised of three sections, including (1) enumeration and description of the CHW Workforce, (2) CHW definition, (3) CHW Scope of Practice.

METHODS: This anonymous, on-line survey was adapted from the CHW-centered CHW workforce sustainability survey conducted by the New York CHW Network. The survey was distributed through CHW, Promotora and CHR networks, list serves, and personal contacts of members of the CHW Workforce Coalition from April 1, 2013 through May 18, 2013. UA researchers in collaboration with AzCHOW board members developed the survey. AzCHOW board members who are bilingual Spanish English conducted translation of the survey. Survey results will be presented to the Annual AzCHOW Meeting on June 21, 2013 and posted on the AzCHOW website.

RESULTS

SURVEY PARTICIPANTS

159 total responses

47 CHW Employer, Supervisor or Organization

111 Community Health Workers

  • All counties represented
  • Agency Type:
  • 28% Federally Qualified Community Health Center
  • 25% Health Department
  • 25% Not for Profit/Community based Agency
  • 7% Other/Unknown
  • 6% Hospital
  • 5% Tribe
  • 4% University

CHW JOB TITLES

Community Health Worker, Promotora, Community Health Representative, Community Lay Worker, Care Coordinator, Case Manager, Community Health Advisor, Health Educator, Instructional Specialist, Lay Health Worker, Outreach Program Manager, Outreach Promtotora, Patient Navigator, Peer Support Specialist, Promotora de Salud, Educadora de Salud, Public Health Aide, Public Health Specialist, Teen Health Educator, Trainer, Tribal Liaison, Well-being Promoter.

APHA CHW DEFINITION

A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve 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. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.

SCOPE OF PRACTICE

Scope of Practice Considered Not Important
CHW / EMPLOYER
17% Screening (blood glucose, blood pressure etc.)
17 % Electronic Medical Records
10% Eligibility and enrollment (AHCCS, health plans etc.)
8% Medial interpretations and filling out medical forms
8% Ability to lead group discussion or support groups / 34% Screening (blood glucose, blood pressure) 21% Medial interpretations and filling out medical forms
21% Electronic Medical Records
19% Participation in Research Projects
13% Bilingual
Scope of Practice Considered Very Important
CHW / EMPLOYER
95% Ability to Establish Trust
93% Listening
87% Advocacy (Individual or community)
82% Outreach and Enrollment
81% Provide social support for clients / 100% Listening
98% Ability to Establish Trust
87% Outreach and Enrollment
85% Information Sharing
83% Advocacy (Individual or community)

Statistically Significant Differences Between CHW and Employer Responses

  • Medial interpretations and filling out medical forms
  • Participation in Research Projects
  • Screening (blood glucose, blood pressure etc.)
  • Electronic Medical Records
  • Interacting with physicians/health care system
  • Provide social support for clients

Table 1. CHW and CHW Employer Perspectives on CHW Scope of Practice
Not Important / Important / Very Important
Scope of Practice ( %) / Employer / CHW / Employer / CHW / Employer / CHW / P- Value
Ability to Establish Trust / 0 / 0 / 2 / 5 / 98 / 95 / 0.675
Bilingual / 13 / 7 / 32 / 37 / 55 / 56 / 0,543
Multi-cultural competency / 0 / 1 / 21 / 25 / 79 / 74 / 0.779
Provide social support for clients / 2 / 1 / 36 / 18 / 62 / 81 / 0.018
Advocacy ( Individual or community) / 2 / 0 / 14 / 13 / 83 / 87 / 0.312
Community Organizing / 3 / 5 / 16 / 26 / 60 / 69 / 0.486
Outreach and Enrollment / 0 / 2 / 13 / 19 / 87 / 82 / 0.532
Information Sharing / 0 / 1 / 15 / 19 / 85 / 80 / 0.755
Listening / 0 / 0 / 0 / 7 / 100 / 93 / 0.106
Setting goals and making plans with clients / 1 / 0 / 23 / 22 / 74 / 76 / 0.398
Informal Counseling / 11 / 4 / 40 / 37 / 49 / 60 / 0.160
Ability to lead group discussion or support groups / 7 / 8 / 39 / 23 / 54 / 69 / 0.110
Facilitating workshops or group activity / 4 / 5 / 44 / 25 / 51 / 69 / 0.048
Case management and referrals including insurance / 4 / 2 / 36 / 27 / 59 / 71 / 0.262
Medial interpretations and filling out medical forms / 21 / 8 / 60 / 37 / 19 / 55 / 0.000
Interacting with physicians/health care system / 4 / 5 / 42 / 31 / 22 / 64 / 0.018
Screening ( blood glucose, blood pressure etc. ) / 34 / 17 / 32 / 25 / 34 / 58 / 0.013
Eligibility and enrollment ( AHCCS, health plans etc.) / 11 / 10 / 33 / 29 / 57 / 61 / 0.752
Health education skills / 2 / 0 / 15 / 21 / 83 / 79 / 0.233
Role-playing and modeling health behaviors / 0 / 1 / 32 / 29 / 68 / 70 / 0.895
Adult learning techniques / 0 / 0 / 33 / 29 / 67 / 71 / 0.704
Chronic disease knowledge and management / 2 / 3 / 34 / 26 / 64 / 71 / 0.683
Home assessment and advice on daily routines / 4 / 1 / 28 / 34 / 68 / 65 / 0.261
Computer skills (office email web) / 2 / 1 / 52 / 38 / 46 / 61 / 0.168
Time management / 0 / 0 / 28 / 23 / 72 / 77 / 0.687
Documentation and data collection / 0 / 1 / 30 / 19 / 69 / 80 / 0.257
Mentoring other CHWs / 0 / 0 / 42 / 31 / 58 / 69 / 0.195
Participation in Research Projects / 19 / 7 / 51 / 33 / 30 / 60 / 0.001
Electronic Medical Records / 21 / 17 / 55 / 36 / 23 / 47 / 0.013
Fischer’s Exact Test of Statistical Significance, Bold Faced Values = P < .05