September, 2016 - SUPPORT Summary of a systematic review | print this article |
Community health workers (CHWs), carry out functions related to healthcare delivery, have no formal professional designation to deliver healthcare, but are trained as part of an intervention, and have a relationship with the community being served. They can be used to facilitate improvement in the management of chronic conditions like hypertension.
Key messages
In people with hypertension:
Hypertension is a significant public health problem. Only about 30% of people who are diagnosed with hypertension have their blood pressure under control. In poor settings, overcoming barriers such as health beliefs and values, insufficient access to culturally sensitive care, lack of knowledge about hypertension, and an absence of self-management skills are key to effective hypertension control. In order to improve health outcomes in the community, the involvement of trained laypeople, known as community health workers (CHWs), can have an important role. CHWs can be used to facilitate access to care, promote continuity of care, facilitate the adoption of self-care skills, and enhance compliance with treatment regimens.
Review objectives: To examine the effectiveness of CHWs in supporting the care of people with hypertension. |
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Type of | What the review authors searched for | What the review authors found |
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Study designs & interventions |
Any study design evaluating the effectiveness of CHWs in supporting the care of hypertensive people. |
8 randomized trials, 3 before-after studies, 1 non-randomized trial, 1 interrupted time-series study, and 1 survey. All studies but one focused exclusively on controlling hypertension. CHWs contacted recipients from weekly to yearly. |
Participants |
CHWs with no formal professional designation but trained to deliver healthcare to hypertensive people. |
The CHWs, predominantly women with different experience in community service and training, were recruited from the community, and resembled the participants in race/ethnicity and socioeconomic background. |
Settings |
Healthcare or community settings. |
All studies were conducted in the United States mainly focused on poor, urban African Americans. |
Outcomes |
At least one outcome among participants. |
Participant satisfaction, awareness, behaviour, physiologic measures, health outcomes, and healthcare system outcomes. |
Date of most recent search: May 2006 |
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Limitations: This is a well-conducted systematic review with only minor limitations. |
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Brownstein JN, Chowdhury FM, Norris SL, et al. Effectiveness of community health workers in the care of people with hypertension. Am J Prev Med 2007; 32:435-47. |
Fourteen studies involving 61,366 participants (median of 180 participants per CHW) were included in this systematic review.
Health outcomes
Of the ten studies that examined the effects of CHWs on blood pressure control, nine reported positive improvements. One study reported mortality reductions and two showed improvements in other patient outcomes, such as changes in heart mass and cardivascular risk.
Effects of CHWs in supporting care of people with hypertension |
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Patient or population: Hypertensive people, mainly poor urban African Americans Settings: Healthcare and/or community settings of the Unites States Intervention: CHWs Comparison: Usual care |
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Outcomes |
Impact |
Number of Participants (studies) |
Certainty of the evidence (GRADE) |
Comments |
Blood pressure control |
Improved from 4% to 46% over 6 to 24 months. One study found no important difference over 12 months. |
59,740 (9 studies) |
+++O MODERATE |
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Mortality at 5 years |
Reduction of 12.6% (control 30.2% vs. CHWs 17.6%) |
400 (1 study) |
+++O MODERATE |
Strong correlation among adherence to medication, keeping appointments, and blood pressure control |
p: p-value GRADE: GRADE Working Group grades of evidence (see above and last page). |
Behavioral changes
Positive behavioral changes were noted in nine of the ten studies measuring such changes. Two studies that addressed patient satisfaction found that the competency of the CHWs and the social support they provided were very important to the participants.
Certainty of
the evidence