September, 2016 - SUPPORT Summary of a systematic review | print this article |

Do community health workers improve the care of people with hypertension?

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:

  • CHWs probably improve behavioural changes (such as ap-pointment keeping and adherence to medication), blood pres-sure control, and the 5-year mortality rate.
  • CHWs may slightly improve healthcare utilization and health systems outcomes (such as reduced hospital admissions).
  • All the included studies were conducted in a high-income country but mainly in poor communities.



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.



About the systematic review underlying this summary

Review objectives: To examine the effectiveness of CHWs in supporting the care of people with hypertension.

Type of What the review authors searched for What the review authors found
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.


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.


Healthcare or community settings.

All studies were conducted in the United States mainly focused on poor, urban African Americans.


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

Limitations: This is a well-conducted systematic review with only minor limitations.

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.

Summary of findings

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.


  •  CHWs probably improve blood pressure control. The certain-ty of this evidence is moderate.
  • CHWs probably improve the 5-year mortality rate. The cer-tainty of this evidence is moderate.



Effects of CHWs in supporting care of people with hypertension

Patient or population:  Hypertensive people, mainly poor urban African Americans

Settings:  Healthcare and/or community settings of the Unites States


Comparison: Usual care



Number of Participants


Certainty of the evidence



Blood pressure control

Improved from 4% to 46% over 6 to 24 months. One study found no important difference over 12 months.


(9 studies)



Mortality at 5 years

Reduction of 12.6% (control 30.2% vs. CHWs 17.6%)


(1 study)



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.

  •  CHWs probably improve behavioural changes such as appointment keeping and adherence to medication. The certainty of this evidence is moderate.


Certainty of

the evidence

Relevance of the review for low-income countries

Additional information