Evaluation of Community Health Worker Intervention in San Antonio

Discussion Tips

This study investigates the role of community health care workers (CHWs) working in conjunction with a primary care practice in San Antonio, Texas and how this affected health outcomes for individuals with diabetes mellitus. Community health care workers act through building a relationship based on the Nostros approach to wellness, which prioritizes the goals and wants of the patient. In underserved, chronically ill patients, does this approach which emphasizes self-actualization affect measurable clinical outcomes?

Discussion Questions

• What question is asked by this study and why does it matter?

• What is the difference between a quality improvement project and research? Under which framework did this study best fit?

• What are community health workers and how might they improve patient’s health?

• What does this study bring to the table in regard to the role of community health workers that previous research has not?

• Does the 3-tiered/leveled model create an accurate context for answering the question posed by this article?

• To what degree can the findings be accounted for by:

  1. Preexisting motivations in patient population–(ie, if patients are already willing to work with a community health worker, are they self-selecting for the “self-care emergence” group, regardless of the actual intervention of the CHW?)

  2. Lack of randomization

  3. Attrition of study subjects

  4. Regression to the mean

• What are the main study findings?

  • ∘ What are the limitations of the study outcomes?

• How long were patients included in the study?

• How comparable is the study sample to similar patients in your practice or region? Do you think that the context of an inner-city cohort makes this study transferable to other populations?

  • ∘ What barriers might you face in establishing a community health worker’s intervention in your clinic? How might you overcome these barriers?

  • ∘ How might this study change your practice and how you attempt to engage and motivate patients in their own self-care?

• Who are the constituencies for the findings, and how might they be engaged in interpreting or using the findings?

• What researchable questions remain?