Abstract
The Community Health Worker model is recognized nationally as a means to address glaring inequities in the burden of adverse health conditions that exist among specific population groups in the United States. This study explored Arizona CHW involvement in advocacy beyond the individual patient level into the realm of advocating for community level change as a mechanism to reduce the structural underpinnings of health disparities. A survey of CHWs in Arizona found that CHWs advocate at local, state and federal political levels as well as within health and social service agencies and business. Characteristics significantly associated with advocacy include employment in a not for profit organization, previous leadership training, and a work environment that allows flexible work hours and the autonomy to start new projects at work. Intrinsic characteristics of CHWs associated with advocacy include their belief that they can influence community decisions, self perception that they are leaders in the community, and knowledge of who to talk to in their community to make change. Community-level advocacy has been identified as a core CHW function and has the potential to address structural issues such as poverty, employment, housing, and discrimination. Agencies utilizing the CHW model could encourage community advocacy by providing a flexible working environment, ongoing leadership training, and opportunities to collaborate with both veteran CHWs and local community leaders. Further research is needed to understand the nature and impact of CHW community advocacy activities on both systems change and health outcomes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Rosenthal, E. L., Wiggins, N., Brownstein, N., & Johnson, S. (1998). The final report of the National Community Health Advisor Study. Tucson, AZ: University of Arizona.
Van Duyn, M. A., Reuben, S. H., & Macario, E. (2006). Special populations networks: Themes and lessons learned. Cancer, 107(8 Suppl.), 1945–1954.
Kaufman, A., Derksen, D., Alfero, C., DeFelice, R., Sava, S., Tomedi, A., et al. (2006). The Health Commons and care of New Mexico’s uninsured. Annals of Family Medicine, 4(Suppl. 1), S22–S27.
Kuhajda, M. C., Cornell, C. E., Brownstein, J. N., Littleton, M., Stalker, V. G., Bittner, V. A., et al. (2006). Training community health workers to reduce health disparities in Alabama’s Black Belt: The Pine Apple Heart Disease and Stroke Project. Family & Community Health, 29, 89–102.
Sheppard, V. B., Zambrana, R. E., & O’Malley, A. S. (2004). Providing health care to low-income women: A matter of trust. Family Practice, 21, 484–491.
Nemcek, M. A., & Sabatier, R. (2003). State of evaluation: Community health workers. Public Health Nursing, 20, 260–270.
Brach, C., & Fraser, I. (2000). Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research & Review, 57, 181–217.
Elder, J. P., Ayala, G. X., Campbell, N. R., Slymen, D., Lopez-Madurga, E. T., & Engelberg, M. (2005). Interpersonal and print nutrition communication for a Spanish-dominant Latino population: Secretos de la buena vida. Health Psychology, 24, 49–57.
Corkery, E., Palmer, C., Foley, M. E., Schechter, C. B., Frisher, L., & Roman, S. H. (2005). Effect of a bicultural community health worker on completion of diabetes education in a Hispanic population. Diabetes Care, 20, 254–257.
Hunter, J., Guernsey de Zapien, J., Papenfuss, M., Fernandez, M., Meister, J., & Giuliano, A. (2004). The impact of a promotora on increasing routine chronic disease prevention among women aged 40 and older at the U.S.-Mexico border. Health Education & Behavior, 31(4 Suppl.), 18S–28S.
Hansen, L. K., Feigl, P., Modiano, M. R., Lopez, J. A., Sluder, E., & Moinpour, C. M. (2005). An educational program to increase cervical and breast cancer screening in Hispanic women: A Southwest oncology group study. Cancer Nursing, 28, 47–53.
Navarro, A., Senn, K., McNicholas, L., Kaplan, R., Roppe, B., & Campo, M. (1998). Por la vida model intervention enhances use of cancer screening tests among Latinas. American Journal of Preventive Medicine, 15, 32–41.
Swider, M. (2004). Outcome Effectiveness of Community Health Workers: An Integrative Literature Review. Public Health Nursing, 19, 11–20.
Ingram, M., Torres, E., Redondo, F., Bradford, G., Wang, C., & O’Toole, M. (2007). The impact of promotoras on social support and glycemic control. Diabetes Educator, 33(Suppl. 6), 172S–178S.
Lorig, K., Sobel, D. S., & Stewart, A. L. (1998). Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: A randomized trial. Medical Care, 37, 5–14.
Wakefield, S., & Poland, B. (2005). Family, friend or foe? Critical reflections on the relevance and role of social capital in health promotion and community development. Social Science and Medicine, 60, 2819–2832.
Williams, D. M. (2001). La Promotora. Linking disenfranchised residents along the border to the U.S. health care system. Health Affairs, 20, 212–218.
Mack, M., Uken, R., & Powers, J. (2006). People improving the community’s health: Community Health Workers as agents of change. Journal of Health Care for the Poor and Underserved, 17, 16–25.
Wolff, M., Young, S., Beck, B., Maurana, C. A., Murphy, M., & Holifield, J. (2004). Leadership in a public housing community. Journal of Health Communication, 92(2), 119–126.
Health Resources and Services Administration, Bureau of Health Professions. (2007). Community Health Worker National Workforce Study. Accessed on-line at http://bhpr.hrsa.gov/healthworkforce/chw.
Farquhar, S. A., Michael, Y. L., & Wiggins, N. (2005). Building on Leadership and Social Capital to create change in 2 urban communities. American Journal of Public Health, 95, 596–601.
Meister, J. S., Warrick, L. H., Guernsey de Zapien, J. G., & Wood, A. H. (1992). Using lay health workers: Case study of a community-based prenatal intervention. Journal of Community Health, 17(1), 37–51.
Meister, J. S., & Guernsey de Zapien, J. G. (1989). Un comienzo sano: A model prenatal education project. Maternal and Child Health Education Resources, 4, 1–2.
Cohen, S. J., & Ingram, M. (2005). Border Health Strategic Initiative: Overview and introduction to a community-based model for diabetes prevention and control. Preventing chronic disease. Available from URL, http://www.cdc.gov/pcd/issues/2005/jan/04_0081.htm.
Meister, J. S., & Guernsey de Zapien, J. G. (2005). Bringing policy issues front and center in the community: Expanding the roles of community health coalitions. Preventing chronic disease. Available from URL, http://www.cdc.gov/pcd/issues/2005/jan/04.
Acknowledgement
Researchers would like to acknowledge the Arizona Community Health Outreach Worker Association (AZCHOW) for their collaboration in this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ingram, M., Sabo, S., Rothers, J. et al. Community Health Workers and Community Advocacy: Addressing Health Disparities. J Community Health 33, 417–424 (2008). https://doi.org/10.1007/s10900-008-9111-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-008-9111-y