Effectiveness of community health workers in the care of people with hypertension.

BACKGROUND The contributions of community health workers (CHWs) in the delivery of culturally relevant programs for hypertension control have been studied since the 1970s. This systematic review examines the effectiveness of CHWs in supporting the care of people with hypertension. METHODS Computerized searches were conducted of multiple bibliographic electronic databases from their inception until May 2006. No restrictions were applied for language or study design, and studies were restricted to those that reported at least one outcome among participants. RESULTS Fourteen studies were identified, including eight randomized controlled trials (RCTs). Many of the studies focused on poor, urban African Americans. Significant improvements in controlling blood pressure were reported in seven of the eight RCTs. Several studies reported significant improvements in participants' self-management behaviors, including appointment keeping and adherence to antihypertensive medications. Four studies reported positive changes in healthcare utilization and in systems outcomes. Two of the RCTs showed significant improvements in other patient outcomes, such as changes in heart mass and risk of CVD. CONCLUSIONS Community health workers may have an important impact on the self-management of hypertension. Programs involving CHWs as multidisciplinary team members hold promise, particularly for diverse racial/ethnic populations that are under-served.

[1]  B. Israel,et al.  Social Networks and Social Support: Implications for Natural Helper and Community Level Interventions , 1985, Health education quarterly.

[2]  C. Collier,et al.  Linking community-based blood pressure measurement to clinical care: a randomized controlled trial of outreach and tracking by community health workers. , 1999, American journal of public health.

[3]  M. Hovell,et al.  The effects of lay counseling on medication adherence and blood pressure: adjunctive treatment for hypertension. , 1984, Patient Education and Counseling.

[4]  J. Cutler,et al.  Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. , 2000, Circulation.

[5]  H. Rubin,et al.  Using participant information to develop a tool for the evaluation of community health worker outreach services. , 2002, Ethnicity & Disease.

[6]  Brian T. Austin,et al.  Improving chronic illness care: translating evidence into action. , 2001, Health affairs.

[7]  D. Fedder,et al.  The effectiveness of a community health worker outreach program on healthcare utilization of west Baltimore City Medicaid patients with diabetes, with or without hypertension. , 2003, Ethnicity & disease.

[8]  C. Burd,et al.  The “In-Between People”: Participation of Community Health Representatives in Diabetes Prevention and Care in American Indian and Alaska Native Communities , 2002 .

[9]  Detection.  The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) , 1997 .

[10]  A Zuvekas,et al.  Impact of community health workers on access, use of services, and patient knowledge and behavior. , 1999, The Journal of ambulatory care management.

[11]  M. Northridge,et al.  Community Health Workers and Community Voices: Promoting Good Health , 2003 .

[12]  J. Douglas.  Improving cardiovascular health outcomes through the use of evidence-based medicine. , 2005, Ethnicity & disease.

[13]  D. Becker,et al.  Narrowing the gap in health status of minority populations: a community-academic medical center partnership. , 1992, American journal of preventive medicine.

[14]  E. Noji,et al.  Emergency department detection and follow-up of high blood pressure: use and effectiveness of community health workers. , 1989, The American journal of emergency medicine.

[15]  Daniel W. Jones,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. , 2003, JAMA.

[16]  M. Hill,et al.  A clinical trial to improve high blood pressure care in young urban black men: recruitment, follow-up, and outcomes. , 1999, American journal of hypertension.

[17]  M. B. Love,et al.  Community Health Workers: Who they are and What they do , 1997, Health education & behavior : the official publication of the Society for Public Health Education.

[18]  R P Russell,et al.  Five-year blood pressure control and mortality following health education for hypertensive patients. , 1983, American journal of public health.

[19]  S. Syme,et al.  Improving hypertension control through tailoring: A pilot study using selective assignment of patients to treatment approaches , 1987 .

[20]  T. Horsley,et al.  Effectiveness of community health workers in the care of persons with diabetes , 2006, Diabetic medicine : a journal of the British Diabetic Association.

[21]  D. Becker,et al.  A partnership with minority populations: a community model of effectiveness research. , 1992, Ethnicity & disease.

[22]  T. Whitehead,et al.  Selection, training, and utilization of health counselors in the management of high blood pressure. , 1983, Urban health.

[23]  M. Nemcek,et al.  State of evaluation: community health workers. , 2003, Public health nursing.

[24]  T. Sharpe,et al.  Solutions to the problems of chronic disease management in rural settings. , 1985, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[25]  H. Ward,et al.  A clinic and community-based approach to hypertension control for an underserved minority population: design and methods. , 2000, American journal of hypertension.

[26]  L. Green,et al.  Health education for hypertensive patients. , 1979, JAMA.

[27]  L. Green,et al.  Effect of a structured health education program on reducing morbidity and mortality from high blood pressure. , 1987, Bibliotheca cardiologica.

[28]  L. Becker,et al.  Impact of a Community-Based Multiple Risk Factor Intervention on Cardiovascular Risk in Black Families With a History of Premature Coronary Disease , 2005, Circulation.

[29]  W. Elliott,et al.  Racial/Ethnic Disparities in Prevalence, Treatment, and Control of Hypertension—United States, 1999-2002 , 2006 .

[30]  H. Ward,et al.  Reducing Disparities in Hypertension Control: A Community-Based Hypertension Control Project (CHIP) for an Ethnically Diverse Population , 2002 .

[31]  L. Scott,et al.  Alternative Models in the Delivery of Primary and Secondary Prevention Programs , 2003, The Journal of cardiovascular nursing.

[32]  N Cheal,et al.  Breast and cervical cancer screening in minority populations: a model for using lay health educators. , 2009, Journal of cancer education : the official journal of the American Association for Cancer Education.

[33]  Wendy S Post,et al.  Hypertension care and control in underserved urban African American men: behavioral and physiologic outcomes at 36 months. , 2003, American journal of hypertension.

[34]  L. Green,et al.  Evaluation of Family Health Education to Build Social Support for Long-Term Control of High Blood Pressure , 1985, Health education quarterly.

[35]  Daniel W. Jones,et al.  Recommendations for Blood Pressure Measurement in Humans: An AHA Scientific Statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee , 2005, Journal of clinical hypertension.

[36]  D. Becker,et al.  Roles of nurses and health workers in cardiovascular health promotion. , 1995, The American journal of the medical sciences.

[37]  B. Armstrong,et al.  Pragmatic randomized trial of home visits by a nurse to elderly people with hypertension in Mexico. , 2001, International journal of epidemiology.

[38]  B. Smedley,et al.  Unequal Treatment: Con-fronting Racial and Ethnic Disparities in Health Care , 2002 .

[39]  N. Freemantle,et al.  Specialist nurse-led intervention to treat and control hypertension and hyperlipidemia in diabetes (SPLINT): a randomized controlled trial. , 2003, Diabetes care.

[40]  John E. Ware,et al.  SF-36 physical and mental health summary scales : a user's manual , 1994 .

[41]  L. Bone,et al.  The impact of a planned health education approach on the control of hypertension in a high risk population. , 1990, Journal of human hypertension.

[42]  S. Jan,et al.  HOW DO WE DETERMINE WHETHER COMMUNITY HEALTH WORKERS ARE COST-EFFECTIVE? SOME CORE METHODOLOGICAL ISSUES , 2005, Journal of Community Health.

[43]  M. Hill,et al.  Community health workers as interventionists in the prevention and control of heart disease and stroke. , 2005, American journal of preventive medicine.

[44]  S. Zeger,et al.  The effectiveness of a community/academic health center partnership in decreasing the level of blood pressure in an urban African-American population. , 2003, Ethnicity & disease.