摘要：Objectives. To quantify the characteristics of community health workers (CHWs) involved in community intervention research and, in particular, to characterize their job titles, roles, and responsibilities; recruitment and compensation; and training and supervision. Methods. We developed and administered a structured questionnaire consisting of 25 closed- and open-ended questions to staff on National Institutes of Health–funded Centers for Population Health and Health Disparities projects between March and April 2014. We report frequency distributions for CHW roles, sought-after skills, education requirements, benefits and incentives offered, and supervision and training activities. Results. A total of 54 individuals worked as CHWs across the 18 research projects and held a diverse range of job titles. The CHWs commonly collaborated on research project implementation, provided education and support to study participants, and collected data. Training was offered across projects to bolster CHW capacity to assist in intervention and research activities. Conclusions. Our experience suggests national benefit in supporting greater efforts to recruit, retain, and support the work of CHWs in community-engagement research. Community health workers (CHWs), variously known as lay health workers, lay health advisors, health navigators, community educators, promotores , and other titles, are increasingly involved in intervention research studies and health care teams and have garnered growing national attention in recent years. 1–3 The US Department of Health and Human Services defines CHWs as lay members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language, socioeconomic status, and life experiences with the community members they serve. 4 (piii) In 2009, the US Department of Labor recognized the important role CHWs could play as members of the health care team and recommended a single labor category for these professionals. 5 As diverse as their titles, the varying roles of CHWs and efficacy of CHW-led interventions in public health promotion and disease prevention are the focus of much of the extant literature on CHWs. 6–11 Although a general responsibility of CHWs has been described in the literature as working with communities to improve health outcomes, the depth and breadth of CHW roles in health promotion and disease prevention work appears to be as diverse as the projects to which they contribute. 12,13 Findings from the National Community Health Advisor Study elucidated 7 core competencies of members of this profession: cultural mediation, informal counseling and support, providing culturally appropriate health education, advocating individual and community needs, ensuring that people receive the health services they need, building individual and community capacity, and providing direct services. 12 Other studies have added to these roles, describing the function of CHWs as monitoring health status, promoting screening, facilitating treatment adherence and community participation in the health system, and encouraging self-management. 11,14,15 Several reports document that CHWs are effective in increasing community engagement, connecting host communities to health services, and improving health outcomes, particularly among vulnerable populations. 6–8 Although many research articles describe the efficacy of individual CHW interventions, little is known about the overall characteristics of CHWs who work on research teams, where they may function as research assistants, educators, or interventionists. 11,14,16–18 The contributions of CHWs as members of research teams that address health disparities are seen as critical to reaching and engaging individuals in underserved populations. Because they are members of the community being served, CHWs are well-situated to provide insights to researchers about realities faced by their communities. 9,18 Integrating CHWs into research teams also may increase community involvement in research and reduce health disparities in underserved populations. 1,8,19 Furthermore, because CHWs often have similar demographic and social characteristics (e.g., ethnicity, socioeconomic status) to the populations they serve, including CHWs in research projects may be an effective strategy for addressing fear, mistrust, and historically low participation of the underserved in public health and clinical research. 19–22 Studies describing CHW involvement in research have qualitatively examined the role of CHWs in specific research studies 3,17 and have contributed much to the understanding of CHW participation in individual research projects. Few studies, however, have systematically collected data from a national sample of research projects that employ CHWs; thus, little information exists about CHW roles, responsibilities, recruitment, hiring, and training in diverse research projects. Such activities may include recruiting participants, obtaining informed consent, collecting data for intervention activities, and carrying out behavioral interventions. Furthermore, there is limited evidence to provide a framework for academic and research partners aiming to meet community needs by integrating CHWs into their teams. Evidence to guide the operational integration of CHWs into research teams would be useful for researchers who propose to work with CHWs. The current study contributes to the literature examining the characteristics, skills, and effective integration of CHWs into research teams. Since 2010, 10 centers throughout the United States have been involved in the National Institutes of Health–funded Centers for Population Health and Health Disparities (CPHHD) initiative. 23,24 Each center leads multiple research projects focused on reducing health disparities in cancer and cardiovascular disease among diverse underserved populations across the United States. Among the requirements for funding was that each CPHHD conduct at least 1 community-engaged intervention project. Several of these projects used a community-based participatory research approach, in which communities are expected to be involved in every aspect of the research, from study design to results dissemination. 25 Each project consisted of a unique, often multilevel intervention (e.g., home- or community-based lifestyle intervention, clinic-based educational intervention) in which CHWs played a role in engaging members of an underserved population (e.g., urban African Americans, urban Puerto Ricans, rural Mexicans, rural Appalachians) in the intervention. Across all projects, community engagement was operationalized by including CHWs, establishing community advisory boards, and partnering with community-based organizations (CBOs) to conduct research. The components of CPHHD community-engaged research projects presented a unique opportunity to examine the involvement of CHWs in an effort to add to the understanding of how CHWs engage in and contribute to research.
