摘要：Objectives. To establish a validated, standardized set of core competencies for community health workers (CHWs) and a linked workforce framework. Methods. We conducted a review of the literature on CHW competency development (August 2015), completed a structured analysis of literature sources to develop a workforce framework, convened an expert panel to review the framework and write measurable competencies, and validated the competencies (August 2017) by using a 5-point Likert scale survey with 58 participants in person in Biloxi, Mississippi, and electronically across the United States. Results. The workforce framework delineates 3 categories of CHWs based upon training, workplace, and scope of practice. Each of the 27 competencies was validated with a mean of less than 3 (range = 1.12–2.27) and a simple majority of participants rated all competencies as “extremely important” or “very important.” Conclusions. Writing measurable competencies and linking the competencies to a workforce framework are significant advances for CHW workforce development. Public Health Implications. The standardized core competencies and workforce framework are important for addressing health disparities and maximizing CHW effectiveness. Community health workers (CHWs) have long been an essential component of the US public health workforce. 1,2 They effectively manage chronic disease, promote health, and facilitate access to health care, particularly with underserved populations. 2–4 In the last decade, the CHW workforce has expanded, in part because of the 2010 Affordable Care Act 5 and recognition of the CHW model as a strategy for promoting community–clinic linkages. 6 Our knowledge of CHW workforce composition is growing, 1 but its recent expansion has left some gaps—(1) unclear scopes of practice among CHWs and (2) a lack of measurable, standardized CHW core competencies—both important elements of public health workforce development. 7 As with all public health programs or services, the effectiveness of the CHW model is partially dependent on workforce competency. It is essential to address these workforce gaps as CHW employment is expected to expand 18% by 2026. 8 To this end, the purpose of this study was to establish a community health workforce framework and linked measurable, validated, and standardized CHW core competencies. The American Public Health Association (APHA) defines a CHW as the following: a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A community health worker also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy. 9 Despite this widely accepted definition, there is considerable variability in CHW workplaces, in terms of organization (e.g., community health centers, nonprofits, health ministries, public health agencies) and location (e.g., rural vs urban). 10 As such, “community health worker” often serves as an umbrella term encompassing diverse roles and job titles for unlicensed public health workers ranging from community-based outreach specialists to patient navigators integrated within clinical health care teams. 11 Groundbreaking work to develop the first set of CHW competencies took place 20 years ago with the National Community Health Advisor Study. 12 In 2010, the US Bureau of Labor Statistics recognized CHW as an occupation. 13 More recently, state legislation has led to policies about CHW roles, curricula, and certification processes. 14 All of these efforts have resulted in a plethora of curriculum objectives, competencies, and roles for CHWs that employers and instructors can draw upon for hiring and training. However, no measurable, standardized CHW competencies have been published in the peer-reviewed literature to date. Standardized core competencies are important for addressing health disparities, maximizing CHWs’ effectiveness, and further establishing CHWs as health professionals. 15 Moreover, a workforce framework is beneficial for describing scopes of practice and directing training for CHWs’ diverse roles and work settings. We used competency-based education to guide this study. Competency-based education, often used in public health, 16 focuses on the outcomes of learning and prepares health professionals for future practice needs. 17 In competency-based education, competencies are standards for developing curriculum, teaching, and evaluating learner or worker performance. A competency is a cluster of related knowledge, skills, and attitudes that affects a major part of one’s job (a role or responsibility) that correlates with performance on the job, that can be measured against well-accepted standards, and that can be improved via training and development. 18 (p124) Each competency should have 5 characteristics: Focus on the performance of the end-product or instructional goal, Reflect what is learned in the instructional program, Be expressed in terms of measurable behavior, Use a standard for judging competence independent of others’ performance, and Inform learners and other stakeholders about what is expected of them. 19 We adhered to these tenets to develop CHW core competencies. Indeed, we created guidelines for writing competencies for measurable behavior. This is a unique aspect of this study’s approach, especially when one considers that many competency sets are written in ways that make assessment difficult. For example, the state of Texas has a competency area, “Broad knowledge about the community,” which is considered part of a CHW’s necessary knowledge base of specific health issues. As written, this competency does not convey (1) what community the CHW should know about, (2) what type of knowledge is required, (3) what a CHW might need to do with this knowledge, or (4) how a CHW should demonstrate knowledge. This puts an employer or instructor in the position of having to interpret these issues and then assess competency on the basis of that interpretation..
