标题：The global role, impact, and limitations of Community Health Workers (CHWs) in breast cancer screening: a scoping review and recommendations to promote health equity for all
摘要：Introduction: Innovative interventions are needed to address the growing burden of breast
cancer globally, especially among vulnerable patient populations. Given the success of
Community Health Workers (CHWs) in addressing communicable diseases and non-communicable diseases, this scoping review will investigate the roles and impacts of CHWs in breast
cancer screening programs. This paper also seeks to determine the effectiveness and feasibility of these programs, with particular attention paid to differences between CHW-led
interventions in low- and middle-income countries (LMICs) and high-income countries (HICs).
Methods: A scoping review was performed using six databases with dates ranging from 1978
to 2019. Comprehensive definitions and search terms were established for ‘Community
Health Workers’ and ‘breast cancer screening’, and studies were extracted using the World
Bank definition of LMIC. Screening and data extraction were protocolized using multiple
independent reviewers. Chi-square test of independence was used for statistical analysis of
the incidence of themes in HICs and LMICs.
Results: Of the 1,551 papers screened, 33 were included based on inclusion and exclusion
criteria. Study locations included the United States (n=27), Bangladesh (n=1), Peru (n=1),
Malawi (n=2), Rwanda (n=1), and South Africa (n=1). Three primary roles for CHWs in breast
cancer screening were identified: education (n=30), direct assistance or performance of breast
cancer screening (n=7), and navigational services (n=6). In these roles, CHWs improved rates
of breast cancer screening (n=23) and overall community member knowledge (n=21). Two
studies performed cost-analyses of CHW-led interventions.
Conclusion: This review extends our understanding of CHW effectiveness to breast cancer
screening. It illustrates how CHW involvement in screening programs can have a significant
impact in LMICs and HICs, and highlights the three CHW roles of education, direct performance of screening, and navigational services that emerge as useful pillars around which
governments and NGOs can design effective programs in this area.
关键词：Breast cancer ; health policy ; global health ; community health ; health equity
