Bringing COVID-19 vaccine to medically underserved populations utilizing a community-guided mobile vaccine program.

Health disparities researchers attempting to engage and effectively deliver interventions to underserved populations often encounter a number of challenges ranging from geographical considerations to more complex issues of medical mistrust. While there are a number of strategies researchers may employ to address these challenges, one of the most successful of these has been the use of community health workers (CHWs). Despite the documented success of CHWs, little information exists on the use of theory-driven intervention strategies with these community partners. Researchers who have partnered with CHWs tend to provide brief descriptions of training strategies and provide little discussion of the challenges and barriers to training a lay population in the delivery of technical interventions, including ensuring fidelity to the intervention protocol. The purpose of this article is to describe the feasibility of training CHWs to deliver a motivational interviewing intervention to promote cancer screening in underserved populations. With this article we present an innovative way to use motivational interviewing delivered by CHWs. Specifically, we will detail the development of the training protocol, the implementation of that training in a variety of research settings, and the development and implementation of fidelity protocols. We will use examples from two research studies where CHWs were successfully trained to use MI to promote cancer screening in underserved communities to highlight the challenges and barriers faced in developing and implementing the training and strategies used to overcome these challenges during the refinement of the intervention.

Universal Health Coverage (UHC) will not be achieved if health care worker shortages, estimated to increase to 18 million by 2030, are not addressed rapidly. Community-based health systems, which pivot to effective engagement of community health workers (CHW), may have an essential role in linking communities with health care facilities and reducing unmet health services needs caused by these shortages. The Canadian Red Cross (CRC) has partnered with different National Red Cross/Red Crescent Societies and Ministries of Health in Africa in the implementation of programs where CHWs contributed to the provision of various health services. This study reports on key findings (i.e., beneficiaries reached, CHWs engaged, programs implemented, intervention outcomes) and lessons learned from CRC supported CHW programs in Africa over the last 15 years (2007-2022). Qualitative methodology was employed to conduct document analysis on 17 sets of reports from each CRC-supported community health worker project in Africa over the past 15 years. Focus was on identifying challenges, facilitators, and lessons learned. CRC supported projects have trained over 9000 CHWs, benefiting nearly 7.5 million people across Africa. Key success factors include adaptability and agility in programming and project management, and considering contextual factors (political, social, and cultural systems). Investing in essential training for CHWs, staff, and volunteers is crucial, alongside employing an evidence-based approach to inform all aspects of programming and implementation. Additionally, projects prioritizing protection, gender and inclusion (PGI) while leveraging existing community structures and partnerships important for successful implementation. Despite challenges (i.e., weak health systems, lack of political commitment, insufficient funding, inadequate training) CHWs are recognized as crucial in promoting community-based health, improving access to care, addressing disparities, and contributing to achieving (UHC). Their unique position within communities enables them to provide culturally appropriate and localized primary health care- particularly in remote, resource limited and poverty-stricken regions.

The 12-month vaccination campaign ¡Ándale! ¿Qué Esperas? was launched to increase COVID-19 vaccination rates in Latinx populations in California by expanding community outreach. The objectives of this evaluation were to (1) determine predictors of vaccination rates and (2) identify barriers to vaccination and potential solutions. Five community partners in California serving Latinx populations with high social vulnerability participated in the ¡Ándale! ¿Qué Esperas? campaign. Community health workers were hired to deliver outreach (virtual, one-on-one, group based, and information dissemination), vaccinations, and supportive services. We collected data on outreach strategy used (method and location), number of vaccinations provided and reasons for delay, and number of times that supportive services were provided. We used regression models to assess significant predictors of vaccinations and supportive services. Community health workers (N = 146) hired from June 1, 2021, through May 31, 2022, performed outreach engagements (n = 6297) and supportive services (n = 313 796), resulting in 130 413 vaccinations and 28 660 vaccine appointments. The number of vaccinations administered was significantly higher at events in which supportive services were provided versus not provided (coefficient = 34.02; 95% CI, 3.34-64.68; P = .03). The odds ratio of supportive services was 3.67 (95% CI, 1.76-7.55) during virtual outreach and 2.95 (95% CI, 2.37-3.69) during one-on-one outreach (P < .001 for both) as compared with information dissemination encounters. Vaccination concerns were reported among 55.0% of vaccinated survey respondents (67.7%, vaccine confidence; 51.7%, access). Supportive services facilitate vaccinations, ease transportation and time barriers, and instill confidence among working-class racial and ethnic minority populations.

Community-based participatory research (CBPR) is a strategy often employed to address public health priorities. We explored how to build effective, trusting relationships with key community stakeholders and a group of Hispanic/Latinos with type 2 diabetes (T2D) to develop culturally appropriate projects. In the process of implementing a Patient-Centered Outcome Research Initiative (PCORI) award, our Community Advisory Board (CAB) met monthly to develop a set of comparative effectiveness research questions along with the interventions to develop specific strategies to improve Hispanic/Latino individuals' self-management of T2D. An agenda was prepared for each meeting targeting the PCORI grant timeline. Notes were taken during these meetings and analyzed to determine effective strategies. Ten strategies were identified that led to the success of this CBPR project and to the current sustainability phase. Instrumental to our success was our partnership with a community health worker (CHW) who co-lead this research project. The CHW and CAB individualized general CBPR strategies to make this project successful in their community. Our community partners became influential knowledge holders throughout this research process. They improved researchers' understanding of how to address the needs of Hispanic/Latino individuals with T2D and how community members could become leaders within their community.

Nurse Practitioner Supervised Integration of Community Health Workers in Home Based Heart Failure Care

The Affordable Healthcare Act has, among other changes, created greater incentives to reduce health disparities in low-income communities across the country, which heightened the importance and expectations of community health workers (CHWs) as part of the clinical care team. These heightened expectations have begun to transition what has historically been a paraprofessional role into one that involves more clearly defined competencies and development needs. In an effort to meet these needs in the city of Chicago, a CHW basic certificate program was developed and launched at Malcolm X college (one of the seven city Colleges of Chicago), in collaboration with several community partners. This article presents the experience of this program, the challenges faced in its implementation, and lessons from this experience that may be relevant to others involved in the professional preparation of CHWs.

Background: Community health workers (CHWs) promote health education, address social determinants of health, and bridge the gap between healthcare systems and underserved populations, but the lack of sustainable funding remains a challenge to greater CHW utilization. Medicaid reimbursement has been identified as a promising mechanism to fund CHWs, however, state policies vary widely. A comparative policy analysis can guide future reimbursement strategies. Methods: We conducted a comparative policy analysis of Medicaid reimbursement for CHWs. State government websites and legal databases were searched utilizing keyword search terms related to CHWs and Medicaid reimbursement. We identified and analyzed relevant statutes, regulations, and administrative codes for reimbursement mechanism, rates, supervision, certification, and scope of practice. Results: 26 states currently reimburse CHWs through Medicaid; 3 states started reimbursement in the last six months. 16 states authorize payment through State Plan Amendments (SPAs), 3 use Section 1115 demonstration waivers, 10 use Medicaid managed care organization contracts, and 4 use blended strategies. 13 states require certification and supervision for reimbursement, although the supervising licensed professional can vary. The scope of practice of CHW also varies between states. There is a large range for reimbursement rates; for example, billing code 98960 currently used by 14 states varies from $9.70 in Indiana to $55.25 in Arizona for a 30 minute visit. Policy Implications: This study can inform sustainable reimbursement models through Medicaid for CHWs in Indiana and other states. An SPA may be the most expedient way for Indiana to increase reimbursement for CHWs, but its narrowness and inflexibility could hinder CHWs' positive impact. The variety of strategies currently in use demonstrates that there is no single path to sustainable financing. Protocols for a set of scoping reviews will result from this comparative analysis for more in-depth investigations of key peer-reviewed and grey literature.

Community health workers and non-clinical patient navigators: A critical COVID-19 pandemic workforce

St. Louis, Missouri, sits astride the confluence of the Mississippi and Missouri Rivers, a position that made the city the “Gateway to the West.” Its most famous monument, the Gateway Arch, memorializes the millions of pioneers who traveled to the city seeking transportation to the frontier lands of the West, and who were outfitted with the tools and knowledge they needed on the journey to these new lands of opportunity. The Clinical & Translational Science Awards (CTSA) program has enabled Washington University (WU) and its regional partners to create a gateway of another sort, aimed at helping researchers toward new opportunities and discoveries in clinical and translational research. The Washington University Institute of Clinical and Translational Sciences (ICTS) was founded in September 2007 to serve as the intellectual and physical home for clinical and translational research and clinical research training at WU and its partner institutions. ICTS was founded on WU's 4 prior clinical research and training grants—GCRC, K12, K30, and T32—and on an existing university-wide strategic initiative in multidisciplinary collaborative research emphasizing genome sciences, biological imaging, and clinical investigation. The formation of the ICTS resulted in a new level of regional partnership with other academic, health care, and industrial and community partners. In its second year of existence, the ICTS is increasingly able to integrate the different strengths of its partners to reach its goals of reinventing and reinvigorating CTS research and training. In designing the ICTS, we used a conceptual model that identified important phases in the progress of a clinical or translational research project (Figure 1). For each phase, we identifed needed resources and potential barriers to completion, and have structured the ICTS in a way that attempts to provide needed resources and expertise for each phase of research from development and refinement of research ideas through translation of results to clinical practice and community implementation. Education, training, and career development are at the heart of our ICTS, and are linked to all research phases and programmatic activities. Our ICTS has 15 key Program Functions, each linked to 1 or more research phases, and each with specific goals, milestones, and evaluation criteria for various services, cores, and programs. We will highlight 2 new and important program functions below: our community-based research efforts and our programs in biomedical informatics. Phases in the evolution of clinical research projects. The 3 CCBR arms serve as a model for community participation to improve research relevant to public health. A central transformative element offour ICTS was the establishment of the Center for Community-Based Research (CCBR), which has initiated community engagement ef orts in 3 important groups: community organizations, community-based health care providers, and individuals from medically underserved populations. Each of the 3 arms is designed to solicit community input to increase the relevance of research to community needs, and to encourage partnerships between academic researchers and community groups. Our Community Advisory Board, established by the 3 arms, meets quarterly, to ensure relevance of the CCBR programs and the ICTS programs as a whole. The Community Organizations program has focused on cultivating partnerships with community organizations and conducting community needs assessments. This new model has spearheaded a series of conferences with our Regional Health Commission to address how our academic medical center can better serve the needs of our local community and improve the public health. In the fall of 2009, we will begin a series of shared conferences with community organizations highlighting successful community-based participatory research projects. These conferences will include joint presentations by academics and community partners and will strive to facilitate the formation of new partnerships. To further stimulate new community-based participatory research projects, we will soon initiate a research grants program, supported by a regional coalition of universities and health care institutions, to fund research projects that include a high degree of cooperation between community organizations and academic researchers. The program has also initiated a traveling poster presentation forum that translates data in a community relevant fashion. The Community Health Care Practitioners program seeks to expand community networks of practitioners to increase opportunities for clinical and translational (T2 and T3) research. One such effort is the Washington University Pediatric and Adolescent Ambulatory Research Consortium (WU PAARC). Currently comprised of approximately 60 community pediatricians and 5 pediatric nurse practitioners, the network provides a formal structure to develop research ef orts that identify best practices and translate research findings into practice. Community pediatricians participate in the consortium in different ways, from contributing ideas and receiving study updates to helping develop study protocols and recruit patients from their practices. Some studies are initiated by WU PAARC physicians, such as a recent study on a Telephone Asthma Program that resulted from physicians’ frustration with patients not using their asthma maintenance medications. For this randomized controlled trial, 362 families with asthmatic children were recruited from 95 community pediatric offices over 13 months. The 12-month telephone asthma coaching intervention helped parents better manage their child's asthma care and improved children's asthma control and parents’ quality-of-life scores. An upcoming study will compare 2 corticosteroid treatments for croup, a disease commonly seen in community practice but never before studied in this setting. In addition to WU PAARC-sponsored studies, community pediatricians have opportunities to participate in other studies developed by ICTS researchers including participating in study development and implementation. An example is a prevalence study for community-acquired methicillin-resistant Staph aureu s for which 1,300 children were recruited from 11 WU PAARC practices over an 8-month period. WU PAARC serves as a model for cooperative research between academic and community physicians, and these examples show how those involved have a real opportunity to improve the health of children and adolescents. As our ICTS matures, we plan to expand our practice-based research network activities to include new patient and provider populations. The CCBR has also started HealthStreet, a project linking populations that have been underrepresented in research to health information, referrals to social, medical, and psychiatric services, as well as opportunities to participate in research studies. HealthStreet utilizes Community Health Workers and a comprehensive outreach approach to establish trust between the lay and medical communities. The hub of CCBR activity is a new storefront facility in an underserved neighborhood near our medical center where community members can receive free health screenings, health referrals, and information about WU clinical studies. Community Health Workers also reach people in sites such as beauty shops, laundromats, bus stops, and community agencies to spread the word about services offered, and opportunities for research. The 3 CCBR arms serve as a model for community participation to improve research relevant to public health. CCBR investigators are actively training and engaging other ICTS investigators to collaborate on community-based projects with the goal of addressing “outcomes that matter.” Major institutional goals for improving CTS research are the creation of efficient communication and coordination across key function activities; the creation of an informatics infrastructure capable of integrating ICTS program components for data sharing; and the development of electronic resources of existing clinical and biospecimen data that may be used to develop new clinical studies, identify potential research participants, and execute novel molecular correlative studies. The ICTS Center for Biomedical Informatics (CBMI) is addressing these complex core issues through industry-standard hardware infrastructure and software tools to store, integrate, query, analyze, and visualize complex clinical and molecular data sets. Among the several activities of CBMI are the integration and implementation of the research management tool ClinPortal, development and management of biospecimen tracking tools, and creation of the Clinical Investigation Data Exploration Repository (CIDER), a research repository of medical records. ClinPortal is a research management tool that allows investigators and study coordinators to integrate the data collection and management needs of a clinical study with critical regulatory compliance requirements. Investigators create case report forms using data elements (or variables) that are defined using controlled vocabularies, and ClinPortal then automatically generates the backend database schema as well as the forms to enter the data and conduct queries. Use of ClinPortal offers a number of advantages to the institution and to the investigator. By default, data stored in ClinPortal is available for sharing while following all HIPAA regulations, although the investigator that owns the data may turn of sharing if so desired. As a result, once an investigator has established his or her study within the ClinPortal system, there is potential for sharing relevant data with and from other studies. Data access is controlled both by investigator permissions and by regulatory requirements. Future phases include automated access to clinical data from our hospital and outpatient systems. Assuming appropriate release by the patient and access rights for the researcher, investigators using ClinPortal will eventually have access to clinical data from hospital and clinic sources for their study participants. Tissue Suite, a Web-based biospecimen inventory, tracking, and annotation tool, may be used for study-based biospecimen collection efforts and by other non-study investigators interested in identifying existing biospecimens throughout the medical campus that may be available for translational research. The ICTS Translational Pathology and Molecular Phenotyping (TPMP) Core supports the physical storage of biospecimens, while Tissue Suite is the application supported by both the CBMI and the TPMP to provide the informatics to manage data about those biospecimens. Investigators who are managing their own biospecimen collection efforts outside of the TPMP Core may still make use of the Tissue Suite application to manage their inventory in compliance with caBIG standards. Web accessibility, the ability to share biospecimens and biospecimen-related data, advanced search functionality, and capture of clinical, pathological, and quality assurance data for collected biospecimens are key features of Tissue Suite. Together, ClinPortal and Tissue Suite facilitate collaboration between investigators and data integration across studies. As clinical data becomes available through the ClinPortal tool, biospecimens referenced in the complementary Tissue Suite tool will gain increasing clinical annotation, making them even more valuable for translational research studies. Another major focus of the CBMI has been the development of a comprehensive research patient data warehouse. CIDER contains a wealth of data from the electronic medical records of most inpatients and outpatients seen at the WU medical center and affiliated hospitals in the BJC HealthCare system. This system will become available to ICTS investigators in 2009 and will initially contain data on patient encounters, laboratory testing, and medications. We sought community input in designing the patient notification and opt-out procedures and in strictly designating access and use of this information by qualified investigators. We expect that CIDER will become a very useful tool for many clinical and translational researchers to perform a review preparatory to research, identify potential participants to recruit to active clinical studies both by querying CIDER and as they are encountered in the health care system, and implement quality assurance and improvement initiatives. In addition to these highlighted functions, the CBMI is working on other ways to simplify communication and tracking within the ICTS. One new project is the creation of an electronic Research Concierge function to serve as the focal point to help clinical and translational researchers navigate through the study planning, design, review, and execution processes. This Research Concierge function will be added to WU's existing site that currently provides single sign-on access to the resources necessary to propose, manage, and close research projects and satisfy compliance requirements for research. In a nod to St. Louis history, these resources can be found at the WU Research Gateway Web site (http://research.wustl.edu). More information about the WU ICTS can be found at our main site http://icts.wustl.edu.

Moving Mobile Health Forward: Combining mHealth with Community Health Workers Bolsters Heart Failure Care

To describe the design and participants of a program that employed health coaches and community health workers to address the social, health, and long-term disaster recovery needs of Rockaway residents roughly 2 years after Hurricane Sandy made landfall. Baseline and exit questionnaires, containing demographic, health, and health care utilization measures, were administered to participants at the start and end of the program. Enrollment and encounter information was captured in program administrative records. Descriptive statistics were used to summarize participant characteristics, personal goals, referrals to local organizations and agencies, and outcomes. Qualitative analyses were used to identify recurring themes in challenges faced by participants and barriers to health and wellness. The program served 732 community residents, of whom 455 (62%) completed baseline and exit questionnaires. Participants were directly and/or indirectly impacted by Hurricane Sandy through property damage, closures of health care facilities, limited employment opportunities, and trouble securing affordable housing. Furthermore, many participants faced considerable adversities and struggled to manage chronic health conditions. Personal goals set by participants included locating health care and other resources (44%), weight management and healthy eating (35%), and self-management of chronic conditions (24%). Health coaches and community health workers engaged participants an average of 4 times-providing counseling and referrals to local organizations and services, including medical and dental services (29%), city-issued identification cards (27%), and health insurance and other entitlements (23%). Comparisons of baseline and exit surveys indicated significant improvements in self-reported health, health care utilization, and confidence managing health issues. No significant improvement was observed in the use of preventive health care services. The program represents a model for engaging vulnerable populations and addressing social and economic barriers to health and wellness during the long-term disaster recovery phase. Health coaches and community health workers may be instrumental in helping to address the health and wellness needs of vulnerable residents living in disaster-affected areas.

Cancer health disparities are underlined by structural and conceptual barriers, such as: Adequate cancer awareness and education, functional cancer literacy, appropriate and timely access to cancer screening and follow-up care, and psychological aspects of the decision to undergo cancer screening. Cervical cancer health disparities can be impacted by early detection and screening with the Papanicolaou (Pap) test. The Kin KeeperSM Cancer Prevention Intervention is a culturally and linguistically tailored breast and cervical cancer educational intervention designed to improve functional cancer literacy. The Health Belief Model (HBM) was used as a framework to explore potential associations between responses to a cervical Cancer Literacy Assessment Tool (C-CLAT) item assessing a psychological barrier to Pap screening and a woman's screening accomplishments. Methods: The Kin KeeperSM model has three levels of participants: community health worker (CHW), CHW's female clients (“kin keepers”), and female family members of female clients. Trained CHWs recruited 543 Black, Latina, and Arab women from Detroit and Dearborn, MI to participate in the two-year study. Analysis included only women with two years of data, thus the final number of participants was 446 (117 Black, 157 Latina, 172 Arab). Kin keepers recruited female family members in year one and delivered the cervical cancer educational intervention in year two. After recruitment, CHWs from three local agencies administered the C-CLAT to all participants in English, Spanish, or Arabic before administering an educational intervention (pre-C-CLAT) and after the educational intervention (post-C-CLAT 1); and provided women with Personal Action Plans (PAPs) to identify screening goals based on three statements: Find a health care provider to do first-ever Pap; schedule first-ever Pap; and continue getting yearly Pap. The outcome of interest was indication of these goals as accomplishments in year two. After kin keepers delivered the educational intervention in year two, CHWs administered a post-C-CLAT 2 and an accomplishment-oriented PAP to all participants. Using multivariable logistic regression, we observed the potential effect of responses to a C-CLAT item and sociodemographic covariates on PAP accomplishments. The C-CLAT item “Getting a Pap test is very painful,” suggests a psychological barrier to screening, thus it is relevant to a classic HBM construct, perceived barriers. Post-C-CLAT 1 responses to this item were scored with an answer key and SPSS (PASW Statistics 18) was used for statistical analyses. Results: In year one, the most significant covariates affecting the goals women selected were race, relationship to the kin keeper, and health insurance status. Response to the C-CLAT item “Getting a Pap test is very painful” was not significant to the goal to continue annual Pap tests, yet race and possibly relationship to the kin keeper were significant (with an alpha of .105, p-values were .038 and .104, respectively). Analysis of women's PAP accomplishments 12 months later indicates the majority of women found a health care provider for a first-ever Pap test, scheduled a Pap in the past 12 months, and had a Pap in the past 12 months. Relationship to the kin keeper was the only statistically significant covariate (p = .035) in analysis of having had a Pap test in the last 12 months. Conclusions: Future interventions designed to impact cervical cancer health disparities should support women's intentions to pursue screening despite potential psychological barriers. Such studies should explore dynamics between female family members and how these relationships might modify screening decisions and accomplishments. This research was funded by National Institutes of Health (NIH), National Institute for Nursing Research (NINR), 1R01NR011323. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A22.

Background: Racial/ethnic minorities, low-income individuals and recent immigrants shoulder a disproportionate burden of colorectal cancer (CRC) mortality. In Florida, Blacks and Hispanics remain at an increased risk of colorectal cancer (CRC) compared to non-Hispanic Whites (NHW). In the Miami metropolitan area, this disparity is most prominent within the ethnic enclaves of Little Haiti and Hialeah, comprised predominately of Haitian and Hispanic Americans, respectively These communities experience an increased rate of late-stage CRC diagnosis relative to the state as a whole, largely due to lack of access to, and utilization of, CRC screening. Fecal immunochemical testing (FIT) has proved successful in addressing screening barriers for other medically-underserved communities. The present study represents a novel method for FIT delivery and uptake, particularly for the medically disenfranchished. Community Health Workers (CHWs), indigenous to Little Haiti and Hialeah, identified unscreened individuals, educated them about how to appropriately use FIT, and then provided them a postage-paid envelope to return completed tests to a laboratory for processing. Here we report preliminary acceptability and feasibility data for this approach. Methods: The FIT for Life screening program was available to all persons residing in Little Haiti and Hialeah 50 and 75 years old, who were unscreened or underscreened according to US Preventive Task Force recommendations, and considered average risk for CRC based on a brief screener. Our team worked closely with community partners to identify the CHWs, who ultimately were responsible for participant recruitment and intervention delivery. Following FIT return, a research assistant contacted participants to ask a series of questions in their language of preference about their perceived acceptability of FIT as a modality for CRC prevention. Any participant, identified as FIT positive was navigated to timely colonoscopy Results: To date, 221 participants (112 Hispanic, 109 Haitian) have been consented, received education on CRC screening, and were given the FIT kits. 92 Hispanics (82.1%) and 97 Haitians (88.9%) returned the FIT kits for processing. The test positive rate was 2.2% for Hispanics and 3.1% for Haitians. The mean quantity of blood in stool for positive tests was 896 ng/mL for Hispanics and 950 ng/mL for Haitians. The mean quantity of blood in stool for negative tests was 5.2 ng/mL for Hispanics and 4.8 ng/mL for Haitians. On follow-up clinical care, one Haitian participant was found to have an advanced stage CRC and a second did not want to undergo colonoscopy. Based on acceptability surveys, 100% of Hispanics and 90% of Haitians responded that they would use FIT again if offered for further screening; the same proportions would recommend the FIT with CHW method to friends and family members. Interestingly, 90.2% of Hispanics and only 5.0% of Haitians felt confident that FIT works as well as a CRC screening test that would be administered by a physician or nurse. Conclusion: The pairing of CHWs with CRC screening by FIT appears to be an effective approach to disease prevention that is highly acceptable to study participants. Further examination of whether this method is needed. We have begun collaborating with Federally Qualified Health Centers (FQHC) in Little Haiti and Hialeah to explore the sustainability of this approach and to ensure that participants are linked to a medical home for ongoing cancer prevention. Citation Format: Daniel Sussman, Monica Oriol, Martha Gonzalez, Heisy Asusta, Jose Ruiz, Dinah Trevil, Dorothy Parker, Erin Kobetz. FIT FOR LIFE: Increasing prevention and early detection of colorectal cancer for the medically disenfranchised. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B46. doi:10.1158/1538-7755.DISP13-B46

Community Health Worker (CHW) interventions have shown potential to reduce inequities for underserved populations. However, there is a lack of support for CHW integration in the delivery of health care. This may be of particular importance in rural areas in the Unites States where access to care remains problematic. This review aims to describe CHW interventions and their outcomes in rural populations in the US. Peer reviewed literature was searched in PubMed and PsycINFO for articles published in English from 2015 to February 2021. Title and abstract screening was performed followed by full text screening. Quality of the included studies was assessed using the Downs and Black score. A total of 26 studies met inclusion criteria. The largest proportion were pre-post program evaluation or cohort studies (46.2%). Many described CHW training (69%). Almost a third (30%) indicated the CHW was integrated within the health care team. Interventions aimed to provide health education (46%), links to community resources (27%), or both (27%). Chronic conditions were the concern for most interventions (38.5%) followed by women's health (34.6%). Nearly all studies reported positive improvement in measured outcomes. In addition, studies examining cost reported positive return on investment. This review offers a broad overview of CHW interventions in rural settings in the United States. It provides evidence that CHW can improve access to care in rural settings and may represent a cost-effective investment for the healthcare system.

New variants of the SARS-CoV-2 virus that causes COVID-19 will continue to develop and spread globally. The Omicron variant identified in November 2021 has many lineages. Variants spread quickly and can infect previously vaccinated individuals, prompting the Centers for Disease Control and Prevention to update vaccination recommendations. While ~230 million Americans received the initially-recommended vaccine sequence, booster uptake has been much lower; less than half of fully vaccinated individuals report receiving a booster. Racial disparities also mark patterns of COVID-19 vaccination booster uptake. This study explored willingness and motivations to get a COVID-19 booster among a diverse sample of participants. We used convenience sampling to recruit participants 18 years of age or older who attended a community vaccine event. We conducted informal interviews during the recommended 15-min post-vaccination wait time with 55 participants who attended vaccine events at Marshallese and Hispanic community locations and comprised the recruitment pool for individual interviews. Using a qualitative descriptive design, we conducted in-depth follow-up interviews with 9 participants (Marshallese n = 5, Hispanic n = 4) to explore willingness and motivations to get boosted. We used rapid thematic template analysis to review informal interview summaries and formal interviews. The research team resolved data discrepancies by consensus. Participants reported high willingness to get boosted, especially if boosters were recommended in the future to protect against serious illness and mitigate the spread of COVID-19. This finding underscores how essential including recommendations to get a COVID-19 booster from trusted sources in health messaging and educational campaigns may be for increasing booster uptake. Participants described their preference for receiving future COVID-19 boosters, reporting that they would attend similar vaccine events, especially those held at faith-based organizations and facilitated by the same community partners, community health workers, and research staff. This finding shows how community engagement can overcome barriers to vaccination (ie, transportation, language, and fear of discrimination) by providing services in preferred community locations with trusted community partners. Findings document high willingness to get a COVID-19 booster, emphasize the role of recommendations from trusted sources in motivating booster uptake, and highlight the importance of community engagement to address disparities in vaccination coverage and reach.