Community health workers as interventionists in the prevention and control of heart disease and stroke.
A considerable body of research indicates that community health workers (CHWs) are effective in improving chronic disease care and health outcomes. Much of the focus of cardiovascular research involving CHWs has been on hypertension because of its high prevalence and because it is a major risk factor for cardiovascular, cerebrovascular, and renal diseases. Adding CHWs to the patient-provider team has a beneficial effect on the quality of care for populations most in need. CHWs have contributed to significant improvements in community members' access to and continuity of care and adherence to treatment for the control of hypertension. CHWs assume multiple roles, including patient and community education, patient counseling, monitoring patient health status, linking people with health and human services, and enhancing provider patient communication and adherence to care. Current recommendations for CHWs to be interventionists on healthcare teams and in community-based research increase opportunities for CHWs to play an important role in eliminating disparities in heart disease and stroke. Adequate translation of research into clinical practice remains a major challenge, however. Addressing this issue, which has national implications, will require sustainable funding; appropriate reimbursement; enhanced efforts to incorporate CHWs into healthcare teams; better utilization of their skills; improved CHW supervision, training, and career development; policy changes; and ongoing evaluation, including a reporting of costs.