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      Community health worker interventions to improve access to health care services for older adults from ethnic minorities: a systematic review

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          Abstract

          Background

          The health status of older adults belonging to ethnic minorities in Western countries is an important public issue because their health is often less favourable than that of older adults from the majority population. In addition, the number of older adults belonging to ethnic minorities is increasing rapidly in Western countries. The introduction of community health workers (CHWs) has proven to be successful in addressing health disparities among ethnic minorities; however, an overview of CHW’s benefits for older adults is absent in the literature. We reviewed the literature to explore whether CHWs are also effective in improving the health and the delivery of health care services to ethnic minority older adults in Western countries.

          Methods

          We searched the PubMed database (2002-Present) for RCTs published on the use of CHWs in Western countries.

          Results

          Out of the 729 studies identified, seven studies met our inclusion criteria. The effectiveness of the implementation of CHW programmes in older adults belonging to ethnic minorities is not univocal. In two studies, we found no significant differences. In five studies, we found some positive effects. We did not find negative effects in any of the studies. For better interpretation of the results, effect ratios (ERs) were calculated as the number of positive findings divided by the total number of measured findings. Substantial effects on the access to care (mean ER = 0.58) and on health behaviour (mean ER = 0.45) were found. The mean ER for health outcomes was considerably lower (mean ER = 0.17).

          Conclusion

          We found indications that CHWs serve as a means of improving health care use and health behaviour and, to a lesser extent, health outcomes among ethnic minority older adults. Further research is required to draw more solid conclusions on the effectiveness of CHW interventions in this target group. This is particularly important for Western countries in which the number of ethnic minority older adults has increased significantly because their health status is mostly unfavourable and their access to health care services is often limited.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12913-014-0497-1) contains supplementary material, which is available to authorized users.

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          Most cited references22

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          Community health workers: integral members of the health care work force.

          As the US health care system strives to function efficiently, encourage preventive and primary care, improve quality, and overcome nonfinancial barriers to care, the potential exists for community health workers to further these goals. Community health workers can increase access to care and facilitate appropriate use of health resources by providing outreach and cultural linkages between communities and delivery systems; reduce costs by providing health education, screening, detection, and basic emergency care; and improve quality by contributing to patient-provider communication, continuity of care, and consumer protection. Information sharing, program support, program evaluation, and continuing education are needed to expand the use of community health workers and better integrate them into the health care delivery system.
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            Outcome effectiveness of community health workers: an integrative literature review.

            Community health workers (CHWs) are promoted as a mechanism to increase community involvement in health promotion efforts, despite little consensus about the role and its effectiveness. This article reviews the databased literature on CHW effectiveness, which indicates preliminary support for CHWs in increasing access to care, particularly in underserved populations. There are a smaller number of studies documenting outcomes in the areas of increased health knowledge, improved health status outcomes, and behavioral changes, with inconclusive results. Although CHWs show some promise as an intervention, the role can be doomed by overly high expectations, lack of a clear focus, and lack of documentation. Further research is required with an emphasis on stronger study design, documentation of CHW activities, and carefully defined target populations.
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              Reported health, lifestyles, and use of health care of first generation immigrants in The Netherlands: do socioeconomic factors explain their adverse position?

              Differences in health, lifestyles, and use of health care between groups of varying ethnic origin can have important implications for preventive and curative health care. This paper studies whether socioeconomic factors explain ethnic differences in these outcomes. Data on health status, lifestyles, and use of health care were obtained from interviews with 3296 people aged 16-64 years (response: 60.6%), among whom were 848 first generation immigrants. Ethnic differences in these outcomes were examined with and without adjustment for socioeconomic factors, using logistic regression. General population of Amsterdam, the Netherlands. Health status (self rated health, General Health Questionnaire, functional limitations), lifestyles (smoking, alcohol), and use of health care (general practice, pharmaceuticals, hospitalisations). Immigrants from Turkey, Morocco and (former) Dutch colonies report a poorer health and a higher use of health care, especially primary health care among the elderly. An adverse socioeconomic position partially explains the poor health of these immigrants. In turn, their poor health explains most of their higher use of health care. Cultural factors and poor living conditions seem to contribute to the poor health of immigrants, besides an adverse socioeconomic position. The pressure on various health services will increase in future because of the relatively high increase in immigrants' needs at older ages and their presently low mean age.
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                Author and article information

                Contributors
                i.verhagen-3@umcutrecht.nl
                b.steunenberg@umcutrecht.nl
                n.j.dewit@umcutrecht.nl
                w.j.g.ros@umcutrecht.nl
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                13 November 2014
                13 November 2014
                2014
                : 14
                : 1
                : 497
                Affiliations
                Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Mailbox 85500, 3508 GA Utrecht, The Netherlands
                Article
                497
                10.1186/s12913-014-0497-1
                4241213
                25391432
                303020d2-4ffc-4063-9951-9cb5ea6b9fd1
                © Verhagen et al.; licensee BioMed Central Ltd. 2014

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 6 December 2013
                : 6 October 2014
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2014

                Health & Social care
                community health worker,ethnic minority older adults,access to health care,systematic review

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