Toward an institutional perspective on social capital health interventions: lay CHWs as social capital builders
Sociol Health Illn. 2020 Jan;42(1):95-110. doi: 10.1111/1467-9566.12992. Epub 2019 Nov 1. [Pubmed Abstract]
This article argues that social capital health research should move beyond a mere focus on social cohesion and network perspectives to integrate an institutional approach into the development of social capital health interventions. An institutional perspective, which is unique in its emphasis on linking social capital in addition to the bonding and bridging forms, contextualises social capital, allowing researchers to confront the complexity of social relationships. This perspective allows for the construction of interventions that draw on the resources of diverse actors, particularly the state. One intervention strategy with the potential to create community linkages involves lay community health workers (LCHWs), individuals who are trained to perform a variety of health-related functions but lack a formal professional health education. This article…
N Engl J Med. 2019 May 23;380(21):1990-1992. [Pubmed Abstract]
Lapidos A, Lapedis J, Heisler M
Health care financing in the US, especially since the passage of the Affordable Care Act (ACA) or “Obamacare,” has increased opportunities for financing peer support and community health worker (CHW) programs. In this week’s Tuesday Tip, our colleague, Michele Heisler, and two of her other colleagues from the University of Michigan, Adrienne Lapidos and Jeremy Lapedis outline the case for routine financing of CHWs and several possible mechanisms and paths to accomplish this.
Opportunities include 2018 Medicare provisions to cover CHW and other nonmedical benefits especially for those with chronic diseases. This follows earlier Medicaid provisions included in the ACA to cover CHW and other supportive services for those with mental health and chronic conditions. Medicaid has also updated rules to encourage Medicaid MCOs to cover services including those addressing social…
Am J Public Health. 2017 Oct;107(10):1660-1667. [Pubmed Abstract]
Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA
To determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions.
We conducted a single-blind, randomized clinical trial in Philadelphia, Pennsylvania (2013-2014). Participants (n = 302) were high-poverty neighborhood residents, uninsured or publicly insured, and diagnosed with 2 or more chronic diseases (diabetes, obesity, tobacco dependence, hypertension). All patients set a disease-management goal. Patients randomly assigned to CHWs also received 6 months of support tailored to their goals and preferences.
Support from CHWs (vs goal-setting alone) led to improvements in several chronic diseases (changes in glycosylated hemoglobin: -0.4 vs 0.0; body mass index: -0.3 vs -0.1; cigarettes per day: -5.5 vs -1.3; systolic blood pressure: -1.8 vs…