Table 1 Definitions of constructs, a priori codes and related interview questions for the research
Construct | Connection to the literature | A priori sub-codes | Code definition | Related interview questions |
|---|---|---|---|---|
Roles and Responsibilitiesa | A description of the roles performed by CHWs. This may include formal job descriptions or informal descriptions of the tasks and/or responsibilities of CHWs. A literature review published by Hartzler et al. found that CHW roles in clinical settings could be categorized into three primary categories: (1) clinical services, (2) community resource connections, and (3) health education and coaching. (Hartzler 2018) But the IMPaCT model notably adds an additional CHW role—creative social support—which is not always included in all CHW models. (Kangovi 2018) | Clear definition | The extent to which a CHW’s role is clearly defined and articulated. This may include whether or not different members of the care team share a common definition regarding a CHW’s role. | Can you please describe your current role at UIC? a. What is your official job title? Do you have a different informal title? b. What are your primary roles and responsibilities? c. What department do you work in? |
Clinical services | “Examples include assessment of vital signs, lifestyle, health knowledge, psychosocial factors, and care through routine exams aided by remote communication with physicians. These services provide for patient dialog, helping care teams understand patients’ health, background, and preferences.” (Hartzler 2018) | |||
Community resource connections | “Community resource connections link patients with community-based services, such as referrals for transportation or food assistance” (Hartzler 2018) | |||
Health Education and Coaching | “Health coaching generally involved motivational interviewing and action planning to help patients achieve health goals. Health education typically targeted specific issues, such as cancer screening or self-management of a chronic illness.” (Hartzler 2018) | |||
Social Support | The ability to tailor interventions to patients needs which may have little to do with medical care. This may involve leveraging family, community, or grass-roots resources. It also may include the engagement of CHWs with the patient in the process of intervention or service delivery. (Kangovi 2018) | |||
Purpose and Value | The stated purpose for hiring/employing a specific group of CHWs. The purpose may be different among different members of the program or clinical care team. Some view CHWs as a strategy to address what has been identified as the “Triple Aim” in healthcare—improved patient experience, health of populations, and reduced cost. (Berwick, 2008) While others view CHW services through a health equity lens. Value involves how individuals define a CHW’s specific unique skills or qualities. The IMPaCT program at Penn defines CHW’s unique value as (1) they represent the populations that are being served, and (2) that they are “natural helpers.” (Kanvovi 2018) | Health Equity | Health equity is defined by the WHO as “the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification.” (who.int) | For CHWs: What do you view your purpose to be in your job? What do you think your patients/clients value most about you? What do you think the people that you work with at UIC value most about you? In what ways do you contribute to the work being done by clinicians at UIC? In what ways do you contribute to the health of the patients/clients that you work with? What are your own personal goals in your work? How successful are you in meeting your goals? For administrators: Why are you working with CHWs? What are the primary jobs that the CHW performs? Why are you working with CHWs? What are the primary jobs that the CHW performs? What do you value most about CHWs? [probe: what problems do CHWs help to solve?] What do you think patients/clients value most about CHWs? How do CHWs support (or not support) the goals of your program/department? |
Reduced Cost | Defined by the IHI as “reducing the per capita costs of care for populations” refers to the goal of achieving a measurable decrease in the cost of the provision of health care to target individuals or populations. But reduced costs may also refer to reduced costs for organizations, groups or individuals within the health system (such as a hospital system). | |||
Health Outcomes | Defined by the IHI as “improving the health of populations,” health outcomes refer to a measurable reduction in disease morbidity and/or mortality for groups or populations of people. | |||
Patient Experience | Defined by the IHI as “improving the individual experience of care” patient experience refers to how patients feel about their health care experience including people, places and processes. | |||
Community Representatives | The extent to which CHWs share similar characteristics—such as race, ethnicity, language, country of origin, income, education and/or community of residence with the populations that they are serving. | |||
Natural Helpers | The extent to which CHWs meet the definition of a “natural helper. A natural helper is defined as individual who is “innately empathetic and altruistic.” This may be demonstrated through listening skills, emotional intelligence, or a history of helping and caring for others. | |||
Measurement | The metrics used to measure or evaluate CHW performance or effectiveness. This may include quantitative or qualitative metrics. It also may include metrics related to patient outcomes or improvements to systems or workflows. The Institute for Clinical and Economic Review (2013) released a guidance paper regarding measurement of CHW outcomes. The following categories of measurement were included: process, knowledge/behavior change, satisfaction, health outcomes, or costs. (ICER 2013) | Process Measures | A consideration of the CHW process. This may include adherence to specific targets (number served, number of visits) or it may include assessments of improvements to processes, workflows or patient access. | For CHWs: How do you track whether your patients have made progress? For administrators: What are your goals/objectives for CHWs? When you think of CHWs why are they important to your work? How do you (or your department) evaluate CHWs? From your perspective, are CHWs meeting your goals/objectives? |
Behavior Change | The extent to which an individual patient changes a behavior that has been linked to improved health outcomes. For example, smoking cessation, change in salt intake, or change in prescription adherence. | |||
Satisfaction | A consideration of how satisfied individuals are with CHW services. This may include assessments of patient satisfaction or it may include satisfaction among other care providers due to improvements in work flow or patient care. | |||
Health Measures | The use of health metrics that measure an individual patient’s health status. This may include measures of disease control (such as CD4 or A1C), health status (blood pressure, cholesterol), or health management (hospitalizations, ER visits) | |||
Costs/ROI | The use of metrics to measure the costs associated with healthcare services. This may include an assessment of Return on Investment (ROI) or a consideration of insurance incentive payments. |