We are excited to publish this issue about community health workers (CHWs), also known as lay health promoters (promotore(a)s in Spanish), and lay health workers. Traditionally, CHWs have a long and valuable history as important and trusted members of communities who serve in various health roles. Often, CHWs are the ones to whom community members turn to for health advice, even though they may or may not have a formal health care background. They may have acquired an understanding of health and disease through experience, formal education, or informal on-the-job training. In many communities, the CHW is a trusted advisor who does not receive any formal recognition or remuneration for his or her work. Historically, formal health care practitioners, who wanted to have an effective practice in a community and who were conscious of community relations, strived to identify and develop friendly and collaborative relationships with community/lay workers.
However, the historical role of CHW/lay health workers has changed. Today, these workers are increasingly recognized, valued, and included in health care systems driven by changing practices of health care delivery and reimbursement. Community health workers are recognized for their ability to bridge the gap between formal health care practitioners, educators, researchers, and community residents. This is due to the CHWs demonstration of in-depth knowledge of community residents' beliefs, attitudes, and approaches to health care that formal practitioners often lack. Health care has moved from reliance on pharmacologic and technological approaches to disease treatment to a holistic and behavioral approach that includes primary, secondary, and tertiary prevention. As such, working with communities to advance health is essential, and CHWs provide the link that allows practitioners, educators, and researchers to gain entry into a community to promote positive health care practices and accomplish their work in tandem with community residents.
This issue presents many perspectives on CHWs. The work of Keller et al describes how to ensure that the intervention work done by CHWs adheres to the intent of the intervention (fidelity) and remains valid for the community and reliably provided. These are important components for building a research base that demonstrates CHW efficacy in changing health behavior. Ingram et al illustrate how the efforts of CHWs can be evaluated through a participatory approach with the community served by CHWs. Several of the articles have more of a "how to" approach, in that they provide the reader with ready-made suggestions for CHW collaboration. Ammary-Risch et al provide a tool kit to protect vision that can be used by CHWs and other community residents, and Spiro et al provide a model for the different types of projects CHWs can do in a community and how these projects can be evaluated. Three articles focus on disease reduction in Latino populations, specifically diabetes, heart disease, and HIV/AIDS (Collinsworth, Spinner, and Sanchez, respectively). The review of Stacciarini et al on English, Spanish, and Portuguese literature related to different kinds of mental health care done by CHWs contributes to an international understanding of the scope of practice and value of work by CHWs.
The articles presented in this issue offer thoughtful strategies for advancing the research support for CHWs. As the national perspective on health care moves from a practitioner's office to a community, CHWs are the natural collaborators for practitioners, educators, and researchers who wish to improve the nation's health. The editors thank all of the authors who responded to this call for sharing their insights into the work of CHWs as well as all the reviewers whose thoughtful comments guided the development of this issue.
-Elizabeth Reifsnider, PhD, RN, APRN,
BC, FAAN
Professor
College of Nursing and Health Innovation
Arizona State University
Phoenix
-Elnora (Nonie) P. Mendias, PhD, RN, FNP-BC
Professor
School of Nursing
University of Texas Medical Branch
Galveston, Texas
-Yolanda R. Davila, PhD, RN
Associate Professor
School of Nursing
University of Texas Medical Branch
Galveston, Texas