Engaging Community Health Workers in Research and Evaluation with Common Indicators and Methods

“CHW” is an umbrella title that refers to trusted community members who promote health and advance justice through direct care, community organizing, and serving as expert liaisons between care providers and community members. Community health workers (CHWs) were essential to health systems prior to the Covid-19 pandemic, and are now more critical than ever. Although growing evidence demonstrates the impressive impacts of CHWs in the US and globally, there is a lack of systematic data collection to fully demonstrate their various impacts and what they do to generate these impacts. CHWs have also been largely marginalized from the process of evaluating their own work. Thus, they’ve been disempowered with regards to a crucial strategy for bringing greater support to their workforce and their visions of health equity. The inconsistent engagement of CHWs contributes to ongoing inequities in health care workforces, clinical and research processes in health care settings, and health outcomes.

This paper will address these problems by summarizing the achievements of the CHW Common Indicators Project (CI Project), which aims to identify and recommend a set of evaluation indicators and methods to systematically assess the work and impacts of CHWs in the USA. The CI Project’s long-term objective is nationwide adoption of these indicators and development of infrastructure to collect data and report results, with the ultimate goal of optimizing CHW contributions through standardized monitoring and quality improvement, while centering CHWs as experts and leaders. The CI Project has involved a collaborative process beginning with interviews and surveys with CHWs, CHW employers, and evaluators in Michigan, followed by knowledge-building interactions with CHWs and other stakeholders from a growing number of states, communities, and organizations. The CI Project has focused on assessing the frequency of CHWs’ enactment of 10 core CHW roles, and developing indicators to track key kinds of support that CHWs need to be successful in all of their roles, including high-quality training, supportive and reflective supervision, and fair and equitable pay and benefits. Focal outcome indicators highlight outcomes that CHWs are uniquely suited to improve, including social and structural determinants of health and vulnerability, self-perceived health, empowerment, social support, and quality of life. The CI Project also attends to policy and systems change, which is both a process that can enable CHW work, and an outcome that CHWs can mediate through their community organizing, advocacy, and coalitional activism.