Systematic review of U.S.-based randomized controlled trials using community health workers.
BACKGROUND
There is increasing concern about racial and ethnic disparities in health status and health care in the United States (U.S.). Recent recommendations to address these disparities have encouraged the use of community health workers (CHWs) as a promising intervention.


OBJECTIVE
The purpose of this review is to provide a systematic examination of randomized controlled trial (RCT) evidence regarding the usefulness of CHWs in the U.S. health care system.


METHODS
We searched electronic databases from January 1, 1990, to June 7, 2007, to identify RCTs using CHWs. Two researchers systematically reviewed all eligible articles. Data were extracted from each eligible study and independently reviewed by both investigators.


RESULTS
Twelve studies were eligible for inclusion in this review. Of those 12 studies, 10 demonstrated CHW efficacy in enhancing outcomes. Three of these studies addressed breast cancer screening behaviors and three evaluated Pap smear testing. The review found one study each in the areas of patient enrollment in research, early intervention services, child development, blood pressure reduction and control, and nutritional eating habits.


CONCLUSIONS
Although significant heterogeneity among studies precluded pooling of data and meta-analyses, the weight of the available RCT evidence suggests positive benefits may be attributable to the use of CHWs interventional strategy in the context of the U.S. health care setting.
Gibbons
M Christopher
MC
The Johns Hopkins University Urban Health Institute, USA.
Tyus
Nadra C
NC
D003153:Community Health Services; D003150:Community Health Workers / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D014481:United States