Role Development of Community Health Workers

An Examination of Selection and Training Processes in the Intervention Literature


      Research evaluating community health worker (CHW) programs inherently involves these natural community leaders in the research process, and often represents community-based participatory research (CBPR). Interpreting the results of CHW intervention studies and replicating their findings requires knowledge of how CHWs are selected and trained.


      A summative content analysis was performed to evaluate the description of CHW selection and training in the existing literature. First-level coding focused on contextual information about CHW programs. Second-level coding identified themes related to the selection and training of CHWs.


      There was inconsistent reporting of selection and training processes for CHWs in the existing literature. Common selection criteria included personal qualities desired of CHWs. Training processes for CHWs were more frequently reported. Wide variation in the length and content of CHW training exists in the reviewed studies. A conceptual model is presented for the role development of CHWs based on the results of this review, which is intended to guide future reporting of CHW programs in the intervention literature.


      Consistent reporting of CHW selection and training will allow consumers of intervention research to better interpret study findings. A standard approach to reporting selection and training processes will also more effectively guide the design and implementation of future CHW programs. All community-based researchers must find a balance between describing the research process and reporting more traditional scientific content. The current conceptual model provides a guide for standard reporting in the CHW literature.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Smedley B. Stith A. Nelson A. Unequal treatment: confronting racial and ethnic disparities in healthcare. IOM; The National Academies Press, Washington DC2003
      2. Cervical cancer. 1996; 14 (Apr 1−3): 1-38
        • USDHHS
        Community Health Worker National Workforce Study.
        USDHHS, Health Resources and Services Administration, Washington DC2007
        • Schroeder S.
        We can do better: improving the health of the American people.
        N Engl J Med. 2007; 357: 1221-1228
        • Aiken L.
        • Cheung R.
        • Olds D.
        Education policy initiatives to address the nurse shortage in the United States.
        Health Aff. 2009; 28: 646-656
        • Cohen S.
        A review of demographic and infrastructural factors and potential solutions to the physician and nursing shortage predicted to impact the growing U.S. elderly population.
        J Public Health Manag Pract. 2009; 15: 352-362
        • Lam T.K.
        • McPhee S.J.
        • Mock J.
        • et al.
        Encouraging Vietnamese-American women to obtain pap tests through lay health worker outreach and media education.
        J Gen Intern Med. 2003; 18: 516-524
        • Kash B.A.
        • May M.L.
        • Tai-Seale M.
        Community health worker training and certification programs in the United States: findings from a national survey.
        Health Policy. 2007; 80: 32-47
        • Berger P.
        • Luckmann T.
        The social construction of reality.
        Anchor Books, New York1966
        • Simpson B.
        Reviewing ‘role' in process of identity construction.
        Organization. 2008; 15: 29-50
        • Lynch K.
        Modeling role enactment: linking role theory and social cognition.
        J Theor Soc Behav. 2007; 37: 377-399
        • Hall J.
        Analyzing women's role through graphic representation of narratives.
        West J Nurs Res. 2005; 25: 492-507
        • Morgeson F.P.
        • Delaney-Klinger K.
        • Hemingway M.A.
        The importance of job autonomy, cognitive ability, and job-related skill for predicting role breadth and job performance.
        J Appl Psychol. 2005; 90: 399-406
        • Rhodes S.
        • Foley K.L.
        • Zometa C.S.
        • Bloom F.R.
        Lay health advisor interventions among Hispanics/Latinos: a qualitative systematic review.
        Am J Prev Med. 2007; 33: 418-427
        • Swider S.
        Outcome effectivenes of community health workers: an integrative literature review.
        Public Health Nurs. 2002; 19: 11-20
        • Hsieh H.F.
        • Shannon S.E.
        Three approaches to qualitative content analysis.
        Qualitative Health Research. 2005; 15: 1277-1288
        • Miller F.A.
        • Alvarado K.
        Incorporating documents into qualitative nursing research.
        J Nurs Scholarsh. 2005; 37: 348-353
        • Krieger J.W.
        • Castorina J.S.
        • Walls M.L.
        • et al.
        Increasing influenza and pneumonococcal immunization rates: a randomized controlled study of a senior center–based intervention.
        Am J Prev Med. 2000; 18: 123-131
        • Martin M.A.
        • Hernandez O.
        • Naureckas E.
        • Lantos J.
        Reducing home triggers for asthma: the Latino community health worker approach.
        J Asthma. 2006; 43: 369-374
        • Parker E.A.
        • Israel B.A.
        • Robins T.G.
        • et al.
        Evaluation of community action against asthma: a community health worker intervention to improve children's asthma-related health by reducing household environmental triggers for asthma.
        Health Educ Behav. 2008; 35: 376-395
        • Burhansstipanov L.
        • Dignan M.B.
        • Wound D.
        • et al.
        Native American recruitment into breast cancer screening: the NAWWA project.
        J Cancer Educ. 2000; 15: 28-32
        • Culica D.
        • Walton J.W.
        • Prezio E.A.
        CoDE: community diabetes education for Mexican-Americans.
        Proc (Baylor Univ Med Cent). 2007; 20: 111-117
        • Hunter J.B.
        • de Zapien J.G.
        • Papenfuss M.
        • Fernandez M.L.
        • Meister J.
        • Giuliano A.R.
        The impact of a promotora on increasing routine chronic disease prevention among women aged 40 and older at the US–Mexico border.
        Heath Educ Behav. 2003; 31: S18-S28
        • Erwin D.
        • Spatz T.S.
        • Stotts R.
        • et al.
        Increasing mammography practice by African American women.
        Cancer Pract. 1999; 7: 78-85
        • Brown S.A.
        • Garcia A.A.
        • Kouzekanani K.
        • et al.
        Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative.
        Diabetes Care. 2002; 25: 259-268
        • Humphry J.
        • Jameson L.M.
        • Beckham S.
        Overcoming social and cultural barriers to care for patients with diabetes.
        West J Med. 1997; 167: 138-144
        • Bullock K.
        • McGraw S.A.
        A community capacity–enhancement approach to breast and cervical cancer screening among older women of color.
        Health Soc Work. 2006; 31: 16-25
        • Gary T.L.
        • Bone L.R.
        • Hill M.N.
        • et al.
        A randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African-Americans.
        Prev Med. 2003; 37: 23-32
        • Baker L.M.
        Medical textbooks: can lay people read and understand them.
        Library Trends. 2004; 53: 336-347
        • Perez M.
        • Findley S.E.
        • Mejia M.
        • Martinez J.
        The impact of community health worker training programs in New York City.
        J Health Care Poor Underserved. 2006; 17: 26-43
        • Barnes K.
        • Namerow P.
        • Friedman S.M.
        • et al.
        Impact of community volunteers on immunization rates of children younger than 2 years.
        Arch Pediatr Adolesc Med. 1999; 153: 518-524
        • Hansen L.K.
        • Feigl P.
        • Modiano M.R.
        • et al.
        An educational program to increase cervical and breast cancer screening in Hispanic women.
        Cancer Nursing. 2005; 28: 47-53
        • Watkins E.
        • Larson K.
        • Harlan C.
        • et al.
        A model program for providing health services for migrant farmworker mothers and children.
        Public Health Rep. 1990; 105: 567-575
        • Fedder D.O.
        • Chang R.J.
        • Curry S.
        • et al.
        The effectiveness of a community health worker outreach program on healthcare utilization of west Baltimore City Medicaid patients with diabetes, with or without hypertension.
        Ethn Dis. 2003; 13: 22-27
        • Andrews J.O.
        • Felton G.
        • Wewers M.E.
        • Waller J.
        • Tingen M.
        The effect of a multicomponent smoking cessation intervention in African American women residing in public housing.
        Research in Nursing & Health. 2007; 30: 45-60
        • Campbell M.K.
        • James A.
        • Hudson M.A.
        • et al.
        Improving multiple behaviors for colorectal cancer prevention among African American church members.
        Health Psychol. 2004; 23: 492-502
      3. Israel B.A. Schulz A.J. Parker E.A. Methods in community-based participatory research for health. Jossey-Bass, San Francisco2005
        • Viswanathan M.
        • Ammerman A.
        • Eng E.
        • Garlehner G.
        • Lohr K.
        • Whitener L.
        Community-based participatory research: assessing the evidence.
        Evid Rep Technol Asses (Summ). 2004;August; : 1-8
        • Horowitz C.
        • Robinson M.
        • Seifer S.
        Community-based participatory research from the margin to the mainstream: are researchers prepared?.
        Circulation. 2009; 119: 2633-2642
        • Ingram M.
        • Torres E.
        • Redondo F.
        • Bradford G.
        • Wang C.
        • O'Toole M.L.
        The impact of promotoras on social support and glycemic control among members of a farmworker community at the US–Mexico border.
        Diabetes Educ. 2007; 33: S172-S178
        • Ramos R.
        • Hernandez A.
        • Ferreira-Pinto J.B.
        Promovisión: designing a capacity-building program to strengthen and expand the role of promotores in HIV prevention.
        Heath Promot Pract. 2006; 7: 444-449
        • Navarro A.
        • McNicholas L.
        • Cruz M.
        • et al.
        Development and implementation of a curriculum on cancer screening for small groups of Latino women.
        J Cancer Educ. 2007; 22: 186-190
        • Navarro A.
        • McNicholas L.
        • Senn K.
        • Kaplan R.
        • Campo M.
        • Roppe B.
        Use of cancer screening tests among Latinas: one and two years after participation in the Por La Vida Darnos Cuenta program.
        Women & Cancer. 2000; 2: 23-30
        • Navarro A.
        • Raman R.
        • McNicholas L.
        • Loza O.
        Diffusion of cancer education information through a Latino community health advisor program.
        Prev Med. 2007; 45: 135-138
        • Navarro A.
        • Rock C.
        • McNicholas L.
        • Senn K.
        • Moreno C.
        Community-based education in nutrition and cancer: the Por La Vida Cuidandome curriculum.
        J Cancer Educ. 2000; 15: 168-172
        • Navarro A.
        • Senn K.
        • Kaplan R.
        • McNicholas L.
        • Campo M.
        • Roppe B.
        Por La Vida intervention model for cancer prevention in Latinas.
        J Natl Cancer Inst Monogr. 1995; 18: 137-145
        • Navarro A.
        • Senn K.
        • McNicholas L.
        • Kaplan R.
        • Roppe B.
        • Campo M.
        Por La Vida model intervention enhances use of cancer screening tests among Latinas.
        Am J Prev Med. 1998; 15: 32-41