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Evaluating a Community-Placed and Clinically Integrated Community Health Worker Program

A Realist Approach

Njeru, Jane W., MB, ChB; Ridgeway, Jennifer L., PhD; Asiedu, Gladys B., PhD; Radecki Breitkopf, Carmen, PhD; Gunderson, Jean M., DNP; Quirindongo-Cedeño, Onelis, MD; O'Brien, Michael W., MSW; Nelson, Tara M.; Buzard, Ron, BS, MDiv; Wieland, Mark L., MD

The Journal of Ambulatory Care Management: April/June 2019 - Volume 42 - Issue 2 - p 116–127
doi: 10.1097/JAC.0000000000000268
Original Articles

Community health worker (CHW) programs can act as bridges between patients and health care teams, but the complexity and variability of program components and outcomes make them difficult to evaluate. This evaluation used a realist approach to identify underlying mechanisms and contextual factors associated with successful implementation of a community-placed CHW program affiliated with a primary care practice in the Midwest United States. The analysis identified mechanisms by which stakeholders built trust, self-efficacy, and empowerment to improve patient-centered outcomes and experiences. It also identified conditions that support activation of these mechanisms, including the ability of CHWs to make home visits, effective communication between members of the care team across settings, and clarity about the role of the CHW relative to other support services for patients. This type of context-mechanism-outcome evaluation facilitated development of recommendations responsive to local context.

Division of Primary Care Internal Medicine (Drs Njeru, Quirindongo-Cedeño, and Wieland), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Drs Ridgeway and Asiedu), Division of Health Care Policy and Research (Dr Radecki Breitkopf), and Department of Internal Medicine (Dr Gunderson and Ms Nelson and Mr O'Brien), Mayo Clinic, Rochester, Minnesota; and Intercultural Mutual Assistance Association (Ms Nelson and Mr Buzard), Rochester, Minnesota.

Correspondence: Jane W. Njeru, MB, ChB, Division of Primary Care Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (

This research was made possible in part by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The funders had no role in the data collection, interpretation, or reporting.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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