Original ArticlesTalk to PAPA A Systematic Review of Patient/Participant (PAPA) Feedback on Interactions With Community Health Workers Using a Depth Analysis ApproachGeorge, Sheba PhD; Dixon, Lydia Zacher PhD; Carrasco, Elsa MPH; Romo, Oscar BS; Vides, Lucia MPH; Balcazar, Hector PhDAuthor Information Department of Preventive and Social Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California (Dr George); Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California (Dr George and Ms Carrasco); Health Science Program, California State University, Channel Islands, Camarillo (Dr Dixon); Anteater Instruction and Research Offices, University of California, Irvine (Mr Romo); Providence Health & Services, Southern California, San Pedro (Ms Vides); and College of Science and Health, Charles R. Drew University of Medicine and Science, Los Angeles, California (Dr Balcazar). Correspondence: Sheba George, PhD, Department of Preventive and Social Medicine, Charles R. Drew University of Medicine and Science, 1731 East 120th, Los Angeles, CA 90059 ([email protected]). The first author was supported by NIH National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant Number UL1TR001881 and NIH National Institute for Minority Health and Health Disparities Charles R. Drew University of Medicine and Science Accelerating Excellence in Translational Science (AXIS) Grant Number 3U54MD007598-09S1. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.ambulatorycaremanagement.com). Journal of Ambulatory Care Management: January/March 2020 - Volume 43 - Issue 1 - p 55-70 doi: 10.1097/JAC.0000000000000309 Buy SDC Metrics Abstract Because of their shared backgrounds, community health workers' (CHWs) care of patients/program participants (PAPAs) is assumed to be acceptable, and often not evaluated empirically. Using PRISMA guidelines, we reviewed 9560 articles from 5 databases, selected 37 articles for full-text review, and developed a 5-dimensional depth analysis (focus, context, meaning, range, and voices) to characterize quality/quantity of PAPA feedback. Depth analyses clarified a spectrum of PAPA responses from extremely positive to ambivalence to outright distrust and frustration with perceived CHW limitations. Designing evaluations with 5-dimensional depth analysis can enhance PAPA feedback quality and improve evidence-based, patient-centered, CHW care delivery. © 2020 Wolters Kluwer Health, Inc. All rights reserved.