Table 38Effect of CHW interventions on behavior: strength of evidence

Number of Studies; # of SubjectsRisk of Bias

ConsistencyDirectnessPrecisionOther Modifying Factors (Intensity, Confounding)ResultsOverall Strength of Evidence
Health promotion and disease prevention: health promotion – Latina health
1; 35764,65High

1 RCT/poor
Consistency unknown (single study)IndirectNot reportedPresentNo difference between CHW intervention and tailored or off- the-shelf interventionsLow
Health promotion and disease prevention: disease prevention
5; 1,125+12 churches16,67, 105,107,118,119,127Medium

5 RCTs/3 fair, 2 poor
InconsistentIndirectImprecisePresentMixed results: 3 of 5 studies favor CHW intervention vs. control (no intervention, combination of interventions, media/print)Low
Injury prevention: home safety
2; 2,909101,102Medium

2 RCTs/1 fair, 1 poor
InconsistentIndirectPrecisePresentNo difference between CHW and health professional or no interventionLow
Injury prevention: workplace safety

1 prospective cohort/poor
Consistency unknown (single study)DirectImprecisePresentFavors CHW over community interventionLow
Maternal and child health: environment conducive to child well-being
3; 1,05275,76,78,84,128Medium

3 RCTs/2 fair, 1 poor
InconsistentDirectImprecisePresentMixed results: Most with no difference between CHW & control; some benefit to CHW over no interventionLow
Cancer screening: planned use of screening tests
2; 1,61263,116Medium

1 RCT, 1 cohort/1 fair, 1 poor
InconsistentIndirectImprecisePresentMixed results: 1 study shows benefit in CHW arm vs. usual, other shows no difference vs. no interventionLow
Cancer screening: breast self-examination
5; 3,79861,62,108,110–112,116,125Medium

2 RCTs, 3 cohorts/3 fair, 2 poor
InconsistentDirectImprecisePresentMixed results: 2 of 5 studies show benefit of CHW vs. alternative (mail or minimal CHW), 3 of 5 show no difference vs. delayed or no interventionLow
Chronic disease management: diabetes mellitus
2; 21388–92,124Medium

2 RCTs/fair
ConsistentIndirectPreciseAbsentFavors CHW intervention vs. usual care plus newsletterLow
Chronic disease management: asthma, use of bedding encasements
2; 57296,97,100Low

2 RCTs/1 good, 1 fair
ConsistentIndirectPreciseAbsentFavors CHW vs. less intense CHW arm or delayed CHW armModerate
Chronic disease management: asthma, other behaviors (smoking cessation, removal of mold)
2; 57296,97,100Low

2 RCTs/1 good, 1 fair
InconsistentIndirectImpreciseAbsentNo difference between CHW vs. less intense CHW arm or delayed CHW armLow

CHW, community health worker; RCT, randomized controlled trial.

From: 4, Discussion

Cover of Outcomes of Community Health Worker Interventions
Outcomes of Community Health Worker Interventions.
Evidence Reports/Technology Assessments, No. 181.
Viswanathan M, Kraschnewski J, Nishikawa B, et al.

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