Table 41Effect of CHW intervention on health care utilization: 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; 10366Medium

1 RCT/fair
Consistency unknown (single study)DirectImprecisePresentNo difference between CHW and mailLow
Health promotion and disease prevention: disease prevention
1; 421105Medium

1 RCT/fair
Consistency unknown (single study)DirectPreciseAbsentFavors CHW intervention vs. no interventionModerate
Maternal and child health: prenatal care and perinatal outcomes
1; 14579Medium

1 RCT/fair
Consistency unknown (single study)IndirectImpreciseAbsentFavors CHW vs. health professionalLow
Maternal and child health: Environment conducive to child well-being
1; 73078,128High

1 RCT/poor
Consistency unknown (single study)IndirectImprecisePresentNo difference between CHW intervention and routine clinical careLow
Cancer screening: Pap smears
6; 4,36617,18,61–63,110–112,125Low

5 RCTs, 1 observatio nal/1 good, 4 fair, 1 poor
InconsistentDirectImprecise (when reported)PresentMixed results: 3 of 6 studies show some difference between CHW and minimal CHW, media, direct mail, and usual care, 3 show no difference between CHW and mail or no interventionLow
Cancer screening: mammography
11; 17,40115,17–22,59– 62,103,104,108,110–113,116,125,177Medium

6 RCTs, 5 observational studies/2 good, 4 fair, 5 poor
ConsistentDirectPrecise (when reported)Present8 of 11 studies favor CHW vs. no intervention, mail, print, or minimal CHW; 3 show no difference CHW and no- intervention controlModerate
Cancer screening: clinical breast examination
4; 3,38661,62,110–112,116,125High

2 RCTs, 2 observational/2 fair, 2 poor
ConsistentDirectImprecisePresentNo difference between CHW intervention and mail, CHW in lesser capacity and no interventionLow
Cancer screening: colorectal cancer screening
2; NR107, 78106High

2 RCT/1 fair, 1 poor
InconsistentDirectNRPresentMixed results, 1 study favors CHW versus usual care, the other shows no difference between CHW intervention and controls (no- intervention control, tailored print and video)Low
Chronic disease management: hypertension
1; 722123High

1 cohort/poor
Consistency unknown (single study)DirectNot reportedPresentFavors CHW intervention vs. no interventionLow
Chronic disease management: infectious diseases
1; 244122Medium

1 RCT/fair
Consistency unknown (single study)DirectPreciseAbsentFavors CHW intervention vs. control group given bus tokens, but monetary incentive was more effective than CHW or control given bus tokensModerate
Chronic disease management: mental health
1; 165120,121High

1 RCT/poor
Consistency unknown (single study)IndirectNot reportedPresentNo difference between CHW intervention and usual care (health professionals)Low
Chronic disease management: asthma
2; 57296,97,100Low

2 RCTs/1 good, 1 fair
ConsistentDirectPreciseAbsentFavors CHW vs. less intense CHW arm or delayed interventionModerate

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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