Table 2.

Intervention Components and Outcomes of Included Studies Describing Community-Clinical Linkages with Community Health Workers

Article	Sample Size	Study Entry Criteria	Community Health Worker Activities				Study Design; Method	Outcome
			Participant Recruitment	Linkage	Follow-up Method	Other Activities
Balcazar 2005	223 families or 320 individual family members	Latino families	Promotora outreach in community settings	Cross linkage: a) nurse attended Promotora classes to facilitate screenings or b) Promotoras transported participants to clinics	Telephone home visits	Health education (group); outreach and awareness; participant advocacy	Program evaluation; Pre/post questionnaire and interviews	Improved heart-healthy behaviors; enhanced information sharing beyond families
de Heer 2015	413 participants	Hispanic adult, residents of 2 specific El Paso, TX zip codes; not pregnant	Promotora outreach in community settings	Promotoras based at YWCA, received referrals from clinic, linked participants to recreational resources	Telephone home visits email**	Health education (group); outreach and awareness;	Cohort study; Pre/post survey and clinical measures	Improved health-healthy behaviors and cardiovascular risk factors
Earp 1997 Earp 2002*	801 participants	Rural African American women 50 years and older	Lay Health Advisor outreach in community settings	LHAs linked women to Community Outreach Specialists based in county health department or clinics	Not specified*	COS: trained and coordinated LHAs; LHA: outreach and awareness; health education (group and one on one); navigation; participant advocacy*	Nonrandomized community trial; survey	Increased mammography screening
Felix 2011	919 participants	Medicaid recipients in 3 Alabama counties	CHW outreach in community settings and clinic referral	CHWs used clinic referrals to recruit participants and link them to resources	Not specified	Outreach and awareness; navigation	Longitudinal, quasi-experimental; Pre/post Medicaid record review	Reduced long term care service use and spending
Ingram 2005	589 graduated from program and were reached for follow-up	People of Hispanic decent living in 2 Arizona counties	Promotora outreach in community settings and clinic referral	Promotoras used clinic referrals to recruit participants and link them to resources	Telephone in 1st site; not specified in 2nd site	Health education; participant advocacy; social support	Participatory evaluation; Pre/post clinical measures, survey, qualitative interviews	Improved clinical measures and self-management behaviors
Ingram 2007	260 participants	People of Hispanic decent with type 2 diabetes	Promotora outreach in community settings and clinic referral	Clinic Promotoras cross referred to Community Promotoras; both provided referrals to SDH services	In-person telephone home, hospital, office visits	Health education (group); collaborating with providers; providing social support; participant advocacy	Participatory evaluation; Pre/post clinical measures, questionnaires, participation logs	Improved clinical measures among high risk patients; increased support from family and friends
Johnson 2014	224 patients	African American adults living with type 2 diabetes in Memphis, TN	Church Health Representative outreach in community settings	CHRs linked church members to resources	Case Managers followed-up via phone, email, mail, or other means such as text messaging	Outreach and awareness; participant advocacy	Program evaluation; Pre/post clinical data and survey	Improved: access to resources, self-management, trust and communication with provider, quality of life; improved clinical measures
Lemak 2004	3,666 client baseline survey respondents 266 client subset for follow-up information 40 stakeholder organizations	Uninsured individuals living in 1 Florida county	Health Navigator outreach in community settings	Health Navigators referred participants to the clinic	Not specified	Outreach and awareness; navigation	Case study; interviews, focus groups, reviews of notes and meeting minutes, surveys	Improved coordination between collaborative organizations
Peretz 2012	212 individuals	Families of children with asthma	CHW outreach in community settings and clinic referral	CHWs followed-up on hospital referrals and linked participants to resources	Weekly, monthly, then bimonthly check-ins, the manner of communication is not specified	Providing social support; health education	Program evaluation; Pre/post interview survey	Decrease in emergency department visits; increase in self-efficacy
Redding 2015	115 clients	Residents in 1 of 7 Ohio census tracts with high, low birth weight and poverty rates	Not specified	CHWs used Pathway model to link participants to resources and follow-up	Pathways	Navigation	Cohort study; vital statistics, intervention program, and medical records reviews	Decrease in LBW infants; cost savings
Wennerstrom 2015	31 patients	Vietnamese American adults with hypertension or diabetes	Clinic referral	CHWs used clinic referrals to recruit participants and link them to resources	Telephone home visits	Intervention protocol; participant advocacy; collaborating with providers; providing social support; health education	Program evaluation; Case conference meetings, project team meetings, survey	Participants satisfied with health education and CHW services; recommendations for CHW integration in PCMH

^*As noted earlier, in the case of the Lay Health Advisor program described by Earp, we found that the background information we needed for the review was in the 1997 Earp et al. article while the outcome information was in the follow-up article from 2002 (marked by a *). We included both articles as one study and noted in the methods section which details were retrieved from which article.

^**Information gathered from email correspondence with Dr. H.D. de Heer.