Community health worker (CHW)

Community health workers—also known as community health advocates, lay health educators, community health representatives, peer health promoters, community health outreach workers, and in Spanish, promotores de salud—are "community members who work almost exclusively in community settings. They serve as connectors between health care consumers and providers to promote health among groups that have traditionally lacked access to adequate health care."(Witmer 1995, p. 1055)

One of the most important features of CHW programs is that they strengthen already existing community network ties (Israel 1985; Institute of Medicine 2002). CHWs are uniquely qualified as connectors because they live in the communities in which they work, understand what is meaningful to those communities, communicate in the language of the people, and recognize and incorporate cultural buffers (e.g., cultural identity, spiritual coping, traditional health practices) to help community members cope with stress and promote health outcomes (Wilson, Brownstein, & Blanton, 1998; Walters & Simoni 2002).

CHWs can build partnerships with formal health care delivery systems to connect people with the services they need and to stimulate social action that influences community participation in the health system and political dynamics (DiClemente, Grady & Kegler 2002). Such workers provide a community-based system of care and social support that complements, but does not extend or substitute for, the more specialized services of health care providers (Oregon Public Health Association).

CHWs also educate providers about the community's health needs and the cultural relevancy of interventions (Witmer 1995) by helping providers and health care systems build their cultural competence (Institute of Medicine 2002). Using their unique position, skills, and an expanded knowledge base, CHWs can feasibly help reduce health care and personal costs as they help improve outcomes for community members (Witmer 1995).

The National Community Health Advisor Study, conducted by the University of Arizona and the Annie E. Casey Foundation (Wiggins & Borbon 1998), reached almost 400 CHWs across the country to help identify the core roles, competencies, and qualities of CHWs. The following seven core roles were identified:
 * Bridging cultural mediation between communities and the health care system;
 * Providing culturally appropriate and accessible health education and information, often by using popular education methods;
 * Assuring that people get the services they need;
 * Providing informal counseling and social support;
 * Advocating for individuals and communities within the health and social service systems;
 * Providing direct services (such as basic first aid) and administering health screening tests; and
 * Building individual and community capacity.