“If that goes away, the house of cards falls”: challenges and solutions to ensuring CHW sustainability

Frontiers in Public Health · 2026-05-12

The Community Health Workers (CHWs) for COVID Response and Resilient Communities (CCR) project supported CHWs to strengthen community resilience to combat COVID-19 and address health disparities. This qualitative, participatory case study aimed to identify the sustainability challenges and solutions faced by health organizations and care teams integrating CHWs as change agents. From June to August 2024, 27 interviews were conducted with CHWs ( n = 9), program staff ( n = 9), and program partners ( n = 9), each having expertise in CHW workforce capacity. This study targeted two domains (funding stability and strategic planning) of the Public Health Program Capacity for Sustainability Framework. Data were analyzed using thematic analysis. Funding stability coalesced around three sub-themes: (1) barriers to funding stability , (2) solutions to overcoming funding instability , and (3) the cascading impact on CHWs and communities . Strategic planning was categorized into two prominent sub-themes: (1) the systematic development of organizational strategic plans and (2) the use of data to support action-driven approaches for ensuring the sustainability of the CHW workforce within and across organizations. The findings provide strategies and actionable steps that organizations need to take to fully sustain the CHW workforce within their health systems, including: full inclusion of CHW participation in every decision-making phase; the inclusion of CHW sustainability plans within organizational strategic plans; and rigorous participatory evaluations of CHW-led interventions to demonstrate how CHWs are making an impact on health disparities and promoting health equity. The implementation of all or part of these strategies has important implications for health system transformation and advancing health equity.

A Case Study of CHW Integration in Two Health Departments in Southern Arizona

Journal of Ambulatory Care Management · 2025-05-09

The objective of our participatory case study of community health worker (CHW) integration was to describe the role of CHWs in two local health departments (LHDs). Study partners co-developed an interview guide based on an existing framework. Fourteen staff participated in interviews. CHWs build community trust for LHDs, provide LHD core services, identify community concerns and priorities, and address social determinants of health. Integration barriers include hiring protocols, lack of understanding of the CHW role, inadequate compensation, and sustainable funding. The study identified key factors for an integration process that promotes the effectiveness, wellbeing, and sustainability of the workforce.

The Arizona prevention research center vaccine confidence network: A Mobile health unit intervention and survey results of barriers and facilitators to COVID-19 vaccination

Vaccine · 2025-07-01

BACKGROUND: The COVID-19 pandemic revealed health disparities and disproportionate adverse health outcomes among Arizona's Hispanic population. Structural barriers and social determinants of health that Hispanics face are important determinants of vaccine access and uptake. The Arizona Vaccine Confidence Network (AzVCN) leveraged the expertise of the Arizona Prevention Research Center (AzPRC) and the resources of the Mel and Enid Zuckerman College of Public Health (MEZCOPH) Mobile Health Unit (MHU) to identify, implement and evaluate a MHU intervention to increase uptake of COVID-19 testing and vaccinations. METHODS: The AzVCN focused efforts on structural barriers facing Hispanic, rural, un/underinsured and farmworker communities in the four Arizona border counties. The AzVCN implemented a MHU intervention to reduce vaccination hesitancy and increase COVID-19 vaccination uptake among Hispanic rural, un/underinsured and farmworker populations in Southern Arizona from November 2021 through September 2022. A survey was conducted to assess barriers, facilitators, experiences, and beliefs of COVID-19 vaccination. RESULTS: Hispanics were diagnosed with COVID-19 at a higher percentage (41.9 %) compared to non-Hispanics (20.3 %). Additionally, Hispanics had received a COVID-19 vaccination approximately 10 % higher than non-Hispanics (93.3 % vs 84.8 %). Hispanics also had higher percentages compared to non-Hispanics of personally knowing someone who became seriously ill or died as a result of COVID-19 (63.4 % vs 49.2 %), work or school requiring a COVID-19 vaccination (47.5 % vs 32.2 %), thinking that most people at work or school would get a COVID-19 vaccine if mandated (68.7 % vs 52.5 %), and knowing that the COVID-19 vaccine lessens symptoms of COVID-19 would help in deciding to receive the COVID-19 vaccine (66.2 % vs 57.6 %). CONCLUSION: The COVID-19 pandemic had a major impact on the Hispanic community. Addressing structural barriers of COVID-19 vaccination had a major impact on vaccination experiences, knowledge, beliefs, and uptake among Hispanics in Southern Arizona. By leveraging the MHU to address COVID-19 vaccination structural barriers and misinformation, the AzVCN has made an impact in the COVID-19 vaccine efforts in Arizona.

Using human-centered design to advance health literacy in local health department programming: a case study

BMC Public Health · 2025-03-31 · 2 citations

BACKGROUND: Human-centered design (HCD) and behavioral science are structured, evidence-based methodologies used to develop and evaluate community-driven interventions. While HCD focuses on deeply understanding user needs and co-designing solutions, behavioral science applies empirically tested principles to drive behavior change. Together, these methodologies enable the development of interventions that are both user-centered and behaviorally informed. The Pima County Health Department and project partners leveraged these collaborative methodologies to assemble a Community of Practice to improve health literacy and adherence to COVID-19 public health practices among Hispanic/Latine individuals of childbearing age and ability in Pima County. METHODS: Human-centered design processes identified and evaluated barriers facing the target population. On the basis of these findings, two pilot interventions were implemented between July 2023 and November 2023: one in a clinical setting with 92 participants and another in a community setting with 207 participants. A mixed-methods approach was used to evaluate the impact of these pilots. Quantitatively, a pre-post evaluation and survey design estimated the effect of an intervention by comparing outcomes before and after implementation using paired t-test and chi-square tests. Qualitatively, structured post intervention interviews were conducted with participants who were randomly selected based upon their initial consent and willingness to participate. RESULTS: Participants in the clinical and community pilots perceived fewer barriers to health-seeking behaviors after the intervention. Both pilots increased participants' confidence in health-seeking behaviors (p < 0.01). Only the clinical pilot resulted in an increase in health literacy. In the clinical pilot, the number of unvaccinated participants decreased, and the number of participants who reported needing a booster increased. The community pilot did not find a statistically significant difference in COVID-19 vaccine uptake. CONCLUSIONS: Integrating human-centered design and behavioral science into public health interventions can improve health literacy and confidence in health-seeking behaviors among historically and contemporarily excluded populations. Local health departments can use these methods to develop multicomponent interventions that foster mutual co-invention with communities and improve population health outcomes. Future research should focus on long-term impacts and explore broader applications of these approaches in different contexts. TRIAL REGISTRATION: This project received University of Arizona IRB review and approval. This study was not considered a randomized controlled trial and did not require registration.

The family stress model in the context of the COVID-19 pandemic: Family cohesion as a source of resilience among Latinx families.

Journal of Family Psychology · 2025-06-23 · 5 citations

= 6.27 years) at T1, and the majority were U.S.-born (58.2%) and identified as female (90%). Results indicated that families who experienced more economic hardship during the COVID-19 pandemic also reported greater depressive symptoms, which, in turn, were associated with lower parental warmth. Parental warmth predicted lower adolescent depressive symptoms 1 year later, accounting for prior levels of youth symptoms. Overall, findings supported the indirect associations between greater economic hardship and youth's lower well-being, but also suggested that greater family cohesion moderated links such that it offset the negative association between parent's depressive symptoms and parenting practices. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

A Community-Based Participatory Approach in Applying the Sociocultural Resilience Model in U.S–Mexico Border Communities

Progress in community health partnerships · 2024-03-01 · 1 citations

BACKGROUND: Behavioral models play a key role in identifying pathways to better health and provide a foundation for health promotion interventions. However, behavioral models based in epidemiological research may be limited in relevance and utility in practice. OBJECTIVES: We describe a participatory approach within a community-based participatory research partnership for integrating epidemiological and community perspectives into the application of the sociocultural resilience model (SRM). The SRM posits that cultural processes have a symbiotic relationship with health-promoting social processes, which contribute to the health advantages among Mexicanorigin and other Latinx populations. METHODS: Community action board members engaged with academic partners to interpret and apply the SRM to a community-clinical linkages intervention implemented in the context of three U.S.-Mexico border communities. In a two-day workshop, partners engaged in a series of iterative discussions to reach common definitions and measures for SRM constructs. RESULTS: Partners described daily cultural processes as the food they eat, how they communicate, and a collectivist approach to getting things done. For intervention activities, the partners opted for intergenerational storytelling, sharing of food, and artistic forms of expression. Partners included measures of cultural nuances such as border identity and the complexities that often arise from navigating bicultural norms. CONCLUSIONS: Collaborative approaches within community-based participatory research partnerships can facilitate the adaptation and measurement of conceptual health behavior models in community practice.

Centering the role of community health workers in social risk screening, referral, and follow-up within the primary care setting

BMC Primary Care · 2024-09-13 · 5 citations

BACKGROUND: Community health workers (CHWs) remain an underutilized resource in social risk diagnostics in the primary care setting. This process evaluation study seeks to assess the role of CHWs in social risk screening, referral, and follow-up through process mapping to identify barriers to the process for future quality improvement efforts. METHODS: Researchers at the Arizona Prevention Research Center (AzPRC) engaged with two Federally Qualified Health Centers (FQHCs) in two of Arizona's major urban areas to evaluate their internal processes for social risk screening and intervention. The Consolidated Framework for Implementation Research (CFIR) was used to direct a process mapping exercise to visually describe the workflow, gaps, and barriers to identifying and addressing social risk. RESULTS: The process unveiled key areas for health system improvements in the community setting, the organizational setting, and in the implementation of social risk screening, referral, and follow-up. Further, process maps highlight the potential resources needed for effective CHW integration to address social risk in the primary care setting. CONCLUSIONS: Our findings demonstrate the importance of organizational tools, such as process mapping, to assist primary care settings in evaluating internal processes for quality improvement in addressing social risk and in effectively integrating the CHW workforce. Subsequent research will evaluate rates of social risk screening, referral, and follow-up within all of Arizona's FQHCs and propose models for CHW integration to address social risk in primary care and strengthen social risk screening reach and effectiveness.

Latinx youth’s and parents’ covid-19 beliefs, vaccine hesitancy and vaccination rates: Longitudinal associations in a community sample

PLoS ONE · 2024-07-24 · 6 citations

INTRODUCTION: The Latinx population has the second highest COVID-19 death rate among racial/ethnic groups in the United States and less than half of Latinx youth aged 5-17 years old completed their COVID-19 primary vaccination series as of September 2022. COVID-19 vaccine misinformation detrimentally impacts vaccination rates. In this study, we examined factors that predicted Latinx youth COVID-19 vaccine hesitancy and vaccination status. METHODS: A community-based sample of 290 Latinx parent and adolescent dyads from a Southwestern metropolitan area of the United States who were recruited to complete an online survey at baseline at T1 (August 2020 -March 2021) and one year later. We tested a longitudinal mediation model in which we examined individual and family factors that would predict youth COVID-19 vaccine hesitancy and vaccination status over time. RESULTS: Youth's pandemic disbelief (i.e., the belief that the COVID-19 pandemic is a conspiracy or not real) predicted greater youth's COVID-19 vaccine hesitancy, and in turn, a lower likelihood of youth's COVID-19 vaccination. Youth's pandemic disbelief also predicted greater parent's vaccination hesitancy which, in turn, predicted greater youth's vaccination hesitancy and a lower likelihood of COVID-19 vaccination. Parents' pandemic disbelief predicted their own COVID-19 hesitancy, but not youth hesitancy. DISCUSSION: Our study findings provide initial evidence that general pandemic disbelief was a significant driver of vaccine hesitancy and vaccination among Latinx families. The study contributes to the limited research investigating COVID-19 vaccination in the Latinx community and among Latinx youth, further aiding how COVID-19 vaccine disparities can be mitigated among racial/ethnic populations.

Discrimination, Coping, and Diurnal Cortisol: A Daily Diary Study Among Latinx Adolescents in the U.S.

Psychoneuroendocrinology · 2024-02-01 · 1 citations

Risk factors associated with loneliness among mexican-origin adults in southern Arizona

BMC Public Health · 2024-06-25 · 2 citations

This study examines factors associated with symptoms of loneliness among a sample (n = 213) of mostly Mexican-origin adults at risk of chronic diseases in Southern Arizona's Pima, Yuma, and Santa Cruz counties. It uses baseline data from a community-based participatory research partnership and multinominal logistic regression models. Controlling for chronic diseases and sociodemographic characteristics, perceived social support and hope exhibit negative main effects on loneliness when comparing individuals who experienced loneliness for 5-7 days in the preceding week with those who did not encounter such feelings during the same period (adjusted odds ratio, AOR = 0.49 and 0.47; 95% confidence interval, CI = 0.34-0.73 and 0.29-0.75, respectively). However, when considered together, perceived social support and hope display a positive and statistically significant combined effect on loneliness (AOR = 1.03; 95% CI = 1.01-1.06). Holding all covariates constant, individuals reporting loneliness for 5-7 days exhibit a relative risk ratio of 1.24 (95% CI = 1.06-1.46) for a one-unit increase in physical problem severity compared to those who do not experience loneliness. Moreover, being 65 years old or older (AOR = 0.16, 95% CI = 0.03-0.84), and having been born in Mexico and lived in the US for less than 30 years (AOR = 0.12, 95% CI = 0.02-0.74) are associated with negative main effects on loneliness when comparing individuals who experienced loneliness 1-2, and 5-7 days in the preceding week with those who did not feel loneliness during the same timeframe, respectively. Recognizing the crucial role of loneliness in shaping health outcomes for Mexican-origin adults, our findings underscore the significance of fostering supportive environments that not only enhance well-being but also cultivate robust community bonds within the US-Mexico border region.