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Health Services Research & Development

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2015 HSR&D/QUERI National Conference Abstract

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3076 — Incorporating Community Health Workers into VA Care: What Do Veterans Think?

Silverman JB, VA Puget Sound; Krieger J, Public Health -- Seattle King County; Nelson KM, VA Puget Sound;

Objectives:
Community health workers (CHWs) are lay members who work to improve access to healthcare and social services, support adoption of healthy behaviors and improve overall health. Within the Department of Veterans Affairs (VA), CHW utilization is rare. However, a VA-funded systematic review of healthcare disparities recommended integration of CHWs into VA settings. We conducted a qualitative study to evaluate Veterans' experiences working with a CHW and assess the acceptability of CHW utilization within the VA.

Methods:
We conducted 14 semi-structured phone interviews with Veterans who had received a CHW intervention as part of a randomized controlled trial, Peer AID, which tested a home-visit diabetes self-management program. Peer AID participants had poorly controlled type 2 diabetes (A1c ?8.0%), household income < 250% of the federal poverty level and were 30-70 years old. The CHWs were non-Veterans and paid employees of Public Health - Seattle and King County. Phone interviews occurred after completion of Peer AID study. The recorded interviews were transcribed and analyzed using inductive content analysis.

Results:
Veterans reported high satisfaction with the CHW intervention. Veterans appreciated the convenience of CHW home visits, which allowed Veterans to receive care without the expense and stress of traveling to the VA. They valued the one-to-one attention and the amount of time the CHW spent with them. None of the Veterans were bothered by the non-Veteran status of the CHWs; the CHWs' knowledge and training were more important than their Veteran status. However, several participants mentioned that having a Veteran who has firsthand knowledge of the VA system could be valuable. Participants supported the idea of incorporating CHWs into the VA system.

Implications:
Veterans had overwhelming positive experiences working with a CHW and encouraged the use of CHWs within the VA. The services provided by CHWs are well aligned with the VA's Patient Aligned Care Team (PACT) model, which emphasizes comprehensive, patient-centered, team-based care that improves access and connects Veterans to appropriate services within the VA and the communities in which they live.

Impacts:
Incorporating CHWs into VA care may be an effective intervention to improve chronic disease management and reinforce the PACT principles of Veteran-centered, comprehensive, coordinated care.