Community health workers are non-medical staff who assist health care systems by providing a range of support services to patients, including home visits, health education, and first aid.
Cheryl Y. S. Foo, Ph.D., of Massachusetts General Hospital, and colleagues examined data from 196 adults with SMI (such as schizophrenia or bipolar disorder) as well as tobacco use disorder who received community health worker support as part of a clinical trial on smoking cessation. The community health workers visited participants in their homes or neighborhoods, encouraged them to set smoking-cessation goals, educated them about approved therapies, and assisted them with visits to their physician or self-help group. The community health workers also co-led group counseling sessions on smoking cessation alongside a clinically trained professional.
Foo and colleagues found that the participants who had more contact with community health workers—whether via home visits or group counseling sessions—were much more likely to quit smoking after two years compared with adults who had less community health worker engagement.
The optimal “dosage” of community health worker support—factoring in odds of success versus time commitment—was for an adult to have 30 to 65 visits over two years that lasted about 29 to 34 minutes each, as well as attending 20 to 57 group sessions over two years. Further increasing community health worker engagement above these levels only marginally improved tobacco-cessation outcomes, the researchers noted.
“Ideally, implementation of an evidence-based … intervention should strike a balance between the maximally efficacious dose and the dose that is reasonably affordable and feasibly accepted by a large enough proportion of recipients to maximize benefits in real-world settings,” they wrote.
As part of their study, Foo and colleagues also conducted qualitative interviews with patients, primary care physicians, and community health workers. The interviews indicated that the community health workers helped people quit by building trust and holding patients accountable. In addition, they were instrumental in breaking down structural barriers to treatment by helping to schedule appointments, provide transport, and ensuring insurance was up to date.
For related information, see the American Journal of Psychiatry editorial, “Social Determinants of Health and Smoking Cessation: A Challenge.”
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