Lay Health Worker Model
In this model, community health workers (CHWs) are members of the community they serve and share many of the same social, cultural, and economic characteristics. Depending on the community, lay health workers are known by other titles including promotoras de salud, aunties, and sister-friends.
As trusted members of their community, lay health workers have insight on local health issues and provide information and services tailored to community needs and values. They are the bridge between the populations they serve and the healthcare system. Lay health workers are uniquely positioned to work alongside clinical staff, as a member of the care delivery team, in a variety of practice settings. They often fulfill one or more of the following roles: patient advocate, health educator, mentor, and outreach worker.
Rural communities may use this model to improve the health of migrant and seasonal farmworkers and their families. Lay health workers who work specifically with migrant and seasonal farmworkers may also be called migrant health promoters. These lay health workers often conduct environmental health and home assessments and deliver education about environmental health hazards. They address topics such as lead poisoning prevention, water quality, hazardous waste, and pesticide safety. These types of programs are also common in rural communities along the U.S.-Mexico border.
Examples of Rural Lay Health Worker Models
- The Ben Archer Health Center implemented Health without Borders with the goal of improving health and addressing chronic diseases, such as diabetes, through health education for management and prevention, improved access to care, and better integration of CHWs into the healthcare system. Lay health workers provided outreach, education, health screenings, and other services among border residents and migrant and immigrant populations within the service area.
- The AMIGAS program engaged lay health workers to offer a program that delivered health education and promoted cervical cancer screening. The program doubled the rate of cervical cancer screening among a specific population of women in one border community and one urban community in Texas and one rural community in Washington.
Implementation Considerations
The Lay Health Worker model is most effective when CHWs are members of the population served, not just people who share some characteristics with the communities they serve. This helps ensure they are aware of local health issues, which facilitates their ability to deliver tailored health education, resources, and information. Lay health workers may address a wide range of health information, including potentially sensitive topics, such as violence and abuse and health topics or diseases for which people may experience or perceive stigma.
Even when lay health workers are from the community they serve, they may encounter barriers to delivering education and providing services. A common barrier in border communities is lack of trust between the people living in the community and the program. Another common barrier in rural and frontier communities is limited transportation and geographic barriers to travel. Programs should consider the implications of requiring travel of the lay health worker, including travel costs, time, and safety.