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Implementation Challenges

Many of the implementation challenge faced by rural community health worker (CHW) programs are similar to the challenges experienced by other rural health programs. For an overview of different implementation issues, see Common Implementation Challenges in the Rural Community Health Toolkit. Some of the unique challenges that rural CHW programs face include:

  • Access to transportation: The populations that CHWs serve often have limited access to transportation. Therefore, CHWs often travel to rural communities to provide services or conduct outreach.
  • Safety: Programs must ensure the safety of CHWs. CHWs may travel to remote areas where roads are unsafe or impassable due to inclement weather. Programs may provide safety training to CHWs. Other strategies to promote safety include daily reporting to supervisors, sharing travel routes and anticipated return times for home visits, storing sensitive client information in a locked file within a locked vehicle, and not transporting cash or medications.
  • Program resources: CHW programs emphasize the importance of providing resources such as weather survival kits, wireless Internet access cards and other technologies. However, if program funds are limited, such resources may not be available.
  • Cultural barriers: Program implementers may need to adapt materials, such as information packets, to ensure all program materials are culturally appropriate. For example, if patients are not comfortable with computers, CHWs may use paper charts to collect information during a home visit.
  • Patient referrals: Programs may encounter difficulties referring patients to medical providers, and coordinating services with outside providers and agencies. Some programs have acknowledged challenges integrating CHWs into healthcare systems.
  • Partnerships: Agreements with partners in the community and identifying opportunities to work with new organizations will help extend the reach of the CHW program.

Additional information on implementation considerations for different program models is available in Module 2.

Resources to Learn More

Addressing Chronic Disease through Community Health Workers: A Policy and Systems-Level Approach
Provides information and resources for integrating CHWs into community-based programs to prevent chronic disease. Includes policy guidance and examples of state legislative action.
Organization(s): Centers for Disease Control and Prevention
Date: 4/2015

Community Health Workers in the Midwest: Understanding and Developing the Workforce
Presents the results from an American Cancer Society assessment of CHWs' work including their professional needs and capacity to promote cancer prevention and early detection. Discusses how an evaluation of a CHW program can be conducted.
Author(s): Hardeman, R. & Gerrard, M.D.
Organization(s): Wilder Research
Date: 6/2012