Feasibility of Clients of Community Health Workers from Minority Low-Income Communities as Research Participants

Abstract

The increased funding provided for Community Health Worker (CHW) hiring and training as part of the COVID-19 pandemic response was to increase their impact in alleviating the effects of negative social determinants of health in the lives of the most vulnerable individuals and communities. This enhanced use of CHW in vulnerable populations can also be used to improve access to such populations for applied research to study ways to improve health outcomes for low-income minority populations. We carried out a feasibility study using the State CHW association as partners to reach CHWs working with low-income minority population. Three hundred and three (303) clients of CHWs were interviewed on various demographic, health access, and employment information and both univariate and multivariate analyses was used to determine factors associated with being unvaccinated against COVID-19 and chi-squared used to determine if employment was associated with having health insurance. About half of the clients self-identified as Black/African American and half as Hispanic. Two-thirds were women and 52.1% were unemployed and 55.1% had no health insurance. There was no association between employment status and having health insurance. Majority (71.6%) had received one dose of a type of COVID-19 vaccine and being younger and being African American were associated with not getting a dose of COVID-19 vaccine, as well as being unemployed and not having health insurance. Most of the clients came to see the CHW about a Health/Healthcare issue of the five social determinants of health (SDOH). There were 38 different job titles provided by the clients and the job titles were mainly blue collar jobs and jobs in health and personal care. Our results indicate that CHWs reach the most vulnerable population who have limited health access and high unemployment and that CHWs can effectively be used for linkage to low-income minority population for applied research. Our analyses found that in this low-income population, being younger, being African American, being unemployed, and not having health insurance are each associated with not getting vaccinated against COVID-19, and employment is not associated with having health insurance. We have shown that partnership with CHWs to access their clients as research subjects leads to elucidating new information on the population that can be used in addressing public health programming.