Study reveals efficacy of CHW-led iniatives in maternal health outcomes

A study published by BMJ Open revealed that expectant mothers serviced by community health workers are less likely to experience low birthweights and pre-term deliveries compared to those who did not receive those supports. 

The ten-year study, conducted by the University of Arizona and Northern Arizona University, examined if participation in the Arizona Health Start Program reduced the rates of low birthweight and pre-term births compared to the same groups of people who did not.

The Arizona Health Start Program is a community health intervention program designed to reach mothers facing specific social determinants of health including racial discrimination, poverty, and previous adverse birth experiences. The program helps members access education and health programs and provides health and developmental screenings for mothers and children up to age two.

 

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Researchers noted that maternal and child health (MCH) inequities are associated with a variety of social and structural determinants beyond the control of individual community members. Their research found that racial discrimination, economic status, and access to quality care “consistently track” with rates of low birthweight (LBW), very low birthweight (VLBW), extremely low birthweight (ELBW) and pre-term birth. 

“It is widely accepted that societal-level influences, including exposure to discrimination, living in disadvantaged neighborhoods, experiencing low socioeconomic status (SES) and lacking access to health insurance, all contribute to the cumulative physiological damage on the body caused by environmental stressors.” 

To test how much of an impact community health workers (CHW) have on improving these outcomes, researchers compared 7,212 Health Start Program mothers with 53,948 mothers who were not enrolled. Arizona’s diverse population allowed researchers to track a wide range of participants, including Native American and Latin populations with a proportionally smaller African American population. 

The study saw a “statistically significant” improvement in almost all subgroups. 

“Consistent with our hypothesis, women enroled [sic] in the Health Start Programme prior to giving birth over the study period of 2006–2016 had improved birth outcomes, with the most statistically significant effects among American Indian women, women with pre-existing health risks, Latina women and teen mothers.” 

Native American mothers experienced the most significant improvement in nearly all subgroups. LBW among this group was 38% lower than the control group and 25% lower for those with pre-existing conditions. Some other subgroups noticed very little statistical improvement. Teenage mothers delivering pre-term saw an improvement of only 0.21%.

Although the statistical result appeared small, the researchers say the impact of this improvement is significant. Cost savings to the state alone can be in the millions. 

“Early healthcare costs associated with a surviving ELBW infant is approximately $202,700 compared with $1,100 for a healthy infant. [A] −0.2%-point effect translates to approximately 16 fewer ELBW cases, translating to an estimated cost savings of $3.2million.” 

Researchers believe this is the largest study of its kind. These findings provide evidence of the efficacy of home visiting community health worker interventions, particularly as they relate to the  social determinants of health. 

“These findings provide important evidence supporting the efficacy of CHW-led home visiting interventions generally, and specifically CHW’s ability to address MCH equity in ethnoracially and geographically diverse, and socioeconomically disadvantaged populations of mothers and children.”