Low-income neighborhoods experience disproportionately poor health outcomes due to many causes, including poverty, unemployment, historical disinvestment, unequal access to opportunity and a fragmented healthcare system. Place-based initiatives aim to improve the health of residents and reduce health disparities in low-income neighborhoods. A community health worker (CHW) and health advocate (HA) initiative was launched by the New York City (NYC) Health Department in partnership with the NYC Housing Authority, community-based organizations, and academic institutions in 5 public housing developments in Central and East Harlem, a neighborhood in which residents have historically viewed government and academic initiatives with caution and mistrust. Academic partners designed an evaluation to assess feasibility and measure intervention effectiveness at improving chronic disease management. The evaluation employed repeated surveys, biomeasure collection and participant authorization to obtain medical records. We analyzed participant consent to evaluation components, early-stage longitudinal follow-up rates, and initial satisfaction levels to assess acceptability of the intervention and evaluation design.
METHODS:
Between February-August 2015, 224 adult participants with at least one qualifying condition (hypertension, diabetes or asthma) from the 5 selected public housing developments were enrolled into the intervention. Another 176 residents with at least one qualifying condition were enrolled into a comparison group from 5 nearby public housing developments with comparable aggregate demographic profiles. Health data and biomeasures were collected using surveys administered by trained interviewers; the first survey was a baseline intake assessment, followed by 3 surveys at 3-, 6-, and 12-months, which are currently underway.
RESULTS:
For the intake assessment, 97.5% of residents consented to provide biomeasures on height, weight and blood pressure (n=219 intervention; n=171 comparison) and 90.3% signed HIPAA authorization forms to access medical records to aid the evaluation (n=207 intervention; n=154 comparison). At 3-months post-enrollment, 366 residents (92% overall) completed a follow-up survey (87% intervention; 97% comparison). On a 1-10 scale, with 10 meaning resident is “totally satisfied” with their CHW, 81.3% of residents scored their satisfaction as 9 or 10. Six-month post-enrollment data collection is currently ongoing.
CONCLUSIONS:
Acceptance of evaluation monitoring, biomeasure collection and requests to access medical records was high in this community, as were initial longitudinal follow-up response rates, potentially reflecting strong interest and satisfaction in the CHW- and HA-led services.