Community Advocate Programs Improve Accessibility and Quality of Health Care

Community advocates link people in underserved neighborhoods with proper health care services. Cheryl A. Maurana, PhD, a Professor of Family and Community Medicine and the Director of the Center for Healthy Communities at the Medical College of Wisconsin, recently helped develop a successful community health advocate program in Dayton, Ohio. She wrote about the Dayton program, and about the common elements and proven benefits of community advocate programs in the April 2000 issue of the journal Family and Community Health.

Helping people deal with health and health care issues at the community level, community advocates also serve as liaisons with formal health service organizations. Proven benefits of using community health advocates include improving local awareness of and the accessibility of health care services; improving the quality and sustainability of health services in underserved communities; giving communities a sense of power to effect change; strengthening local economies; decreasing the costs of care; and increasing communication about health and health care among families, community members and health care providers who then become collaborators in identifying and resolving health-related problems in the community.

"Although no single outreach model or demonstration project is applicable to all communities and circumstances," Dr. Maurana notes, "common elements among successful programs have been found." These include:

• The focus should be on a community needs assessment.
• The advocates should be reflective of the community in which they will be working.
• Programs should be well structured and have institutional support and function on a constant improvement model.
• Health providers and the community-at-large should be educated about the role of the outreach workers.
• A reward and advancement system should exist for the advocates.
• Referral linkages should exist with community-based health care and service agencies.
• Reliable long-term funding should exist.
• Ongoing outcomes-based evaluation and documentation processes should be used to monitor and improve the program.

The Dayton Model

1. Determine community-identified needs.
2. Develop common goals.
3. Develop a working partnership among key players in the community.
4. Form a community health advocate (CHA) committee to plan, implement and evaluate the program.
5. Recruit advocates.
6. Develop training for advocates.
7. Promote the program in the community.
8. Involve health profession students whenever possible.
9. Develop an evaluation process that involves continuous feedback and improvement.

In Dayton, two groups of often uninsured, underserved people -- white Appalachians in East Dayton and African-Americans in West Dayton -- were educated and linked to health or human services by advocates. The two populations shared a problem: access to health care. Many had had negative experiences accessing care and did not know their health care options. Advocates helped people overcome barriers, such as uninformed and misinformed providers, so they could benefit from programs for which they qualified.

"A key component of the program," Dr. Maurana says, "is empowering people in underserved neighborhoods to become active participants in their own health and the health development of their communities -- neighbors helping neighbors."

A client survey found that 71% of respondents reported that their advocate had been very helpful to them and 23% reported that the CHA had been somewhat helpful. When asked if they would recommend working with an advocate to someone else, 97% said yes.

The community partnership of the CHA program continues to act as a force for change in the health professions' education and in health care delivery, stressing the philosophy of "doing with" instead of "doing for" or "doing to."

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.