The role of community health workers in improving maternal and infant wellbeing: Findings from qualitative interviews with Bronx Healthy Start Partnership program participants

Full Description: Healthy Start is a long-standing, evidence-based initiative administered by the Health Resources and Services Administration (HRSA) that aims to improve health outcomes before, during, and after pregnancy and reduce the racial and ethnic differences in rates of infant deaths and negative maternal health outcomes. The Healthy Start model employs community health workers (CHWs) to conduct outreach and home visits, provide education, and connect expecting and new parents to health care and community-based resources.

In 2014, the Albert Einstein College of Medicine established the Bronx Healthy Start Partnership (BxHSP), its initial Healthy Start grant. BxHSP serves four community districts (4, 5, 7, and 11) in the Bronx – the county with the lowest median household income in New York State. These districts tend to fare worse than the Bronx in terms of economic stress and maternal and child health outcomes, with their predominantly Black and Latinx populations being disproportionately impacted.

The Center for Evaluation and Applied Research (CEAR) at The New York Academy of Medicine is conducting an evaluation of BxHSP and, if selected for the conference, its presentation would focus on findings from one evaluation component: interviews with BxHSP participants. From June through October 2020, CEAR evaluators conducted interviews in English and Spanish with 16 BxHSP participants. Interviews explored participant perspectives on the program, barriers and facilitators of program participation, and perceived program impacts. Interviews were recorded, transcribed, and analyzed using Nvivo 12.0, focusing on relevant pre-identified themes and themes that arose from the data. Saturation of themes most relevant to the evaluation was achieved. According to interviewees, participation in BxHSP activities and their relationships with the CHWs contributed to improved knowledge and skills related to childbirth and newborn care, as well as a sense of increased material and psychological support. Interviewees indicated that changes in knowledge, skills, and perceived support led to greater adherence to recommended newborn care practices; improved self-efficacy and empowerment related to health and parenting; and improved maternal mental health. Interview results facilitated the creation of a data-derived logic model used to affirm participants’ experiences and attribution of added value to the Healthy Start CHW model.

During the presentation, the presenter would use direct quotes from interviewees to illustrate the interview findings. The logic model would also be included in the presentation to provide a visual representation of BxHSP. Overall, the presentation would relate to the conference theme as it would highlight a program working to address some key challenges that mothers, families, and infants – particularly those experiencing poverty and who are part of racial and ethnic groups that are marginalized in this country – have faced and continue to face.

Abbreviated Description: The Bronx Healthy Start Partnership (BxHSP) provides services to new and expecting parents, seeking to reduce racial and ethnic differences in infant and maternal health outcomes in the Bronx. BxHSP relies on community health workers (CHWs) to conduct outreach and home visits, provide education, and connect families to resources. In 2020, evaluators interviewed 16 BxHSP clients to explore their perspectives on the program. Transcripts were analyzed using Nvivo 12.0. According to interviewees, program participation and their relationships with the CHWs contributed to improved knowledge and skills, as well as increased material and psychological support. In turn, this led to greater adherence to recommended newborn care practices; increased self-efficacy; and improved maternal mental health.