Elsevier

Academic Pediatrics

Volume 13, Issue 5, September–October 2013, Pages 408-420
Academic Pediatrics

Systematic Review
The Role of Lay Health Workers in Pediatric Chronic Disease: A Systematic Review

https://doi.org/10.1016/j.acap.2013.04.015Get rights and content

Abstract

Background

Children with chronic diseases represent a high-cost and resource-intensive population of children. With continued gaps in chronic disease management and persistent fragmentation in the health care system, stakeholders are seeking new strategies to address the needs of these children.

Objective

We sought to systematically assess the effectiveness of lay health worker interventions in improving health care utilization, symptom management, and family psychosocial outcomes for children with chronic conditions.

Data Source

PubMed, PsycINFO, and Web of Science (January 1961 to February 2013).

Study Eligibility Criteria, Participants, and Interventions

We developed a strategy to search citations to identify relevant articles. Search terms included randomized controlled trial (RCT), lay worker, parent mentor, peer mentor, peer educator, community health workers, community health aids, patient advocate, patient facilitator, patient liaison, promotoras(es), care ambassadors, patient navigator, and nonprofessional. Additional studies were identified by searching the reference lists of retrieved articles and contacting clinical experts. RCTs of lay health worker interventions for children with chronic conditions were included. Studies were restricted to those concentrated on children 0–18 years of age with chronic illnesses.

Study Appraisal and Synthesis Methods

Abstracts were independently screened by 2 reviewers. Articles with relevant abstracts underwent full text review and were evaluated for inclusion criteria. A structured tool was used to abstract data from selected articles. Because of the heterogeneous interventions and outcomes, we did not conduct a meta-analysis.

Results

The search yielded 736 unique articles, of which 17 met inclusion criteria. All interventions focused on specific conditions: asthma, type I diabetes, obesity, and failure to thrive. Interventions were heterogeneous in frequency, mode, and duration of interactions between lay health workers and subjects. Several interventions were multifaceted, including both one-on-one and group interactions. Improved outcomes most commonly reported were reduced urgent care use, decreases in symptoms, fewer missed work and school days, and increased parental quality of life. One study demonstrated that lay health worker interventions were cost-effective.

Conclusions

Lay health workers interventions in children with chronic conditions may lead to modest improvements in urgent care use, symptoms, and parental psychosocial outcomes. Such interventions may also be cost-effective. Future research should focus on interventions targeted toward other chronic conditions such as sickle cell disease or cystic fibrosis and medically complex children whose conditions are noncategorical.

Section snippets

Eligibility Criteria

We searched for randomized controlled trials (RCT) of interventions that were delivered by lay health workers to families of children 18 years of age or younger with chronic health conditions. Lay health workers were identified as individuals who were specifically trained to deliver a health-related intervention but who had no formal professional or paraprofessional training in health care. A lay health worker could not be a family member trained to provide care or support exclusively for

Results of the Search

The literature review yielded 736 unique articles, of which 27 articles met criteria for initial review (Fig.). After abstract review, 10 of the 27 studies were excluded because they did not meet inclusion criteria: 8 articles were eliminated as a result of nonrandomized design and 2 were eliminated because the study design did not include one-on-one interaction with the lay health workers. The final group of 17 studies comprised 4 specific pediatric chronic conditions: asthma, type I diabetes,

Discussion

The evidence for lay health worker interventions improving the care of children with chronic conditions is generally positive according to this review. Benefits of interventions included reduced urgent health care use, decreased symptoms, improved child health status, fewer missed parental work days, fewer missed child school days, improved parental quality of life, and increased self-efficacy. However, these findings were not consistent across all studies. Two studies demonstrated that

Conflict of Interest

The authors declare that they have no conflict of interest.

Acknowledgments

Supported in part by a grant to JLR (NIH grant 1K23 HL105568-01A1).

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