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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Breastfeeding.

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Strategy. Community Health Workers

Approach. Develop community health worker program to disseminate breastfeeding education to expecting and new parents

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Overview. Community health workers (CHWs), sometimes called lay health workers, promotores de salud, community health representatives, for community health advisors, serve a variety of functions including providing outreach, education, referral and follow-up, case management, and home visiting services. They may work with women at high risk for poor birth outcomes, providing pregnant women and new mothers with emotional and practical support and education on topics such as family planning, pregnancy, childbirth, breastfeeding, and vaccination.

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of community health workers (CHWs) trained to provide breastfeeding education and support. (Measures capacity building for program implementation) Number of expecting and new parents receiving breastfeeding education from CHWs. (Quantifies the reach and scale of CHW-provided education)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of CHW breastfeeding education that aligns with national guidelines and best practices. (Assesses quality and consistency of CHW-provided education) Percent of CHWs who complete training to provide responsive education. (Measures CHWs' ability to effectively serve all families)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of partnerships established between CHWs and clinical providers to coordinate breastfeeding support. (Assesses care integration and teamwork) Number of expecting parents experiencing disproportionate breastfeeding challenges identified and supported by CHWs. (Evaluates strategic outreach to focus populations) Number of mothers receiving CHW support who breastfeed exclusively for 6 months. (Measures impact on a key duration benchmark and health outcome) Number of parents who receive CHW education and report improved partner support for breastfeeding. (Shows CHWs' influence on family-level enabling factors)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of CHWs hired from and representative of the communities they serve. (Assesses CHW congruence and community connection) Percent of breastfeeding education funding allocated to CHW programs serving communities with limited resources. (Measures distribution of resources based on need) Percent reduction in gaps in breastfeeding initiation compared to pre-CHW program. (Evaluates impact on a key perinatal health indicator) Percent of low birthweight infants born to mothers receiving CHW support who are breastfed. (Links CHW efforts to a critical outcome for a population experiencing increased risk)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Lewin S, Munabi-Babigumira S, Glenton C, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database of Systematic Reviews. 2010;(3):CD004015.

2 Andrews JO, Felton G, Wewers ME, Heath J. Use of community health workers in research with ethnic minority women. Journal of Nursing Scholarship. 2004;36(4):358-65.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.