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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, or community health advisors, serve a variety of functions including providing outreach, education, referral and follow-up, case management, advocacy, 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. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

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 directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

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

PROCESS MEASURES:

  • 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.)
  • Number of community sites where CHWs deliver breastfeeding education (e.g., clinics, homes, schools). (Tracks the settings and accessibility of CHW services.)

OUTCOME MEASURES:

  • Number of parents who report increased breastfeeding knowledge after CHW education. (Assesses the educational impact of CHW interactions.)
  • Number of mothers visited by CHWs who initiate breastfeeding after delivery. (Links CHW support to a key short-term behavioral outcome.)
  • Number of referrals made by CHWs to breastfeeding support services and resources. (Measures CHWs' role in facilitating access to additional assistance.)

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

PROCESS MEASURES:

  • 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 cultural humility training to provide culturally responsive education. (Measures CHWs' ability to effectively serve diverse families.)
  • Percent of CHW-parent interactions that involve goal-setting and action planning for breastfeeding. (Evaluates use of empowerment-based approaches by CHWs.)

OUTCOME MEASURES:

  • Percent of parents who report high satisfaction with the breastfeeding education received from CHWs. (Measures perceived value and effectiveness of CHW support.)
  • Percent of mothers contacted by CHWs prenatally who attend a breastfeeding class before giving birth. (Assesses CHWs' influence on proactive breastfeeding education.)
  • Percent of CHWs reporting increased job satisfaction and self-efficacy as a result of breastfeeding training. (Captures CHW empowerment and professional development outcomes.)

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

PROCESS MEASURES:

  • Number of partnerships established between CHWs and clinical providers to coordinate breastfeeding support. (Assesses care integration and teamwork.)
  • Number of community breastfeeding promotion campaigns that feature CHWs as trusted messengers. (Measures CHWs' role in population-level education efforts.)
  • Number of expecting parents at high risk for breastfeeding challenges identified and supported by CHWs. (Evaluates strategic outreach to priority populations.)

OUTCOME MEASURES:

  • 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. (Captures CHWs' influence on family-level enabling factors.)
  • Number of provider referrals to CHWs for supplemental breastfeeding education and support. (Demonstrates provider buy-in and value placed on CHW services.)

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

PROCESS MEASURES:

  • - Percent of CHWs hired from and representative of the cultural communities they serve. (Assesses CHW cultural congruence and community connection.)
  • - Percent of breastfeeding education funding allocated to CHW programs serving high-need areas. (Measures equitable distribution of resources based on need.)
  • - Percent of CHW client caseload from priority populations with breastfeeding disparities (e.g., low-income, teens). (Tracks focus on groups with greatest needs.)

OUTCOME MEASURES:

  • - Percent reduction in socioeconomic disparities in breastfeeding initiation compared to pre-CHW program. (Evaluates equity 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 high-risk population.)
  • - Percent of all new mothers in the community who receive at least one CHW contact focused on breastfeeding. (Measures population-level reach and shifts community norms.)

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.