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. 2024 Jul 10;8(1):469-479.
doi: 10.1089/heq.2024.0038. eCollection 2024.

"She's a Family Member": How Community Health Workers Impact Perinatal Mothers' Stress Through Social-Emotional Support and Connections to Programs and Resources

Justin Rex  1 , Nichole Fifer  2 , Karen D Johnson-Webb  3 , Maddi Menich  2 , Alyissa Horn  4 , Carly Salamone  5 , Holly T Renzhofer Pappada  6 , Camelia Arsene  7 , Crystal Martin  6 , Malcolm Cunningham  8   9
Affiliations

"She's a Family Member": How Community Health Workers Impact Perinatal Mothers' Stress Through Social-Emotional Support and Connections to Programs and Resources

Justin Rex et al. Health Equity. .

Abstract

Introduction: This study examines whether being a client in the Northwest Ohio Pathways HUB program reduces stress and improves mental wellbeing for perinatal mothers. The HUB works to improve health by connecting mothers to community health workers (CHWs) who assess mothers' risk factors and connect them to evidence-based care pathways to reduce known risks associated with adverse birth outcomes.

Methods: A one-time survey of 119 mothers in the program and monthly semi-structured interviews with 41 mothers, totaling 220 interviews.

Results: Almost all mothers reported significantly reduced stress after joining the program. The majority also reported an improved sense of safety, security, and hope. Interviews show additional moderate reductions in stress over time while being a program client. Interviews also indicate that mothers' relationship with their CHW is key to these improvements: CHW provide social-emotional support, access to tangible goods, and help navigating social service bureaucracies.

Discussion: The results support the broader literature on the health benefits of community health workers and address identified gaps within the literature, which has infrequently studied CHWs in the perinatal context.

Conclusion: CHWs may be one way to address racial inequity in birth outcomes linked to infant mortality, given research on the links between inequitable exposure to stressors, the impacts of racism-induced stress, and preterm and low birth weight babies. Further, the findings indicate the need to better support CHWs, and the programs that utilize them, with increased funding, insurance reimbursement, and certification.

Keywords: health disparities; minority health; pregnancy; reproductive health.

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Conflict of interest statement

The research in this article is part of a larger program evaluation of the Hospital Council of Northwest Ohio (HCNO) Pathways HUB program that was funded by a grant received from the Ohio Department of Higher Education. The co-authors of this study were all part of the funded grant team. Two of the co-authors (C.S., H.P.) work for or used to work for HCNO. One co-author (C.M.) currently works for HCNO but was involved in the study as an undergraduate research assistant while a student at Bowling Green State University. Two co-authors (C.A., M.C.) work for or used to work for ProMedica Health System, where some of the research participants were recruited. To maintain the objectivity of the research, coauthors from these organizations were involved in the project in an advisory capacity and identifying information about the research participants (CHWs, mothers) was kept confidential from these co-authors. In their advisory capacity as experts in the fields of medicine and public health, these co-authors shared study recruitment flyers with their staff and clients and provided a sounding board for questions about the research and feedback on the results. However, all decisions about research design, along with data collection and analysis, were conducted by the co-authors at (or formerly at) Bowling Green State University (J.R., N.F., J.A.W., M.M., C.M., A.H.).

Figures

FIG. 1.
FIG. 1.
Theoretical Links Between Racism, Stress, and Birth Outcomes and the Impact of Community Health Workers (CHWs). This model is adapted from those developed by other scholars. It displays the theorized relationship between historical and ongoing racism, stress exposure, the impacts of stress on health during pregnancy, and birth outcomes. In addition, it shows the potential impact CHWs can have on stress by providing social-emotional support and improving access to programs and health resources.
FIG. 2.
FIG. 2.
Risk Factors at Pathways HUB Enrollment. When clients enroll in the Pathways HUB, they complete an initial checklist with their CHW to screen them for known risk factors associated with infant mortality. Figure 1 shows the percentage of clients who indicated a risk factor at the time of their enrollment. The data are for mothers who enrolled between January 2018 and September 2020.
FIG. 3.
FIG. 3.
Mean Stress Level Before and After Pathways Enrollment. Clients were asked to rank their stress level before and after enrolling in the HUB: “On a scale of 1–10 (with 1 being the lowest amount of stress and 10 being the highest amount of stress), what would you say your stress level was before enrolling in the Pathways Hub Program?”; “On a scale of 1–10 (with 1 being the lowest amount of stress and 10 being the highest amount of stress), what would you say your average stress level was after enrolling in the Pathways Hub Program?”. Figure 2 shows that there was a substantively and statistically significant decrease in the self-reported stress level after enrolling. *Before: M = 7.12; SD = 2.66; After (M = 3.43; SD = 2.07); paired sample t test, t (114) = 14.08, p < 0.001). A one-way analysis of variance test (ANOVA) shows that there was not a statistically significant difference in the change in stress levels between the groups, F (3, 114) = 0.999, p = 0.39.
FIG. 4.
FIG. 4.
Average Stress Level at Time of Monthly Interview. Each month, interviewees were asked to indicate their stress level: First interview, “How is your current stress level on a scale of 1–10 (with 1 being low stress and 10 being high stress)?”; Subsequent interviews, “How is your current stress level? Last month when we spoke you said you were at a ___? Where would you rate your level now on a scale of 1 to 10 (with 1 being low stress and 10 being high stress?” This figure shows the mean stress level for mothers at each interview, indicating a small decrease in the average stress level over time.
FIG. 5.
FIG. 5.
Effects of HUB Participation on Feelings of Hope, Security, Isolation, and Safety. Survey respondents were asked: 1) “How has being in the Pathways HUB program impacted your overall feelings of hope?” 2) “How has being in the Pathways HUB program impacted your overall feelings of security?” 3) “How has being in the Pathways HUB program impacted your overall feelings of safety?” 4) “How has being in the Pathways HUB program impacted your overall feelings of isolation?” For each question respondents were given the option to answer, “significantly decreased, decreased, no change, increased, or significantly increased.” Figure 4 indicates the percentage of respondents who chose a given option for each question.
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