Community Health Workers as a Strategy to Tackle Psychosocial Suffering Due to Physical Distancing: A Randomized Controlled Trial

Dorien Vanden Bossche, Sara Willems, Susan Lagaert, Peter Decat

Keywords: community health workers; primary healthcare; mental health; psychosocial support; vulnerable populations; COVID-19; health crisis

During the COVID-19 pandemic, many primary care professionals were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psychosocial support.

Research questions:
This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks.

CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined.

We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health.

This study confirms partially the existing evidence on the effectiveness of CHW interventions as a strategy to address mental health in PHC in a COVID context. Our findings support the potential of CHW interventions as a task shifting strategy to reduce family physicians’ and other primary care professionals’ workload. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises.

Points for discussion:
A hypothesis possibly explaining this contradiction could be that the intervention on itself was not community-oriented in its design nor in its implementation.