Community Health Worker Interventions Addressing Social Determinants of Health in Chronic Disease: A Systematic Review

Chronic diseases disproportionately affect people facing social and economic adversity. Community health workers (CHWs) are increasingly recognized as a key workforce for addressing social determinants of health (SDOH). However, evidence for the effect of CHW-led interventions on social and clinical outcomes among US adults with chronic disease is limited. This systematic review evaluated the effects of CHW-led interventions on SDOH and health outcomes.

Following PRISMA guidelines and a registered Prospero protocol, we searched PubMed, Scopus, and Embase (Ovid) in April 2024 for US-based randomized or quasi-experimental studies involving adults with chronic disease and a patient-facing CHW intervention addressing at least 1 SDOH domain. Eligible studies were required to have a comparator group and report social or health outcomes. We used standardized forms to extract data and assess quality.

We identified 1,939 records and screened 1,058 abstracts. We reviewed 110 full-text articles; 7 studies met inclusion criteria. All were randomized controlled trials addressing at least 1 SDOH domain. Interventions most commonly targeted health care access, housing stability, or care coordination among adults with diabetes, HIV, asthma, hepatitis C, or hearing loss. CHW interventions demonstrated improvements in several condition-specific clinical outcomes, but overall effects on major clinical indicators were modest and inconsistent.