The Waco Community Health Worker Program: A Qualitative Investigation and Community Focused Restructuring

Abstract

Community health care worker programs have been increasingly used as a novel approach to reintegrating those historically excluded from healthcare, yet their varied characteristics lead to vastly different outcomes. The Waco Community Health Worker (CHW) Initiative is an example of a program with mixed results. The purpose of this study is to pin-point the weaknesses of the initial program and ways those issues may be concretely resolved. First, a background on CHW programs - their origin, their development, and the role they play in the healthcare system in the United States - is provided. Additionally, a review of the history of the Waco initiative is included. Two methods of research were used to collect data: a systematic literature review as well as snowball sampled general interview approach to collect qualitative data from key community informants. The interviews were transcribed via an A.I. transcription service, and then coded for themes and keywords using Atlas.ti. The qualitative data from the interviews was evaluated against the standardized six domains of successful CHW programs in the literature review in order to identify specific areas of strengths and weaknesses in the Waco program. Finally, potential structural and policy related revisions that would improve the effectiveness of the revised Waco CHW Initiative are suggested to improve program results after its reimplementation.