Abstract
The aim of this thesis is to assess the effectiveness of a Community Health Worker (CHW) intervention programme to improve immigrant elderly’s access to health- and welfare services. Additionally, effects on loneliness, health related quality of life (HRQOL), and self-efficacy were explored.
Analysis of health care use showed that primary
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health care facilities (GP services and medication prescriptions) within most ethnic minority groups is higher than that for ethnic Dutch. On the other hand, ethnic minority elderly generally make less use of hospital care, medical aids, and physical therapy. Multimorbidity and loneliness, similar to native elders, determine the level of HRQOL reported by elderly immigrant populations.
The key element of the CHW programme is the deployment of specifically trained CHWs who act as intermediaries between immigrant elderly and providers of health care and social welfare services. The CHWs from ethnic backgrounds similar to the elderly immigrants were deployed to identify health and social problems and to frame feasible solutions in close collaboration with providers of services.
This thesis demonstrates effects in use of curative health services. The use stabilised in the intervention group after the implementation of the CHW programme in the elderly immigrant community compared to a control group without CHWs. In the latter group, however, the use of curative health services was increased. The health education sessions and information meetings in the intervention programme may have resulted in increased knowledge and self-efficacy, improved self-management, and less frequent medical consultations and therefore in a more effective use of GP care and hospital care. We found no impact of the CHW programme on the use of care health services.
Loneliness was reduced among the elderly immigrants in the intervention programme, especially among those who actively participated in the improvement activities initiated by the CHWs. We found no impact of the CHW programme on HRQOL or self-efficacy. A longer period of time is likely required for finding an effect on these outcomes.
This thesis shows that for a successful deployment of CHWs it is essential to gain the trust of the target group. To achieve this, it is important to offer practical benefits to the target group at an early stage of the project. Good insight into the composition of the target group is another important factor, with attention to diversity of subgroups, spoken languages and dialects, and degree of social cohesion. In the selection of the CHWs, one should ensure that the CHWs match the different subgroups.
Commitment of and collaboration with stakeholders and institutions relevant for elderly immigrants (such as church, mosque, migrant organisations) are also essential, as well as a local project organisation embedded in a network of health- and welfare organisations.
The findings of this thesis are important for health care and welfare providers and policy makers in the joint ambition to create culturally sensitive care and cures for elderly immigrants. This is essential, because their number is rapidly growing. This thesis reveals that the deployment of CHWs could be an effective means to achieve this goal.
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