Community health workers as field infodemiologists: a co-created toolkit for frontline evidence

Background

Community health workers are exposed daily to client confusion, misinformation, and service barriers that rarely surface in administrative data. Despite this, few mechanisms exist to systematically capture what CHWs observe. Most insights remain anecdotal, limiting opportunities to improve programmes and communication strategies. Mobilizing frontline worker knowledge into decision-making is a recognized challenge for health systems globally.

Methods

A structured toolkit was developed to embed systematic observation into CHW practice, turning everyday client interactions into evidence for programme decisions. Co-creation workshops with 16 CHWs at the New York City Department of Health and Mental Hygiene identified approaches compatible with existing workflows. The final design combined weekly structured entries on Microsoft Teams with facilitated monthly group reflections. Four pilot cycles were completed. A synthesis process produced short insight reports shared with bureau leadership.

Results

CHWs completed weekly entries with minimal reported burden. Insight reports surfaced recurring challenges invisible to administrative data, including complex eligibility processes, outdated programme information, and limited service availability. One report directly informed a communication update addressing a widely misunderstood eligibility rule. Enabling factors such as trust built through CHW-client relationships and co-located services were also identified. Co-creation, use of familiar platforms, and timely synthesis emerged as the conditions most critical to feasibility.

Conclusions

CHWs can generate structured, community-driven evidence using existing workflows and tools. Co-creation was essential to feasibility and uptake. The approach is adaptable to any programme relying on frontline staff to bridge communities and health systems, and offers a replicable model for agencies seeking more responsive and equitable intelligence.

Key messages

• Frontline workers hold real-time community intelligence that health systems routinely waste. Structured, co-created workflows can capture it without adding burden.

• Tools built with CHWs, not just for them, produce findings that are feasible, grounded, and more likely to reach decision-makers.