Roles and definitions of community health workers, peer workers, navigators, and other lay workers

Background

Community health workers, peer workers, patient navigators, and other lay health workers assist health systems and the people they serve by facilitating cultural adaptations, mentoring, care coordination, health education, and access to care. In international literature, many systematic reviews include numerous titles for lay health workers in search criteria and consider their effectiveness together. However, the boundaries between these professions are poorly understood. To better understand the roles and definitions of different types of lay health workers, we completed a systematic umbrella review.

Methods

Our review includes over 200 scientific review articles on lay health workers, including systematic, scoping, narrative, and other reviews. Included reviews compiled data from over 80 countries. The review was registered a priori with OSF. Screening, evaluation of quality, and extraction were completed by two team members per article, with disagreements resolved via discussion and consensus. Extracted data were analyzed with content analysis.

Results

Health education emerged as a primary role of lay health workers. Other key roles included connecting people with resources, navigating obstacles to care, providing emotional support, and promoting treatment adherence. While roles and definitions overlapped greatly, community health workers tended to have a greater emphasis on direct care, such as testing and vaccination. Peer workers tended to focus more on role modeling, social support, and coaching. Navigators had a greater emphasis on care coordination.

Conclusions

These results can inform choice of language and clarity of responsibilities for lay health workers. In addition, the review has strong implications for future research on lay health workers, including the need for clear definitions of worker roles, remuneration, intervention types, peer status, and other characteristics.

Key messages

• Lay health workers, including community health workers, peer workers, and patient navigators, have overlapping roles and definitions in scientific literature.

• Health education is a primary role of lay health workers, including community health workers, peer workers, and patient navigators.