Common Themes in Systematic Reviews

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Common themes in systematic reviews include:

Results are promising but more study needed
Very few studies include costs
Key points often unspecified (e.g., specific CHW intervention, selection, training)
Wide range of activities and health issues means lack of common metrics, difficulty in generalizing, comparing, or replicating

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Systematic reviews of the CHW literature all conclude that CHW interventions show promising results, but more study is needed. Out of 1,000 or more studies examined, reviewers commonly end up with only 40 or 50 studies meeting their rigorous criteria for inclusion.

The lack of cost data in most CHW studies creates a serious hurdle for policy change, but it is understandable considering that most of the studies were funded as short-term research projects.

Most reviews criticize the majority of published studies for failing to specify key points such as the details of the CHW intervention, the qualifications and selection process for the CHWs themselves, and the extent and content of the training provided to CHWs.

Another pattern evident from these reviews is that published studies cover a wide range of activities and health issues and use many different measures, making it difficult to come to overarching conclusions. Most of the studies reported changes in individual self-reported knowledge, attitudes, and behaviors, and a significant number reported changes in clinical measures such as blood pressure or blood glucose, but very few reported conclusions based on clinical outcomes.