Championing Community Health Workers in Oklahoma

Health promotion science Associate Professor Kerstin M. Reinschmidt is a trained medical anthropologist and has worked extensively with community health workers (CHWs) for the past 20 years. The American Public Health Association CHW Section defines a community health worker as “a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served.” This trusted relationship makes CHWs intermediaries between community members and health/social services. Recently, Reinschmidt’s interests have expanded from CHW training and intervention to workforce development efforts.

Like many of us, Reinschmidt took note of the pandemic in March of 2020. “I was in Stillwater at an Oklahoma State University-led CHW forum just a couple of days before everything shut down,” recalls Reinschmidt. The timing was serendipitous since the forum was focused on creating awareness of the CHW workforce. Reinschmidt began thinking about how CHWs could be involved in the pandemic response. Since her previous work involved CHWs working with chronic diseases, Reinschmidt began researching CHWs working with infectious diseases. “I came across information about how CHWs have worked on Ebola prevention and control in African states,” says Reinschmidt. This reinforced that CHWs could be incredibly useful in helping to prevent and control COVID-19 in local communities.

During this time, Reinschmidt also attended numerous webinars hosted by CHWs to learn more about how they were helping with the COVID-19 response. This led to her first COVID-19 research project, where she compiled pandemic-related resources for CHWs. She presented this information at the 2021 Oklahoma Community Health Worker Forum Series. To watch the presentation, visit the Oklahoma Public Health Association (OPHA) YouTube channel link at www.youtube.com/watch?v=wlWgF42AYVQ.

In order to learn more about CHW pandemic experiences and needs in Oklahoma, Reinschmidt talked to CHW members of the OPHA CHW Section and the OCCHD Wellness Now CHW Workgroup, both of which she co-founded. “I was interested in looking at what was going on at the community level with respect to COVID-19,” says Reinschmidt. “That’s what health promotion science is all about: working and collaborating with communities.” Reinschmidt notes that she observed a lot of top-down communication and messaging from the Centers for Disease Control and Prevention and the state and local health departments. She wondered if these messages were a one-size-fits-all approach or if they were being tailored for different communities. “I wanted to know if communities were receiving the messages, and if they were, did the messages make sense to them,” comments Reinschmidt.

Reinschmidt is also passionate about data reflecting the diversity among communities. She notes that a lot of the data collected early on in the pandemic was missing information about racial and ethnic groups. “We need to know that information,” says Reinschmidt. She specifically recognizes the need to contextualize data that reflects the disproportionate burden of COVID-19 for different racial and ethnic groups. “We must acknowledge that some groups have a higher burden of COVID-19 because of the continued disparities related to social determinants of health,” says Reinschmidt. “This is important to take the stigma away.” Public health professionals and communicators need to work with community partners and directly involve them in public health messaging. “Community health workers are perfect for helping with this because their work is about reducing health disparities, supporting health equity, and helping with social justice,” states Reinschmidt.

In late 2020, Reinschmidt was asked by a group of colleagues to send out the CHW COVID-19 Impact Survey to community health workers across Oklahoma. “The survey specifically focused on what trainings CHWs took during the pandemic and what trainings they need to better prepare for future public health emergencies,” she says. Reinschmidt worked with a BERD staff member and a biostatistics student to analyze the survey results. Unsurprisingly, she found that the pandemic impacted CHWs at the professional and personal level. At the start of the pandemic, CHWs were utilized as contact tracers, which pulled them out of their communities. “The direct contact with the population they serve was cut off, which was really bad because that’s at the core of what a frontline public health worker does,” says Reinschmidt. Many CHWs also had to balance continued needs in their communities (e.g., food, transportation, and chronic health care) with the added burden of COVID-19. 

In 2021, Reinschmidt was asked to do a follow-up survey with CHWs that included questions about the recently approved vaccines. She worked with a colleague from OSU and a biostatistics student at the Hudson College of Public Health to organize a townhall and advisory board with CHWs to present the results from the first CHW COVID-19 Impact Survey, and ask CHWs for recommendations and input on what additional information they wanted and/or needed to know. The responses were used to revise the survey before R¬inschmidt distributed it. It’s important to note that CHWs from tribal nations were included in the townhall and survey distribution. The results from this follow-up survey indicated that CHWs felt that high-risk and disproportionally disadvantaged communities in Oklahoma weren’t being heard and didn’t have adequate access to necessary resources. “The data from the two surveys is invaluable and super important because it highlights that this is a workforce that needs to be valued and supported,” says Reinschmidt. “The next step is to make our findings part of the CHW Coalition work that I’m leading.” The fi¬nal survey reports can be found on the Oklahoma Public Health Training Center website at https://ophtc.ouhsc.edu/Resources.

When discussing why she chose to study public health, Reinschmidt mentions her medical anthropology doctoral dissertation chair who had a background in public health and a master of public health degree. “I was impressed by the way he was able to apply medical anthropology with the added benefit of public health,” recalls Reinschmidt. This inspired her to pursue an M.P.H. program at the University of Arizona, the same semester that she graduated with her doctoral degree.