社区卫生工作者针对慢性病社会健康决定因素的干预：一项系统综述

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中文摘要

引言： 慢性病对面临社会和经济困境的人群造成不成比例的影响。社区卫生工作者（CHW）作为应对健康社会决定因素（SDOH）的关键人力日益受到认可。然而，关于CHW主导的干预对美国慢性病成人社会与临床结局影响的证据仍然有限。本系统综述评估了CHW主导的干预对SDOH和健康结局的影响。
方法： 遵循PRISMA指南和注册的Prospero方案，我们于2024年4月检索了PubMed、Scopus和Embase（Ovid），纳入基于美国的随机或准实验研究，研究对象为患有慢性病且接受针对至少1个SDOH领域的面向患者CHW干预的成人。合格研究需设有对照组并报告社会或健康结局。我们使用标准化表格提取数据并评估质量。
结果： 我们识别出1,939条记录并筛选了1,058篇摘要。我们审阅了110篇全文文章；7项研究符合纳入标准。所有研究均为针对至少1个SDOH领域的随机对照试验。干预最常针对糖尿病、HIV、哮喘、丙型肝炎或听力损失成人的医疗可及性、住房稳定性或照护协调。CHW干预在若干疾病特异性临床结局方面显示出改善，但对主要临床指标的整体效果温和且不一致。
结论： CHW主导的干预在解决社会需求和改善慢性病成人照护参与方面显示出前景，但具有意义的临床获益证据仍然有限。缺乏大型、把握度充分的研究突显了需要更严谨的研究来加强美国卫生系统中CHW驱动的SDOH干预的证据基础。

英文摘要

INTRODUCTION: Chronic diseases disproportionately affect people facing social and economic adversity. Community health workers (CHWs) are increasingly recognized as a key workforce for addressing social determinants of health (SDOH). However, evidence for the effect of CHW-led interventions on social and clinical outcomes among US adults with chronic disease is limited. This systematic review evaluated the effects of CHW-led interventions on SDOH and health outcomes.
METHODS: Following PRISMA guidelines and a registered Prospero protocol, we searched PubMed, Scopus, and Embase (Ovid) in April 2024 for US-based randomized or quasi-experimental studies involving adults with chronic disease and a patient-facing CHW intervention addressing at least 1 SDOH domain. Eligible studies were required to have a comparator group and report social or health outcomes. We used standardized forms to extract data and assess quality.
RESULTS: We identified 1,939 records and screened 1,058 abstracts. We reviewed 110 full-text articles; 7 studies met inclusion criteria. All were randomized controlled trials addressing at least 1 SDOH domain. Interventions most commonly targeted health care access, housing stability, or care coordination among adults with diabetes, HIV, asthma, hepatitis C, or hearing loss. CHW interventions demonstrated improvements in several condition-specific clinical outcomes, but overall effects on major clinical indicators were modest and inconsistent.
CONCLUSION: CHW-led interventions show promise for addressing social needs and improving engagement in care among adults with chronic disease, but evidence of meaningful clinical benefit is still limited. The lack of large, well-powered trials underscores the need for more rigorous research to strengthen the evidence base for CHW-driven SDOH interventions in US health systems.