Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework

Abstract

Introduction

Community health workers (CHWs) are health promotion specialists who are trusted members of the community served and have a close understanding of the community’s needs and values. CHWs are a cost-effective and scalable workforce to promote health among men through tailored approaches. The purpose of the present review was to use the RE-AIM Framework to assess design, implementation, and outcomes of CHW-implemented health promotion efforts tailored for men to provide recommendations for future efforts.

Methods

The protocol was pre-registered with PROSPERO. The primary inclusion criteria were that the interventions were (a) implemented at least partially by CHWs, (b) conducted only among men, and (c) designed to improve a health-related outcome. PubMed, EMBASE, PsycINFO, CINAHL, Web of Science, and Global Index Medicus were searched using a librarian-generated search strategy. In all, 1,437 articles were uploaded to Rayyan and two reviewers blindly reviewed each article for inclusion. A total of 24 articles met the inclusion criteria.

Results

Most interventions (a) targeted men under 50 years, (b) were conducted among a subset of underserved men, (c) improved health outcomes, (d) community-based and informed, (e) atheoretical, and (f) had satisfactory retention rates. The roles and responsibilities of CHWs were varied. Attention was given to training of CHWs, but limited attention was given to how/if the CHWs were supervised.

Discussion

CHW-implemented interventions can improve health outcomes among men. Opportunities exist to build on past interventions, such as addressing mental health and incorporating prosocial aspects of masculinity. The results have implications for designing similar interventions.

Keywords

community health workers men health promotion scoping review implementation

Introduction

Surveillance data from the World Health Organization (WHO) indicates that women have a higher healthy life expectancy (i.e., the average number of years that a person can expect to live in “full health”) than men, that women live longer than men, and that many of the causes of unhealthy life expectancy and premature mortality among men are preventable (WHO, 2019). Efforts seeking to promote health and mitigate the impact of these preventable causes of premature mortality among men have been limited in their impact. Too few health promotion efforts are tailored for men (Griffith, 2016; Robertson et al., 2008; Treadwell & Young, 2013), despite widespread recommendations that efforts seeking to promote health among men should be tailored for men. This recommendation is supported by the 2001 WHO Madrid Statement—a statement that strongly recommended that health promotion efforts recognize the psychosocial differences in health promoting facilitators and barriers between women and men (WHO, 2001). This recommendation has been echoed by experts in men’s health (Baker, 2016; Baker et al., 2014; Ostlin et al., 2006; Teo et al., 2018; Weller & Campbell, 2009) and a comprehensive systematic review (Robertson et al., 2008).

Men are underrepresented in health promotion efforts that are not gender specific (Rounds & Harvey, 2019). For example, physical activity interventions whose inclusion criteria includes both men and women report much higher recruitment and retention (>80%) of women (Maher et al., 2014; Newton et al., 2014; Ryan et al., 2019; Whitt-Glover et al., 2014; Whitt-Glover & Kumanyika, 2009). While this has often led men to be characterized as a “hard to reach” population or as people who do not care about their health (Griffith et al., 2012, 2016; S. Robertson, 2006), qualitative and other empirical research suggests otherwise (Gough, 2013; Gough & Conner, 2006; Griffith et al., 2011, 2015). The limited attention to gender-tailoring of recruitment and intervention efforts may help to explain difficulties in the recruitment (Halbert et al., 2020; Robertson et al., 2008; Teo et al., 2018) and retention (Halbert et al., 2020; Maher et al., 2014; Ryan et al., 2019) of men in these efforts. These gendered patterns in health promotion intervention participation suggest that more attention is needed to understand and address how recruitment strategies, intervention approaches, intervention materials, and other health promotion components are gender and age appropriate (Griffith et al., 2012). Therefore, there is a need for interventions that are tailored to and for men by explicitly considering the psychosocial norms, beliefs, attitudes, and expectations that adult males experience. Developing interventions intentionally for men has the unique potential to boost recruitment, increase retention, and enhance the impact on men’s health promotion and men’s health outcomes.

Tailoring Efforts for Men

There is ample literature identifying and arguing for the need to understand the barriers to participation that impact health and health-promoting efforts among men, but the bulk of this research is at the Institute of Medicine’s (IOM) T₀ stage of research (i.e., basic findings). This literature points to the underlying role of hegemonic or traditional masculinity (Seidler et al., 2016)—an idealized form of masculinity in a given place, time, and culture that reflects assumed norms and beliefs that are questioned and accepted as true (Courtenay, 2000). The Health, Illness, Men, and Masculinities is a theoretical framework that has been offered to help explain how these normative expectations shape men’s health and health behavior (Evans et al., 2011). This framework shifts the focus of understanding men’s health and health promotion away from the individual toward the sociocultural phenomenon of masculinity—a structural context that fosters and reinforces adverse health knowledge/views and practices through socially created gender norms (Griffith, 2020).

The direct and indirect impact of how men accept, reject, or reimagine aspects of gender ideals on men’s health and health promotion have been well-researched, but often men’s health patterns are attributed to characteristics of men rather than the structural conditions that shape their health (Griffith, 2016, 2018, 2020). Research indicates that men, compared to women, have low health-related knowledge (Beier & Ackerman, 2003) and a functional view of their body and health (Robertson et al., 2008). In addition, men are more likely to engage in adverse health practices—they are less likely to seek health-related help (Teo et al., 2016), less likely to engage in health promoting behaviors (Teo et al., 2016; Yousaf et al., 2015), and more likely to engage in health risk-taking behaviors (Harris et al., 2006). These adverse health knowledge/views and practices regarding health are modifiable (Griffith, 2016) and may serve as targets for tailored health promotion efforts among men, though attempts to translate research findings into clinical trials or health promotion efforts (i.e., IOM T₁ stage and beyond) among men are limited in quantity and have been largely unsuccessful (Robertson et al., 2008).

There are empirical findings and a strong theoretical rationale to focus on peer-based health promotion efforts. Systematic reviews and qualitative research has found that men like intervention approaches where only men are present, and where they are able to learn from and engage with other men (Friedman et al., 2012; Griffith et al., 2013, 2014, 2018; Hooker et al., 2011; James, 2004; Valdez et al., 2021; Wong et al., 2012; Young et al., 2012). Several theories have been used justify peer-based efforts (e.g., Social Learning Theory, Social Inoculation Theory, Role Theory, and Communication of Innovations Theory) (Turner & Shepherd, 1999). Because masculinity is a socially created, learned phenomenon, leveraging peers to promote men’s health can be particularly effective (Gough & Novikova, 2020). Research shows that peer-related social control is significantly associated with health promoting behaviors among men (Houle et al., 2017). This is supported by qualitative interviews with men that indicate that peer-related social control influences men’s health-promoting behaviors through inspiration and positive role-modeling (Houle et al., 2017). In addition, it is known that men prefer to receive health-related information from peers with shared experiences and circumstances (Lefkowich & Richardson, 2018), and who are credible and relatable (Sharp et al., 2018).

Improving Men’s Health Efforts With Community Health Workers

Given the literature on masculinities, peer-based health promotion, interventions that only include men, and interventions that are designed explicitly for men, it is likely that health promotion efforts implemented using community health workers (CHWs) may be a viable strategy to promote men’s health. The CHW Section of the American Public Health Association defines CHWs as “frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served.” That is, by definition, CHWs are peers with shared experiences and circumstances, in addition to being credible and relatable. The roles of CHWs are varied including providing culturally appropriate health education and information, providing coaching and social support, building individual and community capacity, and conducting outreach, among others (Rosenthal et al., 2021). CHW’s membership and understanding of the communities served have enabled them to be successful in promoting health among underserved and at-risk communities across the globe (Viswanathan et al., 2010). Their membership of the communities served is also particularly useful to health promotion efforts among men. That is because recruitment and participation (i.e., uptake) of men in health promotion efforts are improved if such efforts occur in places that are more congruent with men’s gender norms and where men routinely reside/frequent (Oliffe et al., 2020).

There is widespread evidence indicating that CHWs have been successful in improving numerous health outcomes such as stroke, heart disease, Type II diabetes, HIV, and asthma (Jack et al., 2017). The impact of CHWs goes beyond improving the health of underserved and at-risk communities. These efforts are also cost-effective. One study found that CHWs generated a net savings of $1,135 per patient which equated to a savings of $2.30 for every dollar invested into a CHW program (Findley et al., 2014).

Purpose of Present Review

Despite the robust literature that demonstrates the success of CHWs, no known systematic or scoping review has sought to understand the impact of CHW-implemented interventions to improve men’s health. This is surprising because CHW-implemented health promotion efforts are well suited to promote recruitment and retention of men in health promotion efforts, in addition to producing meaningful changes in the health of the participating men. The purpose of the present scoping review is to assess the design, implementation, and outcomes of CHW-implemented health promotion efforts that are tailored for men. The findings of this review were analyzed using the RE-AIM Framework (Glasgow et al., 1999). This addition to a scoping review provides us the ability to assess recent CHW-led interventions to improve health among men and to provide evidence-based recommendations for the development and implementation of future CHW-led health promotion efforts targeting men.

RE-AIM Framework

The RE-AIM Framework is one of the most frequently used frameworks in the field of implementation science that is used to plan and evaluate health promotion programming (Glasgow et al., 1999, 2019). The RE-AIM Framework contains five dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance. The Reach dimension accounts for the representativeness and characteristics of intervention participants. The Effectiveness dimension represents the ability of the intervention to produce significant health improvements. The Adoption dimension represents the uptake, acceptability, and suitability of the intervention within a given system or community. The Implementation dimension represents the processes and components of the intervention, how and when they are delivered, and general intervention execution. The Maintenance dimension represents intervention sustainability and evaluation of individual-level health outcomes.

Methods

This scoping review protocol was prepared in accordance with the PRISMA Extension for Scoping Review’s (PRISMA-ScR) 22-item methodological checklist and the framework for scoping reviews proposed by Arksey and O’Mally (Arksey & O’Malley, 2005; Tricco et al., 2018), in addition to the PICOS (i.e., population, intervention, comparison, outcome, and study type) framework (Petticrew & Roberts, 2008). See Supplemental File 1 for the PRISMA-ScR checklist. Prior to extraction and synthesis, the protocol was registered with and published by PROSPERO, an international database of systematic reviews (Wippold et al., 2021b). The authors collaborated with a research librarian at the authors’ institution to ensure a comprehensive search strategy. The finalized search strategy is provided in Supplemental File 2. Articles were identified by searching CINAHL (EBSCO), EMBASE (Ovid), Global Index Medicus, PsycINFO (EBSCO), PubMed, and Web of Science (Clarivate).

Studies were included if: (a) the primary target population was adult men or trans-men (age 18 or above), (b) the intervention sought to improve one or more health indicators, (c) the intervention was entirely or partially implemented by CHWs, (d) the study included a quasi-experimental or experimental design, and (e) the article was available in English or Spanish. Studies were excluded that (a) targeted men/trans-men and women, (b) targeted men or trans-men and children, (c) were not entirely or partially implemented by CHWs, (d) did not report the outcomes of a health promotion intervention, and (d) were not available in English or Spanish. Interventions implemented by individuals designated with often-used synonyms for CHWs (e.g., lay health advisors, promotores) were also included because these individuals share characteristics, roles, and responsibilities with CHWs. See search strategy for these synonyms. There were no restrictions on publication dates or country of implementation.

After conducting the search, results were imported into EndNote to identify and remove duplicates. The remaining titles and abstracts were uploaded to Rayyan—a reference managing software (Ouzzani et al., 2016). The titles and abstracts were independently screened by GMW and KAG against the eligibility criteria to identify studies for inclusion. Data extraction was guided and organized utilizing the RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance)—a framework often used in the planning and evaluation of health interventions to ensure generalizability and facilitate the translation of research to practice (Glasgow et al., 1999). The following variables for data extraction were selected to align with each dimension of the RE-AIM framework: (1) Reach: participant age, inclusion criteria, and primary outcome(s); (2) Effectiveness: measure type (i.e., self-report and/or objective measures) and intervention results; (3) Adoption: intervention development, country of intervention, intervention setting, and theoretical framework or model; (4) Implementation: intervention dosage, CHW roles, CHW community embeddedness, barriers to intervention implementation, CHW title, training, and supervision, and study design; and (5) Maintenance: schedule of post-intervention data collection.

Results

A total of 2,857 articles were identified in the database searches, in which 1,420 duplicates were removed. The remaining 1,437 abstracts were uploaded to Rayyan and blindly examined by two reviewers (GMW & KAG) to assess inclusion. Reasons for the exclusion of articles during the full-text review included (a) the study included children, (b) there were multiple articles about the same intervention, and (c) the study was not based on an intervention (e.g., only focus groups conducted). This process resulted in 24 studies that met inclusion criteria for this scoping review. See Supplemental File 3 for PRISMA flowchart.

Reach Dimension

Data extracted that align with the Reach dimension were participant participant age, inclusion criteria, and primary outcome(s) (see Table 1).

Table 1.

Reach Dimension.

Reach
Study	Primary outcome(s)	Mean age in years	Participant inclusion criteria
August et al., 2016	Involvement in maternal health	36.7% were 35 or older	Partners that gave birth in the past 2 years
Chan et al., 2011	Prostate cancer screening	61	Hispanic men ages 40+ with no history of prostate cancer
Cole et al., 2017	Colorectal cancer screening (CRC)	57	Black men not up to date on CRC screening; high blood pressure, working telephone; able to speak English
Documet et al., 2020	Social support, healthcare access, depressive symptoms, alcohol consumption	Most were less than 45	Latino immigrant men
Ghanotakis et al., 2017	Gender norms, family planning, HIV service uptake	40	Unspecified
Grinstead et al., 1997	HIV education	31–32	Adult inmates
Grinstead et al., 1999	HIV risk	36	Adult White and African American men who are inmates
Hill et al., 1999	Hypertension	39	Black or African-American male residents within the Johns Hopkins Hospital catchment area; age between 18 and 49 years, BP ≥140 or ≥90 mm Hg, or BP <140/90 mm Hg and currently taking HBP medication; able to give their telephone number and address, verified name, and telephone number of two or three people through whom they could be reached; written informed consent; no acute or terminal condition precluding participation
Hill et al., 2003	Hypertension	42	Black men between ages 18 - 54 and residing in inner-city Baltimore, MD; systolic BP (SBP) was ≥ 140 mm Hg or their diastolic BP (DBP) was ≥ 90 mm Hg on 2 separate occasions or on antihypertensive medication
Holt et al., 2009	Prostate cancer screening	56	African American men ages 45+ who had not had prostate cancer
Ibiloye et al., 2021	Antiretroviral drug refills	25	HIV+ MSM
Lau et al., 2013	Behavioral intention to use condoms, behavioral intention to take up VCT	50% of participants between 18 and 25	Hong Kong Chinese males 18+; self-reported having had anal or oral sex with another man in the last 12 months; had not been diagnosed as HIV+; willing to be interviewed 2 months afterward
Mi et al., 2015	Risk behaviors and treatment	31	Men 18+ residing or employed in Chengdu; informed consent; reported at least one sexual encounter with another male in the past year; confirmed HIV+
Moore et al., 2016	Heavy drinking	43	Latino; ages 21+; speaks Spanish; consume 14+ drinks per week or 4+ drinks at least twice per week; not currently in treatment for an alcohol or substance disorder; no plans to leave town in the following 6 months; had a telephone number
Nadkarni et al., 2020	Home-detoxification and relapse prevention for alcohol dependence	38	Adult participants that scored 20 on AUDIT. Participants who scored 16 - 19 on the AUDIT were asked follow-up questions to identify those with symptoms of alcohol withdrawal. Anyone screening positive on these follow-up questions were also included. Any patient admitted to the secondary care deaddiction center for inpatient detoxification was eligible for participation.
Ornelas et al., 2019	Unhealthy alcohol use	48	Latino; spoke Spanish; foreign-born; 18+; score of 6 or more on the AUDIT
Pinyaphong et al., 2020	Condom use	20	Unspecified
Rhodes et al., 2009	Condom use, HIV testing	30	Latino men in a local soccer league
Simon et al., 2013	Diagnostic resolution, treatment initiation of prostate cancer screening	Most under the age of 65	Patients at VA urology clinic for follow-up of an abnormal prostate cancer screening test and who were recommended for a biopsy.
Somerville et al., 2006	HIV knowledge, social norms, risk behaviors	Most were 18 to 25 years old	Ages 18–30 years old; Latino; engaged in male–to–male sex
Treadwell et al., 2010	Obesity, diabetes reduction	Unspecified	African American men that reside in Lorain County, Ohio; at risk for and/or diagnosed with diabetes and/or were in poor health that may be related to obesity and/or other health concerns
Tsoh et al., 2015	Smoking cessation	54	18+; self-identified as Chinese, Chinese-American, Vietnamese, or Vietnamese-American; able to read and speak Cantonese or Mandarin or Vietnamese; having smoked at least one cigarette daily in the prior 7 days
Wirtz et al., 2015	HIV prevention	25 (Median)	18+; assigned male at birth; reported having sex with another man in the last 12 months
Holt et al., 2017	Prostate cancer screening informed decision making	56	African American men; ages 45–69; no history of prostate cancer

Note. Overview of CHW-implemented health promotion interventions among men. HIV = human immunodeficiency virus; VCT = voluntary counseling and testing; VA = Veterans Affairs; CHW = Community health workers; BP = blood pressure; MSM = men who have sex with men; AUDIT = Alcohol Use Disorders Identification Test.

Effectiveness Dimension

Data extracted that align with the Effectiveness dimension were measure type and intervention results (see Table 2).

Table 2

Effectiveness Dimension.

Effectiveness
Study	Measure	Outcome(s)
August et al., 2016	Subjective	Increase in maternal health involvement
Chan et al., 2011	Subjective	Increase in knowledge, preferences, and importance
Cole et al., 2017	Subjective	Increase in likelihood to be screened
Documet et al., 2020	Subjective	Increase in access to healthcare
Ghanotakis et al., 2017	Subjective	Increase in equitable gender norms, inequitable gender norms, some health seeking behaviors, condom use
Grinstead et al., 1997	Subjective	Increase in HIV knowledge and intent to use condoms greatest in professional educator group and peer educator group
Grinstead et al., 1999	Subjective	IG was significantly more likely to have used a condom after release
Hill et al., 1999	Objective	Decrease in diastolic blood pressure for both groups; no change in systolic blood pressure
Hill et al., 2003	Objective	Decrease in diastolic and systolic blood pressure for more intensive group; greater control in more intensive group; left ventricular mass was lower in more intensive group
Holt et al., 2009	Subjective	Spiritually based intervention most effective in improving knowledge, reading of materials
Ibiloye et al., 2021	Objective	Increase in refills
Lau et al., 2013	Subjective	Improvements in intention to use condoms and efficacy on taking up VCT among IG.
Mi et al., 2015	Subjective	IG reported significant increases in disclosing HIV status to partners, motivating partners to accept HIV testing compared to CG. No between-group differences in receiving early treatment or using condoms consistently.
Moore et al., 2016	Subjective	Improvement in alcohol related measures in IG and CG with no statistically significant differences at any of the time points. Post-hoc analyses identified statistically significant reduction in number of drinks over time for IG and not CG.
Nadkarni et al., 2020	Subjective and Objective	Most participants completed home detoxification. Nearly half completed treatment or had a planned discharge.
Ornelas et al., 2019	Subjective	Both IG and CG improved alcohol-related behaviors over time. No significant differences between groups.
Pinyaphong et al., 2020	Subjective	Increase in consistent condom use and condom use at last sexual encounter, no significant difference in the proportion of consistent condom use at 3-month post-intervention.
Rhodes et al., 2009	Subjective	IG reported more consistent condom use in the 30 days preceding follow-up than CG. Participants in the IG were more likely to report condom use and HIV testing.
Simon et al., 2013	Subjective and Objective	Among those with an abnormal screen, navigation did not have a significant effect on time to diagnostic resolution compared to CG, on analysis of the period beyond 80 days, navigated men reached resolution faster than controls. Among those with cancer, navigation did not have a significant effect on time to treatment initiation compared to CG.
Somerville et al., 2006	Subjective	Significant increase in HIV social norms; no significant changes in HIV knowledge and risk behaviors (e.g., condom use)
Treadwell et al., 2010	Subjective and Objective	Increase in knowledge about strategies for prevention and management of obesity and diabetes; increase in engagement in exercise and fitness activities; decreased blood pressure, weight, and BMI levels; visited a primary care doctor more frequently.
Tsoh et al., 2015	Subjective and Objective	Decrease in abstinence rates: 7-day rate was 30.2% and 30-day rate was 24.0%.
Wirtz et al., 2015	Subjective	Improvement in condom use and disclosure of sexual behaviors/orientation
Holt et al., 2017	Subjective	Increase in prostate cancer screening decision making

Note. Overview of CHW-implemented health promotion interventions among men. HIV = human immunodeficiency virus; IG = intervention group; VCT = voluntary counseling and testing; CG = comparison group; BMI = body mass index; CHW = Community health workers.

Adoption Dimension

Data extracted that align with the Adoption dimension were intervention development, country of intervention, intervention setting, and theoretical framework or model (see Table 3).

Table 3.

Adoption Dimension.

Adoption
Study	Intervention setting	Country of intervention	Theoretical framework	Intervention development
August et al., 2016	Home visits	Tanzania	Unspecified	Unspecified
Chan et al., 2011	Subsidized senior housing sites, senior centers	United States	Unspecified	Key informant interviews, Focus groups
Cole et al., 2017	Telephone	United States	Unspecified	Based on available data; linguistic approach; sociocultural approach based on known cultural values
Documet et al., 2020	Convenient place for participant in emerging Latino community	United States	SEF	Designed by Latino engagement group for health, researchers, and social service providers
Ghanotakis et al., 2017	Public health centers	Uganda	Unspecified	Customized for the community, though no information on how
Grinstead et al., 1997	Prison classroom	United States	Unspecified	Unspecified
Grinstead et al., 1999	Prison	United States	Unspecified	Unspecified
Hill et al., 1999	Various settings	United States	Unspecified	Unspecified
Hill et al., 2003	Home visits	United States	PRECEDE-PROCEED Model	Unspecified
Holt et al., 2009	Church	United States	SCT, HBM	Informed by previous work with African American women
Ibiloye et al., 2021	Community-based organization	Nigeria	Unspecified	Unspecified
Lau et al., 2013	Interactions through email and text messages	China	SCT, TPB, HBM, diffusion of innovations	Developed by panel of health psychologists, epidemiologists, public health researchers, and three MSM volunteers
Mi et al., 2015	ART clinic of Chengdu Municipal Hospital for Infectious Diseases; Internet-Based Program	China	Unspecified	Key informant interviews followed by a pilot study
Moore et al., 2016	Various settings	United States	MET	Culturally adapted and piloted with three Latino men
Nadkarni et al., 2020	Primary care clinics and a de-addiction center in a secondary care district hospital	India	Unspecified	Formative research including a systematic review and qualitative interviews with patients, family members, and clinicians
Ornelas et al., 2019	Day Laborer Center	United States	Unspecified	Intervention was culturally adapted using an established framework
Pinyaphong et al., 2020	Unspecified	Thailand	HBM, SCT, TRA	Formative development including focus groups and brainstorming with target population
Rhodes et al., 2009	Soccer field	United States	SCT, empowerment theories	Formative qualitative research
Simon et al., 2013	VA hospital	United States	Unspecified	Need assessments with key informants, community advisory board
Somerville et al., 2006	Various venues including gay bars	United States	Theory of Diffusion	Focus groups and key informant interviews adapted from intervention for White gay men
Treadwell et al., 2010	Unspecified	United States	Unspecified	Focus groups and key informant interviews
Tsoh et al., 2015	Unspecified	United States	Social network theory, Transtheoretical model of change, SCT	Qualitative findings of interviews. Materials were field-tested in focus groups.
Wirtz et al., 2015	Study office	Malawi	Fenway Guide, MSMGF-JHU guide	Formative qualitative research
Holt et al., 2017	Churches	United States	HBM	Community advisory panel, formative research including focus groups, and extensive piloting

Note. Overview of CHW-implemented health promotion interventions among men. SEF = Social Ecological Framework; SCT = Social-Cognitive Theory; HBM = Health Belief Model; TPB = Theory of Planned Behavior; MSM = men who have sex with men; ART = antiretroviral therapy; MET = Motivational Enhancement Therapy; TRA = Theory of Reasoned Action; VA = Veterans Affairs; MSMGF-JHU = Global Forum on MSM & HIV Johns Hopkins University Curriculum; CHW = community health workers.

Implementation Dimension

Data extracted that align with the Implementation dimension were intervention dosage, CHW roles, CHW community embeddedness, barriers to intervention implementation, and CHW title, training, supervision, and study type (see Tables 4 and 5).

Table 4.

Implementation Dimension.

Implementation
Study	Intervention dosage	Intervention components implemented by CHWs	CHW community embeddedness	CHW title
August et al., 2016	4 visits, 60–90 min per visit	Recruitment and outreach; delivery of intervention	Members of community	CHWs
Chan et al., 2011	1.5–2 hr per	Participant consent; group intervention discussions; survey administration	Unspecified	Promotores
Cole et al., 2017	2+ telephone sessions for CHWs in Comparison 1; 2+ telephone sessions and 4 MI sessions for CHWs in IG	Educational sessions	Unspecified	CHWs/Patient Navigators (PN)
Documet et al., 2020	Monthly	Recruitment; intervention meetings; referral to services	Latino immigrant men from the community	Promotores
Ghanotakis et al., 2017	10-session workshop	Recruitment; conducted workshops; administered surveys	From the community	Emanzis
Grinstead et al., 1997	Single, 60- to 90-min meeting	Intervention implementation	HIV+ inmates	Peer Educators
Grinstead et al., 1999	30 min	Risk reduction plan; referrals for services	HIV+ inmates	Peer Educators
Hill et al., 1999	Unspecified	Unspecified	Unspecified	CHWs
Hill et al., 2003	Unspecified	Annual home visit by CHW to engage and assist participant	Unspecified	CHWs
Holt et al., 2009	1 hr	Led educational sessions	African American men from the church	Community Health Advisors (CHAs)
Ibiloye et al., 2021	Unspecified	Refilled ART and provided counseling and condoms	Unspecified	CHWs/Lay Healthcare Workers
Lau et al., 2013	2 months	Standardized, brief preventive messages	MSM	Peer Educators
Mi et al., 2015	Unspecified	Interviews at baseline and follow-up and provided counseling	HIV-positive MSM	Peer Educators
Moore et al., 2016	Three, 45- to 55-min sessions in a manualized series delivered in 1- to 2-week intervals	recruitment; baseline data; delivered intervention	The volunteer promotoras were all primarily Spanish-speaking Latina women immigrants.	Promotoras
Nadkarni et al., 2020	Up to four, 30- to 60-min counseling sessions delivered over 4–8 weeks	Assessed eligibility and delivered intervention	Unspecified	Lay Healthcare Workers
Ornelas et al., 2019	Single, 30-minute session	Recruitment; delivered intervention; administration of surveys	Promotores were Spanish-speaking Latino immigrants	Promotores
Pinyaphong et al., 2020	Six, 2-hr education modules conducted over 6-week period delivered once a week	Data collection	University Students	Peer Educators
Rhodes et al., 2009	18 months	Intervention delivery	Teammates nominated and elected one LHA per intervention team.	Navegantes
Simon et al., 2013	Reminder calls 1 month and 10 days prior to scheduled biopsy appointment, at minimum.	Interviews with patients to identify potential barriers to care and follow-up assistance	Lay health worker was male	Lay Health Workers
Somerville et al., 2006	7 months	Delivery of intervention.	Most popular persons within the target population	Promotores
Treadwell et al., 2010	6, 12-hr educational sessions over 6 weeks	Data collection; delivery of intervention; connected men with providers and supportive resources.	CHWs are from the targeted neighborhood	CHWs
Tsoh et al., 2015	Two months	Recruitment; delivery of intervention	LHWs also had to be current non-smoker; Chinese or Vietnamese	Lay Health Workers (LHWs)
Wirtz et al., 2015	Unspecified	Delivery of intervention	Unspecified	Peer Educators
Holt et al., 2017	Four workshops administered every other month	Recruitment; delivery of intervention	Church members	CHAs

Note. Overview of CHW implemented health promotion interventions among men. CHW = community health workers; HIV = human immunodeficiency virus; ART = antiretroviral therapy; MSM = men who have sex with men; MI = motivational interviewing; IG = intervention group; LHA = lay health advisor.

Table 5.

Implementation (Continued) and Maintenance dimension.

Implementation contd.			Maintenance
Study	CHW training	CHW supervision	Study type	Post-intervention data collection schedule
August et al., 2016	Two weeks	Under master trainer; refresher training every 2 months for 1 day	Quasiexperimental	2 years
Chan et al., 2011	Unspecified	Unspecified	RCT	Immediately
Cole et al., 2017	2 day training; each CHW conducted 3 practice sessions; 3 hr of role play; 2 hr on documentation; 3 hr of follow-up training; 56 hr of formal CHW training	Sessions were digitally recorded to assess fidelity; Behavior Change Consortium Treatment Implementation Model	3-parallel-arm, randomized trial	6 months
Documet et al., 2020	20-hr training; 11-hr refreshers during intervention	Supervision by super-promotor	Pre, post, single group	6 months
Ghanotakis et al., 2017	2-week training	Study team visited three times during implementation to ensure adherence to curriculum	Pre, post, single group	6 months
Grinstead et al., 1997	4-day workshop	Video feedback	3-group randomized post-test only	Immediately
Grinstead et al., 1999	1-week training	Supervisor reviewed intervention checklists and provided feedback and additional training	Pre, post randomized control	17 days after release
Hill et al., 1999	Unspecified	Unspecified	Randomized trial	12 months
Hill et al., 2003	Unspecified	Unspecified	Randomized trial	36 months
Holt et al., 2009	1/2-day training	Unspecified	RCT	Immediately
Ibiloye et al., 2021	Unspecified	Unspecified	Retrospective cohort study	6 months
Lau et al., 2013	Training workshop	Kept logbook to record daily progress and submitted the log to research team on a weekly basis	RCT	Unspecified
Mi et al., 2015	25 hr of training on study procedures	Unspecified	Quasirandomized	6 months
Moore et al., 2016	2-day period (total of 16 hr),	Training continued via bi-weekly supervision	RCT	6, 12, 18 weeks post-baseline
Nadkarni et al., 2020	Training for 3 days each, and 4-day refresher training 6 months later	Weekly peer-group supervision	Pre, post, single group	3 months post-recruitment
Ornelas et al., 2019	Training over several	Ongoing supervision and evaluation of intervention fidelity using the Motivational Interviewing Treatment Integrity Tool	RCT	2- and 8-weeks post-baseline
Pinyaphong et al., 2020	2-day training	Before starting each session; debriefing meeting at end of each session	Quasiexperimental	Immediately post-Intervention, 3 months, and 6 months
Rhodes et al., 2009	4-session, 16-hr training, held over 2 consecutive weekends	Unspecified	Quasiexperimental	18 months post-baseline
Simon et al., 2013	Participated in local training, monthly state-level trainings, and national annual training conferences relative	Unspecified	Quasiexperimental	Unspecified
Somerville et al., 2006	2–day training	Once a month	Pre, post, cross-sectional	Unspecified
Treadwell et al., 2010	Completed training; no information	Unspecified	Pre, post, single group	Immediately
Tsoh et al., 2015	3 training sessions; 12 hr in total	Unspecified	Pre, post, single group	3 months
Wirtz et al., 2015	2-day training	Unspecified	Pre, post, single group	10, 13, 16 months follow-up from baseline
Holt et al., 2017	8-hr training over 2 days	Videotaped performance of their workshop presentation; provided written critique and constructive feedback	RCT	12 months post baseline

Note. Overview of CHW implemented health promotion interventions among men. CHW = Community health workers; RCT = randomized controlled trial.

Maintenance Dimension

Data extracted that align with the Maintenance dimension are schedules of post-intervention data collection of health outcomes (see Table 5).

Retention Rates

Retention rates for intervention groups were available for a total of 18 studies and ranged from 48.90% to 100%. Retention rates for comparison groups were available for a total of nine studies and ranged from 69.74% to 100%. It should be noted that time periods varied. See Supplemental File 4 for more information.

Discussion

This scoping review is the first to focus exclusively on health promotion efforts conducted by CHWs targeting various facets of men’s health promotion. Despite the fact that CHW programs date back to the 1920s and have a unique potential to promote men’s health, this scoping review found only 24 interventions that met the inclusion criteria (Perry et al., 2014). The data extracted from these studies were presented using the RE-AIM Framework to inform future efforts to promote health among men implemented by CHWs.

The reach of the interventions was varied as indicated by the mean age of participants, inclusion criteria, and recruitment and retention rates. Two noteworthy results with regard to reach emerged from the present review: (a) most of the CHW-implemented interventions targeted underserved men (e.g., Hispanic men, Black men, inmates, men who have sex with men) and (b) retention rates were satisfactory. Rigorous reviews have confirmed that CHWs are well-suited to promote health among underserved populations (Perry et al., 2014), and the present review confirms that CHW-implemented interventions can be effective in promoting health among underserved men. Furthermore, given that many health promotion efforts have difficulty retaining men, particularly underserved men, it should be noted that the retention rates were satisfactory. The overwhelming majority of the interventions were below the threshold that signals a high risk of bias from baseline to post-intervention evaluation (20% loss of participants from pre- to post-intervention (Schulz & Grimes, 2002).

Most of the interventions resulted in an ability to effectively improve the primary targeted health concern. With that being the case, it is significant that the vast majority of interventions were based on self-report data—an approach that can result in a high risk of bias, particularly if participants are not blinded to the outcome. The data also indicate that the vast majority of efforts targeted colorectal cancer screening or sexual health practices. Notably absent are efforts that target mental health concerns, given that holistic approaches have been advocated for some underserved groups of men (Wippold et al., 2021a). The results also indicate that most interventions were adopted in a community-based setting, which aligns with qualitative research indicating that men prefer community-based health programming (Oliffe et al., 2020). Significant results with regard to adoption were the (1) lack of theoretical framework/model for many of the interventions and (2) use of formative research among members of the target community to develop the intervention. The first represents a concerning limitation and the second represents a strength.

As with the other RE-AIM outcomes, the implementation of the interventions varied. The data indicate that the CHWs conducted a wide-range of intervention activities, ranging from participant recruitment to data collection. There are three noteworthy implementation-related findings. First, many interventions described the embeddedness of the CHW (i.e., how well the CHW’s demographics matched the demographics of the targeted participants). Research suggests that men prefer a higher degree of embeddedness (Lefkowich & Richardson, 2018; Sharp et al., 2018). Second, most of the CHWs were trained by the researchers and the trainings were well-described. Future similar interventions can build off these trainings. Third, there was limited information on the supervision of the CHWs once their roles as implementers started. The first and final implementation-related finding may be an artifact of limited space when reporting the results of the interventions in peer-reviewed journals, though suggest that more attention is needed to intentionally ensure CHW embeddedness and for ongoing supervision of CHWs during the implementation of the intervention.

In addition to the recommendations embedded throughout this section (e.g., need for more rigorous designs and information on CHW supervision), there are ample literature-informed opportunities to enhance CHW-implemented interventions seeking to improve health among men. These opportunities include the need for multi-level interventions and interventions that explicitly help increase men’s awareness of how the ways they define and demonstrate their gender ideals have implications for their health. CHWs also are uniquely positioned to model manhood and other prosocial masculinities that can be sources of motivation to promote health. These two recommendations will contribute to sustainable health programming and acknowledge that health promotion is dynamic and ongoing. In addition, the last recommendation marks an intentional deviation from traditional deficit-based lens of men’s health.

Strengths and Limitations

The results and recommendations of this scoping review should be viewed in light of its strengths and limitations. The methods for data acquisition were rigorous—the authors pre-registered the protocol, consulted with a research librarian when creating the search terms, acquired articles from five search engines and one grey-literature search engine, and each article was blindly assessed for inclusion by GMW and KAG. Discrepancies were blindly resolved by SGF. In addition, evidence was synthesized by all authors, including DMG—an expert in men’s health promotion. Despite these strengths, there are some noteworthy limitations. First, the present review has the limitations often levied against scoping reviews. That is, the present review does not assess methodological rigor of the included interventions and does not quantitatively synthesize findings to calculate an overall effect—characteristics of systematic reviews and meta-analyses. Despite this being the case, the present scoping review provides a foundation for these other types of reviews. Second, only three studies reported an effect size, all of which were small. Third, the present review is likely limited by the publication bias. It is probable that national and international CHW organizations are conducting men’s health promotion efforts that are not published in peer-reviewed journals or grey literature repositories.

Implications and Conclusion

The results of the present review have implications for prevention and health promotion programs. First, implementation of CHW-led interventions may be a viable strategy to promote health and prevent adverse health outcomes among men—a group that has traditionally been underserved by health promotion specialists. Such interventions will benefit from gender tailoring to prosocial masculinities by assuming a strengths-based lens by incorporating and building on existing research that has identified health promotion facilitators among men. This approach constitutes a novel strategy to promote men’s health. Second, the training of CHWs in future efforts can build on training programs used by previous health promotion efforts, though it should be noted that attention should be given to the supervision of these CHWs. Finally, opportunities exist to address a diversity of health-related factors, including mental health, and determinants of health such as racism and discrimination.

Efforts are needed to improve healthy life expectancy among men. It is widely recommended that to improve recruitment, retention, and outcomes, such efforts must be tailored to the unique psychosocial factors that impact the health and health promotion of men. The present scoping review is the first to collate, summarize, and synthesize health promotion efforts for men that were implemented by CHWs—a workforce that aligns well with the health promotion preferences of men, are scalable, and cost-effective. The results of the present review highlight the importance of CHW-implemented health promotion efforts targeting men. Efforts implemented by CHW to improve health among men are scalable strategy that can promote recruitment, retention, and health-related outcomes.

Supplemental Material

sj-docx-1-heb-10.1177_10.1177_10901981231179498 – Supplemental material for Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework

Supplemental material, sj-docx-1-heb-10.1177_10.1177_10901981231179498 for Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework by Guillermo M. Wippold, Kaylyn A. Garcia, Sarah Grace Frary and Derek M. Griffith in Health Education & Behavior

Supplemental Material

sj-docx-2-heb-10.1177_10.1177_10901981231179498 – Supplemental material for Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework

Supplemental material, sj-docx-2-heb-10.1177_10.1177_10901981231179498 for Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework by Guillermo M. Wippold, Kaylyn A. Garcia, Sarah Grace Frary and Derek M. Griffith in Health Education & Behavior

Supplemental Material

sj-docx-3-heb-10.1177_10.1177_10901981231179498 – Supplemental material for Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework

Supplemental material, sj-docx-3-heb-10.1177_10.1177_10901981231179498 for Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework by Guillermo M. Wippold, Kaylyn A. Garcia, Sarah Grace Frary and Derek M. Griffith in Health Education & Behavior

Supplemental Material

sj-docx-4-heb-10.1177_10.1177_10901981231179498 – Supplemental material for Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework

Supplemental material, sj-docx-4-heb-10.1177_10.1177_10901981231179498 for Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework by Guillermo M. Wippold, Kaylyn A. Garcia, Sarah Grace Frary and Derek M. Griffith in Health Education & Behavior

Footnotes

Acknowledgements

The authors would like to acknowledge Ms. Kristina Schwoebel, MA, Sciences and Computing Librarian at the University of South Carolina for input and consultation on the search strategy.

Authors’ Contributions

Guillermo M. Wippold: Conceptualization, Methodology, Resources, Data Curation, Writing—Original Draft, Writing—Review & Editing, Supervision, Funding Acquisition; Kaylyn A. Garcia: Conceptualization, Methodology, Data Curation, Writing—Original Draft, Writing—Review & Editing, Visualization; Sarah Grace Frary: Conceptualization, Methodology, Data Curation, Writing—Review & Editing; Derek M. Griffith: Writing—Original Draft, Writing—Review & Editing.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr. Guillermo M. Wippold was funded by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number K23MD016123. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Kaylyn A. Garcia has no financial disclosures. Sarah Grace Frary has no financial disclosures. Dr. Derek M. Griffith has no financial disclosures.

ORCID iDs

Kaylyn Ann Garcia

Derek M. Griffith

Supplemental Material

Supplemental material for this article is available online at .

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