A Case Study of a Community Health Worker Program Located in Low-Income Housing in Richmond, Virginia

Iyabo Obasanjo, Monica Griffin, Alison Scott, Sarena Oberoi, Charles Westhoff, Patrice Shelton, Stephanie Toney

Research output: Contribution to journalArticlepeer-review


We reviewed data from the electronic health data system used by Community Health Workers (CHWs) in the Richmond/Henrico Health District of the Virginia Department of Health from January 1st 2013 to December 31st 2020, to map the Community Health Workers’ impact on Social Determinants of Health. We also interviewed the CHWs to obtain demographic information and information about the challenges their communities face. Most referrals were for Healthcare Access (48.7%) and Economic Stability (38.3%), while Neighborhood and Built Environment (0.09%) was the least used referral in the Social Determinants of Health during the time under review. Community Health Workers also carried out 1367 and 565 Blood Pressure and Blood Sugar measurements respectively during the period. The Community Health workers were all women and their education ranged from High School graduate to Master’s degree graduate and they served as Community Health Workers for time ranging from 1 to 8 years. We found their answers to the questions on the issue plaguing the community they serve to indicate empathy and understanding of the issues of low-income communities. Having CHWs working as part of the public health system to deliver health promotion and provide referrals for social determinants of health could serve as a model for improving health access and impacting Social Determinants of Health positively for low-income populations across the country.

Original languageEnglish
Pages (from-to)316-323
Number of pages8
JournalJournal of Community Health
Issue number2
StatePublished - Apr 2022

Bibliographical note

Funding Information:
The following students helped with interviews: Ruth Bekele, Victor Adejayan, Munachi Udenyi and Miguel Monllor-Pacheco. Ruth Bekele was supported by a Summer Research Grant from the Charles Center of William and Mary. Sarena Oberoi did the data extraction and data management from the Electronic Health Record system used by the Community Health Workers program. We want to extend our thanks to the Community Health Workers who worked in the health district over the years under review and are responsible for generating the data and the ones that participated in the interviews.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.


  • Community health workers
  • Health inequities
  • Low-income housing
  • Social determinants of health

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health


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