A Systematic Review of Community Health Workers’ Role in Occupational Safety and Health Research

  • Jennifer E. Swanberg
  • Helen M. Nichols
  • Jessica M. Clouser
  • Pietra Check
  • Lori Edwards
  • Ashley M. Bush
  • Yancy Padilla
  • Gail Betz
Review Paper


We systematically reviewed the literature to describe how community health workers (CHWs) are involved in occupational health and safety research and to identify areas for future research and research practice strategies. We searched five electronic databases from July 2015 through July 2016. Inclusion criteria were as follows: (1) study took place in the United States, (2) published as a full peer-review manuscript in English, (3) conducted occupational health and safety research, and (4) CHWs were involved in the research. The majority of 17 included studies took place in the agriculture industry (76%). CHWs were often involved in study implementation/design and research participant contact. Rationale for CHW involvement in research was due to local connections/acceptance, existing knowledge/skills, communication ability, and access to participants. Barriers to CHW involvement in research included competing demands on CHWs, recruitment and training difficulties, problems about research rigor and issues with proper data collection. Involving CHWs in occupational health and safety research has potential for improving inclusion of diverse, vulnerable and geographically isolated populations. Further research is needed to assess the challenges and opportunities of involving CHWs in this research and to develop evidence-based training strategies to teach CHWs to be lay-health researchers.


Community health workers Occupational safety and health Latino workers 



The work presented in this paper was supported by the CDC/NIOSH Cooperative Agreement 5U54OH007547-16. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC/NIOSH.

Compliance with Ethical Standards

Conflict of interest

Each author of this paper declares that she has no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Informed Consent/Human Research Protection

This is a systematic review of published articles. Institutional review board approval was not needed.


  1. 1.
    Souza K, Steege AL, Baron SL. Surveillance of occupational health disparities: challenges and opportunities. Am J Ind Med. 2010;53(2):84–94.CrossRefPubMedGoogle Scholar
  2. 2.
    Steege AL, Baron SL, Marsh SM, Menéndez CC, Myers JR. Examining occupational health and safety disparities using national data: a cause for continuing concern. Am J Ind Med. 2014;57(5):527–38.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. National Occupational Research Agenda (NORA): National Agriculture, Forestry, and Fishing Agenda. Washington, D.C.: NIOSH; 2008. AgForFishDec2008.pdf. Accessed 4 April 2017.
  4. 4.
    Murray LR. Sick and tired of being sick and tired: scientific evidence, methods, and research implications for racial and ethnic disparities in occupational health. Am J Public Health. 2003;93(2):221–6.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Okechukwu CA, Souza K, Davis KD, de Castro AB. Discrimination, harassment, abuse, and bullying in the workplace: contribution of workplace injustice to occupational health disparities. Am J Ind Med. 2014;57(5):573–86.CrossRefPubMedGoogle Scholar
  6. 6.
    Krieger N. Workers are people too: societal aspects of occupational health disparities - An ecosocial perspective. Am J Ind Med. 2010;53(2):104–15.CrossRefPubMedGoogle Scholar
  7. 7.
    Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health. Occupational Health Disparities. programs/ohd/default.html. Accessed 2 October 2017.
  8. 8.
    Quesada J, Hart LK, Bourgois P. Structural vulnerability and health: Latino migrant laborers in the United States. Med Anthropology. 2011;30(4):339–62.CrossRefGoogle Scholar
  9. 9.
    Clougherty JE, Souza K, Cullen MR. Work and its role in shaping the social gradient in health. Ann N Y Acad Sci. 2010;1186:102–24.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Rodriguez G, Trejo G, Schiemann E, Quandt SA, Daniel SS, Sandberg JC, et al. Latina workers in North Carolina: work organization, domestic responsibilities, health, and family life. J Immigr Minor Health. 2016;18(3):687–96.CrossRefPubMedGoogle Scholar
  11. 11.
    Bureau of Labor Statistics. Foreign-born workers: Labor Force Characteristics—2015. Washington, D.C.: U. S. Department of Labor; 2016. Accessed 4 April 2017.
  12. 12.
    Bureau of Labor Statistics. Labor Force Characteristics by Race and Ethnicity, 2014. Washington, D.C.: U. S. Department of Labor; 2015. Accessed 4 April 2017.
  13. 13.
    Zhang X, Yu S, Wheeler K, Kelleher K, Stallones L, Xiang H. Work-related non-fatal injuries among foreign-born and US-born workers: findings from the U.S. National Health Interview Survey, 1997–2005. Am J Ind Med. 2009;52(1):25–36.CrossRefPubMedGoogle Scholar
  14. 14.
    Cummings KJ, Kreiss K. Contingent workers and contingent health: risks of a modern economy. JAMA. 2008;299:448–50.PubMedGoogle Scholar
  15. 15.
    Howard J. Nonstandard work arrangements and worker health and safety. Am J Ind Med. 2017;60(1):1–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Kalleberg AL. Good jobs, bad jobs: the rise of polarized and precarious employment systems in the United States, 1970s to 2000s. New York: Russell Sage Foundation; 2011.Google Scholar
  17. 17.
    Gong F, Baron S, Stock L, Ayala L. Formative research in occupational health and safety intervention for diverse, underserved worker populations: a homecare worker intervention project. Suppl Public Health Rep. 2009;124(Suppl 1):84–9.CrossRefGoogle Scholar
  18. 18.
    Moir S. Ideological influences on participatory research in occupational health and safety: a review of the literature. New Solut. 2005;15(1):15–28.CrossRefGoogle Scholar
  19. 19.
    Baron SL, Beard S, Davis LK, et al. Promoting integrated approaches to reducing health inequities among low-income workers: applying a social ecological framework. Am J Ind Med. 2014;57(5):539–56.CrossRefPubMedGoogle Scholar
  20. 20.
    Gong F, Baron S, Ayala L, Stock L, McDevitt S, Heaney C. The role for community-based participatory research in formulating policy initiatives: promoting safety and health for in-home care workers and their consumers. Am J Public Health. 2009;99(Suppl 3):S531–8.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Minkler M, Lee PT, Tom A, et al. Using community-based participatory research to design and initiate a study on immigrant worker health and safety in San Francisco’s Chinatown restaurants. Am J Ind Med. 2010;53:361–71. Scholar
  22. 22.
    Chang C, Salvatore AL, Lee PT, et al. Adapting to context in Community-Based Participatory Research: “Participatory Starting Points” in a Chinese immigrant worker community. Am J Community Psychol. 2013;51:480–91. Scholar
  23. 23.
    Rhodes SD, Foley KL, Zometa CS, Bloom FR. Lay health advisor interventions among Hispanics/Latinos: a qualitative systematic review. Am J Prev Med. 2007;33:418–27.CrossRefPubMedGoogle Scholar
  24. 24.
    American Public Health Association. Community health workers. Accessed 4 April 2017.
  25. 25.
    Ingram M, Sabo S, Rother J, Wennerstrom A, De Zapien JG. Community health workers and community advocacy: addressing health disparities. J Community Health. 2008;33:417–24.CrossRefPubMedGoogle Scholar
  26. 26.
    U. S. Department of Health and Human Services. Community Health Worker National Workforce Study. Health Resources Services Administration, Bureau of Health Professions. 2007. Accessed 4 April 2017.
  27. 27.
    Bureau of Labor Statistics. Union Members Summary. Washington, D.C.: U. S. Department of Labor; 2017. Accessed 4 April 2017.
  28. 28.
    U. S. Government Accountability Office. Contingent Workforce. Washington. D.C.: US. Government Accountability Office; 2015. GAO-15-168R 670/669766.pdf.
  29. 29.
    Israel BA, Schurman SJ, House JS. Action research on occupational stress: involving workers as researchers. Int J Health Serv. 1989;19(1):135–55.CrossRefPubMedGoogle Scholar
  30. 30.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Liberati A, Altman DG, Tetzlaff J, et al. PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Littell JH, Corcoran J, Pillai V. Systematic reviews and meta-analysis. New York: Oxford University Press; 2008.CrossRefGoogle Scholar
  33. 33.
    Law M, Stewart D, Pollock N, Letts L, Bosch J, Westmorland M. (1998). Guidelines for critical review form—quantitative studies. 1998. Accessed 4 April 2017.
  34. 34.
    National Institutes of Health. Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Accessed 4 April 2017.
  35. 35.
    Arcury TA, Vallejos QM, Feldman SR, Quandt SA. Treating skin disease: self-management behaviors of Latino farmworkers. J Agromedicine. 2006;11(2):27–35.CrossRefPubMedGoogle Scholar
  36. 36.
    Arcury TA, Marin A, Snively BM, et al. Reducing farmworker residential pesticide exposure: evaluation of a lay health advisor intervention. Health Promot Pract. 2009;10(3):447–55.CrossRefPubMedGoogle Scholar
  37. 37.
    Grzywacz JG, Arcury TA, Marin A, et al. Using lay health promoters in occupational health: outcome evaluation in a sample of Latino poultry-processing workers. New Solut. 2009;19(4):449–66.CrossRefPubMedGoogle Scholar
  38. 38.
    Luque JS, Monaghan P, Contreras RB, et al. Implementation evaluation of a culturally competent eye injury prevention program for citrus workers in a Florida migrant community. Prog Community Health Partnersh. 2007;1(4):359–69.CrossRefPubMedGoogle Scholar
  39. 39.
    Marin A, Carrillo L, Arcury TA, et al. Ethnographic evaluation of a lay health promoter program to reduce occupational injuries among Latino poultry processing workers. Suppl Public Health Rep. 2009;1(124):36–43.CrossRefGoogle Scholar
  40. 40.
    Monaghan P. Lessons learned from a community coalition with diverse stakeholders: the partnership for citrus worker health. Ann Anthropol Pract. 2011;35:27–42.CrossRefGoogle Scholar
  41. 41.
    Monaghan PF, Forst LS, Tovar-Aguilar JA, et al. Preventing eye injuries among citrus harvesters: the community health worker model. Am J Public Health. 2011;101(12):2269–274.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Monaghan PF, Bryant CA, McDermott RJ, et al. Adoption of safety eyewear among citrus harvesters in rural Florida. J Immigr Minor Health. 2012;14:460–66.CrossRefPubMedGoogle Scholar
  43. 43.
    Quandt SA, Grzywacz JG, Talton JW, et al. Evaluating the effectiveness of a lay health promoter-led, community-based participatory pesticide safety intervention with farmworker families. Health Promot Pract. 2013;14(3):425–32.CrossRefPubMedGoogle Scholar
  44. 44.
    Tovar-Aguilar JA, Monaghan PF, Bryant CA, et al. Improving eye safety in citrus harvest crews through the acceptance of personal protective equipment, community-based participatory research, social marketing, and community health workers. J Agromedicine. 2014;19:107–16.CrossRefPubMedGoogle Scholar
  45. 45.
    Forst L, Lacey S, Chen HY, et al. Effectiveness of community health workers for promoting use of safety eyewear by Latino farm workers. Am J Ind Med. 2004;46:607–13.CrossRefPubMedGoogle Scholar
  46. 46.
    Forst L, Noth IM, Lacey S, et al. Barriers and benefits of protective eyewear use by Latino farm workers. J Agromedicine. 2006;11(2):11–7.CrossRefPubMedGoogle Scholar
  47. 47.
    Forst L, Ahonen E, Zanoni J, et al. More than training: Community-based participatory research to reduce injuries among Hispanic construction workers. Am J Ind Med. 2012;56:827–37.CrossRefGoogle Scholar
  48. 48.
    Liebman AK, Juarez PM, Leyva C, Corona A. A pilot program using promotoras de salud to educate farmworker families about the risks from pesticide exposure. J Agromedicine. 2007;12(2):33–43.CrossRefPubMedGoogle Scholar
  49. 49.
    Salvatore AL, Castorina R, Camacho J, et al. Home-based community health worker intervention to reduce pesticide exposures to farmworkers’ children: a randomized-controlled trial. J Expo Sci Environ Epidemiol. 2015;0:1–5.Google Scholar
  50. 50.
    Bush DE, Wilmsen C, Sasaki T, Barton-Antonio D, Steege AL, Chang C. Evaluation of a pilot promotora program for Latino forest workers in Southern Oregon. Am J Ind Med. 2014;57:788–99.CrossRefPubMedGoogle Scholar
  51. 51.
    Farquhar S, Shadbeh N, Samples J, Ventura S, Goff N. Occupational conditions and well-being of indigenous farmworkers. Am J Public Health. 2008;98(11):1956–9.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Rosenthal EL, Wiggins N, Ingram M, Mayfield-Johnson S, De Zapien JG. Community health workers then and now: an overview of national studies aimed at defining the field. J Ambul Care Manag. 2011;34(3):247–59.CrossRefGoogle Scholar
  53. 53.
    Hohl SD, Thompson B, Krok-Schoen JL, Weier RC, Martin M, Bone L, et al. Characterizing community health workers on research teams: results from the Centers for Population Health and Health Disparities. Am J Public Health. 2016;106(4):664–70.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Terpstra J, Coleman KJ, Simon G, Nebeker C. The role of community health workers (CHWs) in health promotion research: ethical challenges and practical solutions. Health Promot Pract. 2011;12(1):86–93.CrossRefPubMedGoogle Scholar
  55. 55.
    Bureau of Labor Statistics. Census of Fatal Occupational Injuries Summary, 2015. Washington, D.C.: U. S. Department of Labor; 2016. news. release/cfoi.nr0.htm. Accessed 4 April 2017.
  56. 56.
    Bureau of Labor Statistics. Nonfatal Occupational Injuries and Illnesses Requiring Days Away from Work, 2015. Washington, D.C.: U. S. Department of Labor; 2016. Accessed 4 April 2017.
  57. 57.
    Eggerth DE, Flynn MA. When the third world comes to the first: ethical considerations when working with Hispanic immigrants. Ethics Behav. 2010;20(3–4):229–42.CrossRefGoogle Scholar
  58. 58.
    Peacock N, Issel LM, Townsell SJ, Chapple-McGruder T, Handler A. An innovative method to involve community health workers as partners in evaluation research. Am J Public Health. 2011;101(12):2275–80.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Minkler M. Community-based research partnerships: challenges and opportunities. J Urban Health. 2005;82(2):ii3–ii12.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Findley SE, Matos S, Hicks AL, Campbell A, Moore A, Diaz D. Building a consensus on community health workers’ scope of practice: lessons from New York. Am J Public Health. 2012;102(10):1981–87.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    O’Brien MJ, Squires AP, Bixby RA, Larson SC. Role development of community health workers: an examination of selection and training processes in the intervention literature. Am J Prev Med. 2009;37(6 Suppl 1):S262–9.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Cargo M, Mercer SL. The value and challenges of participatory research: strengthening its CHW Role in Occupational Safety and Health Research practice. Annu Rev Public Health. 2008;29(1):325–50.CrossRefPubMedGoogle Scholar
  63. 63.
    Weerts DJ, Sandmann LR. Building a two-way street: challenges and opportunities for community engagement at research universities. Rev High Educ. 2008;32(1):73–106.CrossRefGoogle Scholar
  64. 64.
    Sabo S, Wennerstrom A, Phillips D, et al. Community health worker professional advocacy: voices of action from the 2014 National Community Health Worker Advocacy Survey. J Ambul Care Manag. 2015;38(3):225–35.CrossRefGoogle Scholar
  65. 65.
    National Community Health Worker Advocacy Survey: 2014 Preliminary Data Report for the United States and Territories. Mel & Enid Zuckerman College of Public Health, Arizona Prevention Research Center, University of Arizona, Tucson.Google Scholar
  66. 66.
    Poole DL. Building community capacity to promote social and public health: challenges for universities. Health Soc Work. 1997;22(3):163–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Maryland School of Social WorkBaltimoreUSA
  2. 2.Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Center for Health Services Research, College of MedicineUniversity of KentuckyLexingtonUSA
  4. 4.Department of Public Health and Community MedicineTufts University School of MedicineBostonUSA
  5. 5.University of Maryland School of NursingBaltimoreUSA
  6. 6.Health Sciences and Human Services LibraryUniversity of Maryland, BaltimoreBaltimoreUSA

Personalised recommendations