Table 5 Themes identified through qualitative analysis of participant interviews

Intervention as a viable education tool for supporting CHW programming

I'll have to say it (ECHO) was just more engaging. Most of my (other) trainings, I have to drive somewhere so it's really nice that I was sitting in my office. I didn't have to go anywhere. I really loved hearing all the cases and how people deal with all these different patients. Because they sound very similar to some of the patients that we all share.

Sometimes, it's a little frustrating when you have a patient where you're more invested in getting things done than they are. And those (ECHO sessions) were good for me because I just needed some more-- I guess I needed my own motivation.

I think it definitely has shaped the community health worker role here since we are just starting and forming that position. It's given us some guidelines to go by and some expectations that we haven't previously had.

After working with the Project ECHO, it was very helpful and more hands-on for us because the ideas that other facilities gave us with ways to work with our patient helped us out a lot because we learned how other facilities work with their patients.

It was helpful because we were able to start thinking about different situations that we hadn't seen, yet, hear other centers. So we were able to take that knowledge and keep it in mind for future situations.

Heightened intent to improve patient-centered and team-based care practices

I plan to focus more on educating patients and also on determining individual patient needs. By focusing on individual needs, I can increase the chances of success of the patient.

I will work more with the patient so they can feel like we are both doing together instead of me doing it for them.

Going forward I will utilize all (or more) members of my patient's care team to better serve our population.

I look forward to sharing the tools and case study recommendations gained with my program teams and clinic leadership teams, in order to optimize on our current work and provide opportunities for supporting care teams working with patients in need of support (to help remove barriers and reach health goals).

Variability in roles and responsibilities of CHWs

One thing that's always kind of amazing to me, and just talking to community health workers around the state or to being part of an ECHO, is the difference that the agency chooses to utilize community health workers. So you do have those agencies that it's like a one-time, here's the issue, fix it, and you're done kind of thing. Whereas, for myself, I might get a referral. And I can get referrals from social workers or I can get them from therapists or nurses or I can get them from doctors.

I know that some community health workers might only deal with diabetes. Other people deal all across the board with everything imaginable.

We (CHWs at participating site) all have very different aspects and roles that we take care of. We have two CHWs that handle diabetes and we do OB. Then we have one CHW that just does transportation.

Challenges in validating CHW’s added value to care team

My main topic that I found that it was helpful through the ECHO was having to integrate yourself with the team. It's very difficult to let the team know that you are needed as a CHW. It is very difficult to work at a big health center and be able to gain the trust of other team members as providers and nurses working along with the patients, and let them know that you are here to help the patient as much as they are.

Sometimes, we CHWs help the patient much more than the providers due to time limit. They have such a small time to be with a patient that the patient end up coming to us and talking to us of their problems and needs, and even medical problems. Sometimes, it's a challenge to let the provider know that the patient has talked to you on such intimate topics as their health and be able to relay that to them at the same time as not crossing the boundary, or that respect for the patient that they give you as talking to you about their problems.

In the past, I don't think CHWs have been valued because it's not a service that you can get payment or reimbursement for, But, I think that people are open to the idea now of CHWs. It's like a new buzzword. People are picking up on it and so the support is growing. I think in the past, a lot of times people across the board have not valued nonclinical people, but I think that CHWs have a lot to offer whether they're clinical or not.