To systematically review and map the evidence on community-based nutrition interventions implemented in humanitarian and emergency settings in low- and middle-income countries (LMIC), focusing on intervention types, outcomes, evidence gaps and implications for humanitarian nutrition systems.

Systematic review and evidence mapping conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight electronic databases and twenty-six organisational websites were searched for studies published between 2010 and 2024. Studies are mapped by intervention and outcome categories. Findings are synthesised narratively.

Humanitarian and emergency settings in LMIC affected by conflict, fragility, displacement or natural disasters.

Women, infants, children, adolescents, caregivers and households receiving community-based nutrition interventions delivered through community health workers (CHW), volunteers, peer counsellors, care groups or other community platforms.

Fifty-three documents met inclusion criteria, including thirty-nine primary study documents representing thirty-three interventions across twenty countries and fourteen systematic reviews. Most evidence originates from Africa and focuses on community groups, nutrition counselling and community-based management of acute malnutrition. Preventive interventions generally improved infant and young child feeding practices and caregiver behaviours but showed inconsistent effects on anthropometric outcomes. Treatment interventions delivered through CHW and community volunteers improved recovery, programme coverage and treatment performance. However, evidence on dietary intake, food security, caregiver capacity, relapse prevention and longer-term outcomes remains limited.

Community-based nutrition interventions are central to extending nutrition service delivery in humanitarian settings and show strong potential to improve feeding practices and treatment outcomes. More integrated and context-sensitive evaluation frameworks are needed to strengthen evidence for resilient humanitarian nutrition programming.

We previously developed and tested a peer-led research best practices training for community health workers and promotoras (CHW/Ps) to enhance the capacity of a workforce that is increasingly important for community-engaged research. This paper explores results of training implementation at 4 additional sites – 3 academic institutions and 1 community-based organization.

Forty-two CHW/Ps were trained over 6 trainings and 10 site staff participated. We used a mixed methods design consisting of surveys and interviews to assess site staff’s perceptions of the training and its implementation. Survey data were examined using basic statistics and thematic content analysis. Two coders analyzed the interviews inductively then deductively by mapping codes onto the Consolidated Framework for Implementation Research (CFIR). Survey and interview results were integrated using a joint display to identify meta-inferences.

Surveys of staff quantitatively demonstrated high acceptance, appropriateness, and feasibility of the peer-led research best practices training for CHW/Ps. Several qualitative themes emerged that aligned with CFIR domains, highlighting perceptions of the training and factors related to its implementation. Meta-inferences revealed staff’s perspectives about implementing the training were influenced by characteristics of the training and implementation sites, learner engagement and compensation strategies, and implementation processes.

The peer-led research best practices training for CHW/Ps is acceptable, appropriate, and feasible for implementation by academic and community-based organizations, particularly due to the flexibility of how it was designed. While successful implementation at all sites requires engaged Champion peer facilitators, other needs to support implementation vary based on site characteristics and environment.

This article reports on the feasibility, acceptability of a trial design and results of ¡Coma, Muévase y Viva!, an adapted version of the Eat, Move, Live! Curriculum, a 10-week diet and lifestyle change intervention for low-income Latina and Indigenous Mexican women in rural Inland Southern California.

A pilot randomised intervention and wait-list controlled parallel trial.

Latina and Indigenous Mexican women participated in ¡Coma, Muévase y Viva!, the adapted version of the curriculum customised for Spanish speakers with a focus on health literacy, cultural norms and values, and delivered by community health workers/promotoras.

Participants were randomised into the intervention (n 19) or wait-list control (n 16). Most were Latino (88 %), mothers (75 %) and foreign-born (87 %).

The adapted intervention was feasible and acceptable with 87·5 % of participants retained at three months. The intervention was delivered with high fidelity. Intervention compared to control participants reported success with predetermined prioritised goals (OR = 0·25, 95 % CI: 0·06, 0·99, P = 0·03) and showed a greater likelihood of cooking healthier food (OR = 4·87, 95 % CI: 1·04, 22·90, P = 0·05), enjoyment of cooking healthy meals (OR = 3·94, 95 % CI: 0·87, 17·92, P = 0·08) and doing physical activities (OR = 5·30, 95 % CI: 1·16, 24·24, P = 0·03). Healthy eating and physical activity as primary outcomes indicated the intervention group was more likely to eat healthy and be active (OR = 2·08, 95 % CI: 1·12, 3·89, P = 0·02).

The adapted intervention was feasible and acceptable and indicated an effect on dietary and lifestyle behaviour change with significant changes in meeting desired goals and engaging in healthy eating and physical activity.

In Indiana, Black women had 12% higher cervical cancer incidence, and 21% higher mortality compared to White women during the years 2008–2017. Human Papillomavirus (HPV) self-sampling delivered by community health workers (CHW) has demonstrated potential to increase cervical cancer screening rates among at-risk populations. This study aims to understand patient attitudes toward HPV self-sampling and CHW-delivered screening.

We conducted a cross-sectional online survey among patients from three Planned Parenthood clinics in Lake County, IN, which has one of the highest cervical cancer mortality rates in Indiana. Patients’ willingness to self-sample and to receive health education and services related to cervical cancer screening from CHWs was analyzed using logistic regression.

In the final sample (N = 140), the largest proportions of respondents were below age 30 (54.3%), aware of cervical cancer (78.6%), up to date on cervical cancer screening (84.3%), had no prior self-sampling experience (53.6%) and were aware of CHWs (52.1%). Multivariable logistic regression analyses showed Black patients had higher odds of being willing to: self-sample at home (aOR = 3.749, 95% CI = 1.619–8.681), receive health education from CHWs (aOR = 4.952, 95% CI = 2.124–11.548), and receive health services from CHWs (aOR = 3.305, 95% CI = 1.479–7.388) compared to White patients.

Our results showed Black patients had higher willingness for HPV self-sampling and CHW delivery of cervical cancer screening services. Study findings can be used to inform future CHW-led interventions for outreach, education, and delivery of self-sampling interventions to increase cervical cancer screening rates among Black women in underserved areas.

In low- and middle-income countries (LMICs), suicide is a major problem. Research on the effectiveness of large-scale suicide prevention interventions is limited.

To test the effectiveness of an integrated intervention (school-based prevention; reducing access to means of suicide; increased identification and management of suicide risk) in reducing deaths by suicide and suicide attempts; and to evaluate the implementation and effectiveness of sub-interventions.

In this pragmatic cluster randomised controlled trial, 124 villages from Mehsana, India, were randomly assigned to either intervention or control arm. The intervention comprised school-based awareness intervention, community pesticide storage and training of community health workers (CHWs) to recognise, support, refer and follow up people at risk. Intention-to-treat analysis using mixed-effects Poisson regression tested the primary outcome (suicide attempts plus deaths by suicide), and multilevel linear models assessed sub-interventions. The primary outcome was captured through a novel suicide surveillance system.

There was no statistically significant difference in the primary outcome between the intervention (54 of 62 consenting villages) and control (62 villages) arms. Separately, the intervention arm showed a 43% reduction in risk of death by suicide at 12 months (suicide rate 30.7 versus 43.6 per 100 000 person-years in intervention versus control arm; incidence rate ratio 0.57, 95% CI: 0.32–1.02, adjusting for baseline and clustering). Most students (≥90%, n = 2330/2560) from 47 schools received the intervention and had lower depression and suicidal ideation than controls at month 3. Nearly all villages (52/54, 96.2%) provided pesticide lockers (n = 8370 households, 88.83% uptake). Compared with controls, CHWs in the intervention arm had significantly higher knowledge, confidence and skills, and identified 108 at-risk individuals.

The intervention increased identification without significantly reducing suicide attempts, but reduced suicide deaths. This trial, involving 116 villages and a multicomponent intervention implemented at scale, advances suicide prevention and complex intervention research, especially in LMICs.

To overcome the dearth of high-quality, evidence-based, role-specific training for community health workers and promotoras (CHW/Ps) working with research teams, we developed and evaluated a peer-led research best practices training for CHW/Ps. This article qualitatively explores the training experiences from the perspectives of CHW/Ps.

CHW/Ps were recruited from communities and partners affiliated with study sites in Michigan, Florida, and California to participate in peer facilitated trainings in English and Spanish. A purposeful sample of CHW/Ps completed interviews from July to December 2023 about their perceptions of the training. Three coders analyzed the interviews using a combination of the rigorous and accelerated data reduction (RADaR) technique and thematic text analysis.

Seventeen CHW/Ps participated in interviews (N = 10 in English; N = 7 in Spanish). The mean age was 43.7 ± 14.5 years, most were female (59%), and 47% identified as Hispanic, Latino, or Spanish. We identified three primary themes, each with resulting subthemes: (1) CHW/Ps’ Perceptions of the Training, (2) Factors Influencing Receipt of the Training, and (3) CHW/Ps’ Recommendations for Future Trainings. Despite offering some opportunities for improvement in various areas, CHW/P learners found the training further clarified their role as CHW/Ps, enhanced their knowledge and skills, and provided a beneficial foundation for CHW/Ps working in community-engaged research.

A peer-led research best practices training for CHW/Ps is an effective strategy for enhancing CHW/Ps’ knowledge and skills. Training CHW/Ps in research best practices is a strategy for enhancing the capacity and capability of this community-engaged research workforce

Disparities in access to palliative care persist, particularly among underserved populations. We elicited recommendations for integrating community health workers (CHWs) into clinical care teams, by exploring perspectives on potential barriers and facilitators, ultimately aiming to facilitate equitable access to palliative care.

Twenty-five stakeholders were recruited for semi-structured interviews through purposive snowball sampling at three enrollment sites in the USA. Interviews were conducted to understand perspectives on the implementation of a CHW palliative care intervention for African American patients with advanced cancer. After transcription, primary and secondary coding were conducted. Framework analysis was utilized to refine the data, clarify themes, and generate recommendations for integrating CHWs into palliative care teams.

Our sample comprised 25 key informants, including 6 palliative care providers, 6 oncologists, 5 cancer center leaders, 2 cancer care navigators, and 6 CHWs. Thematic analysis revealed five domains of recommendations: (1) increasing awareness and understanding of the CHW role, (2) improving communication and collaboration, (3) ensuring access to resources, (4) enhancing CHW training, and (5) ensuring leadership support for integration. Informants shared barriers, facilitators, and recommendations within each domain based on their experiences.

Barriers to CHW integration within palliative care teams included limited awareness of the CHW role and inadequate training opportunities, alongside practical and logistical challenges. Conversely, promoting CHW engagement, providing adequate training, and ensuring support from leadership have the potential to aid integration.

Community health workers (CHWs) stand as critical frontline agents within the Brazilian healthcare system. In this qualitative study, we examined the impact of a community-based behavioral change intervention spearheaded by CHWs.

The intervention focused on promoting healthy behaviors – physical activity, nutrition, and emotional well-being – among individuals aged 50 and older living in a rural community in Brazil. The intervention was designed, implemented, and evaluated in close collaboration with CHWs and local administrators. The implementation of the intervention unfolded in two waves, each lasting 12 months. Interviews with CHWs, health administrators, and intervention participants conducted at post-intervention and 6-year follow-up centered on CHWs as delivery agents and examined the implementation of the intervention in primary care contexts around adoption, implementation, and long-term maintenance.

Inductive analysis revealed four themes that highlight CHWs’ motivation to take active roles in health promotion and overcoming challenges such as unfamiliarity with new roles or limited training. In addition, enhanced community bonds, job satisfaction, and trust in CHWs gained through the intervention, empowered CHWs to realize their potential and importance. Another important area relates to the CHWs’ ability to leverage their deep community ties and cultural insights to enhance the intervention’s significance. CHWs’ participation in the program also led to personal benefits and self-care practices, setting an example for the community they serve.

This study underscores the positive impact of a community-based intervention led by CHWs. Such programs have the potential for nationwide dissemination, leveraging the CHWs’ widespread presence and deep community integration.

Community health workers and promotoras (CHW/Ps) increasingly support research conducted in communities but receive variable or no training. We developed a culturally and linguistically tailored research best practices course for CHW/Ps that can be taken independently or in facilitated groups. The purpose of this study was to evaluate the facilitated training.

CHW/Ps were recruited from communities and partners affiliated with study sites in Michigan, Florida, and California. They participated in virtual or in-person training facilitated by a peer in English or Spanish and then completed a survey about their abilities (i.e., knowledge and skills for participating in research-related work) and perceptions of the training. Linear regression analyses were used to examine differences in training experience across several factors.

A total of 394 CHW/Ps, mean age 41.6 ± 13.8 years, completed the training and survey (n = 275 English; 119 Spanish). Most CHW/Ps were female (80%), and 50% identified as Hispanic, Latino, or Spanish. Over 95% of CHW/Ps rated their abilities as improved after training; 98% agreed the course was relevant to their work and felt the training was useful. Small differences were observed between training sites.

Most CHW/Ps rated the training positively and noted improved knowledge and skills for engaging in research-related work. Despite slight site differences, the training was well received, and CHW/Ps appreciated having a facilitator with experience working in community-based settings. This course offers a standard and scalable approach to training the CHW/P workforce. Future studies can examine its uptake and effect on research quality.

Community health workers and promotoras (CHW/Ps) have a fundamental role in facilitating research with communities. However, no national standard training exists as part of the CHW/P job role. We developed and evaluated a culturally- and linguistically tailored online research best practices course for CHW/Ps to meet this gap.

After the research best practices course was developed, we advertised the opportunity to CHW/Ps nationwide to complete the training online in English or Spanish. Following course completion, CHW/Ps received an online survey to rate their skills in community-engaged research and their perceptions of the course using Likert scales of agreement. A qualitative content analysis was conducted on open-ended response data.

104 CHW/Ps completed the English or Spanish course (n = 52 for each language; mean age 42 years SD ± 12); 88% of individuals identified as female and 56% identified as Hispanic, Latino, or Spaniard. 96%–100% of respondents reported improvement in various skills. Nearly all CHW/Ps (97%) agreed the course was relevant to their work, and 96% felt the training was useful. Qualitative themes related to working more effectively as a result of training included enhanced skills, increased resources, and building bridges between communities and researchers.

The CHW/P research best practices course was rated as useful and relevant by CHW/Ps, particularly for communicating about research with community members. This course can be a professional development resource for CHW/Ps and could serve as the foundation for a national standardized training on their role related to research best practices.