1194: Training Community Health Workers to Support Brain Health

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Thursday, August 27, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

 

It's National Community Health Worker Week. Community health workers, or CHWs, play a vital role in connecting people with the health and social services they need, making them an important part of efforts to improve brain health and support people living with dementia. Corinne Gillenwater, senior analyst for Chronic Disease and Health Improvement at ASTHO, discusses ASTHO's updated e-learning course for CHWs on Alzheimer's disease and related dementias. She explains how feedback from CHWs across the country shaped the new 2.0 version, which covers dementia risk reduction, early detection, caregiving, healthy aging across the life course, and resource navigation.

 

CORINNE GILLENWATER: 

Community health workers or CHWs are front-line public health workers who are trusted members of the community they serve. They have an especially close relationship with the folks that they serve, and they're really vital to public health because they act as this connector for the community and the health and social services that they need. CHW is an umbrella term, so there are many, many other different names for the same role, including navigator, community health representative, promotor de salud, and peer educator, just to name a few, but regardless of these different names, the key roles are the same, which are cultural mediation, care coordination, advocacy, direct services, outreach, health education, coaching, capacity building, assessments, and evaluation and research. So a CHW can educate a community member about making healthy lifestyle choices, like eating nutritious foods or getting enough physical activity or getting enough sleep. A CHW can also help someone set up a primary care appointment with a doctor who speaks the same language as them. Or a CHW could organize and run health information sessions on a variety of public health topics, like heart disease prevention, breastfeeding, and brain health.

 

SHEEHAN: 

And in the past on this show, you've talked about ASTHO's CHW Alzheimer's course. Can you remind us what this is?

 

GILLENWATER: 

Yeah, of course. So last year in July 2025, ASTHO was able to release an e-learning module to equip CHWs to address Alzheimer's disease and related dementias in their communities. And the way the online training is structured is that it starts with a landing page with important foundational information. So again, who CHWs are, why they're important to public health, why they're important to brain health, and then moving into three modules on the topics of risk reduction, early detection, and caregiving. And then there's a very brief end-of-course survey, and then that leads every learner who completes the course to an official downloadable certificate of completion, which is really great. We were able to work with a lot of different jurisdictions to make sure that the certificate is as widely applicable as possible. That way, the maximum amount of CHWs can use that PDF download for their own certification or continuing education requirements. And so we're really proud of this tool that we've created. It's very interactive. Our digital design team used adult learning theory to craft the content and make it as engaging as possible. So features like flashcards, reflection boxes, application-to-practice questions, these have really resonated with CHWs as a way to keep folks engaged even in an asynchronous course. And we were also very happy to highlight that two state spotlights are in each of the modules, so six overall. And it's a really great opportunity to learn from peers and other jurisdictions doing really great work across the country to integrate the CHW workforce into healthy aging efforts. And then the last thing I just wanted to highlight, which I'm so proud to get to showcase, is that the module is completely free to access. There are no cost barriers for CHWs or other learners. And it's fully asynchronous and self-paced so that people can learn on their own time and in their own schedule, and fit it into the busy lives that CHWs have. So, very proud that that's a key aspect of our offering here at ASTHO.

 

SHEEHAN: 

Yeah, and you touched on this briefly, but it was piloted across the country, correct?

 

GILLENWATER: 

Yes, absolutely. We had the chance to work with so many CHWs across the country, and we were super interested in hearing how the training had been received in the field and whether or not it was doing what it set out to achieve, which is of course support CHWs and the community members they serve along the dementia care continuum. So again, with risk reduction, early detection, and caregiving along that continuum, we broke down the pilot and structured it into two parts. The first one is called Phase 1, and that was including eight jurisdictions with 21 CHWs weighing in on the module's quality and utility, and whether or not it had any increases in dementia-related knowledge, skills, and CHWs ability to apply these learnings to practice. And then we also offered an optional listening discussion CHWs to provide context to those survey responses, and half of those eight jurisdictions took us up on that. So we gathered such rich and robust data, quantitative and qualitative, from the survey and the discussion, and we used that to create a list of edits to be made to the module. So this really was, you know, CHW direct feedback. That was the cornerstone of our quality improvement process. We were able to use their voice, their suggestions, their edits, and categorize them according to priority and feasibility, and kept a checklist of all the changes that we made to the module and how they aligned with CHW needs. And then the second part of the program, which we called Phase Two, was a follow-up survey focused on how CHWs had applied the module to their practice in the months since taking it. So nine CHWs from that original pilot cohort from six jurisdictions participated in that follow-up round and provided us with again such great data about how our module filled a gap in brain health training for them, what edits needed to be made in order to better align with day-to-day practice, how it was being applied in real life with community members, and what topics they wanted for the future, what additional trainings and workforce development opportunities would be helpful to them. So it was extremely helpful to hear directly from CHWs about how this training is making a difference and how we can move it forward in the future.

 

SHEEHAN: 

Yeah, absolutely. And that makes complete sense. You know, you want the people who are applying the lessons in real life to give you feedback on the training. What were some What was some high-level feedback that you received?

 

GILLENWATER: 

We have a lot of positive feedback, which is great. The data really demonstrate the impact and value of the training for CHWs in terms of knowledge-building and skill-building, as well as application to practice. So we were fortunate to have 90% of respondents say that the module was very well organized and it provided useful materials and resources that CHWs could use in their day-to-day interactions with community members. And then again, you'll hear the 90%, but 90% of respondents also reported an increase in knowledge across all three of those domains. So again, the risk reduction, early detection, and caregiving. So it was really heartening to see such positive reviews staying at 90% across all three of those domains. And we have similar outcomes, too, for skill-building because 90% also reported an increase in ability to communicate about all three of those domains. So again, really, really great data showing how this training directly led to an increase in knowledge and skills in practice. And during that phase two follow-up that I spoke about, we followed up with pilot participants about three months later, and we found that the training was really seamlessly translating to action. A really impressive 100% of respondents reported that they had applied information from the module to public health practice. So this is just a glimpse into how the module has been doing in the year since we've released it, and we only expect numbers to go up, so it's really great to see that this course is resonating with the CHW workforce.

 

SHEEHAN: 

Sure, of course. What kinds of updates were made as a result of that feedback?

 

GILLENWATER: 

CHW voices and perspectives were really the bedrock to the updates made to the course. So, for instance, CHWs reported that the course took them about between one to two and a half hours to complete, and so we immediately changed the participation hours on the certificate of completion to be two and a half, so that again the maximum amount of CHWs can get the maximum number of credits. So we want to continue to be responsive to their professional development needs and make those updates efficiently, like we've done so far. And in terms of changes to the actual content, this new and improved 2.0 version has a greater emphasis on healthy aging across the life course. So that means not only just caring about brain health when we're older adults, you know, when we're 65 and older, but at all ages, across the entire lifespan. And then we also included more information about how dementia is impacted by other common chronic conditions, infectious diseases, and fall-related injuries, so that helps give learners a clearer picture of the different influences on brain health. And then we also integrated information to support CHWs with the complex resource and service navigation that they always handle, help them choose the best programming for individuals living with dementia based on their interests and values, as well as tips on how to prioritize self-care for caregivers and CHWs alike. So we have mindfulness techniques in there, meditation tips, support group suggestions, so I really loved adding that in this time around. And then we also added a repository of state-specific resources, which was great. We were able to crowdsource from state health agency staff across the country for tools and resources to share directly with CHWs working in this field with individuals with dementia. So that was great to be able to get that input as well. And then finally, we updated the course to have ASTHO's Healthy Aging email address so that learners can reach out to us at any time with questions, requests for support, or suggestions for edits, because we know that this is a lifelong process.

 

SHEEHAN: 

What are some examples of ways that CHWs have applied these learnings to their their real-life practice?

 

GILLENWATER: 

That's been one of my favorite parts about this project is getting to hear directly from individuals about how they're taking what they're learning and using it in their everyday work as CHWs. So, we've heard a lot of great examples across the different surveys and discussions we've had, and, you know, some examples are CHWs sharing content and resources with community members and other CHWs, a lot about spreading the word about dementia risk reduction, early detection, and caregiving at meeting people where they are. So, where CHWs are at outreach events, promotional campaigns, health education sessions, and on a one-on-one basis with patients as well. And so we've seen CHWs really take this module and use what they learned to support program development and evaluation, impact reporting, and communications and messaging. And I'll give you two very specific examples of how CHWs are applying the course to their practice. So, one CHW that we spoke to really was inspired by the module and felt motivated after taking it to build deeper connections with state health department staff and leaders in their local dementia organizations. So, after taking the module, they felt compelled to reach out to those orgs and encourage them to integrate the CHW workforce into their healthy aging efforts. And then another CHW that we had the ability to talk to mentioned that she felt much more confident communicating about dementia and the need for action plans around dementia when she went to a work convening with health district and community-based organization colleagues, which is great to see the the boost in confidence around messaging there. And then she was also integrating some of our module content and resources into the product she was designing. So, a new brain health toolkit, and then a landscape assessment for healthcare providers and community members. So, it was great to see the information we provided live on in other deliverables in other states as well.

 

SHEEHAN: 

Sure. And, Corinne, finally, for a CHW who maybe hasn't taken the course or wasn't aware of it, what's your sales pitch?

 

GILLENWATER: 

I definitely suggest CHWs to take this course, and especially this new and improved version, because it's updated by them for them. The ASTHO team had, again, the amazing opportunity to work hand-in-hand with so many incredible CHWs across the nation through this pilot program. So, we created that safe space where CHWs can share what they're working on, how they felt about the training, what worked, what needed improvement, what gaps in educational needs still persist. And so, from that great relationship building, I'm proud of the work that our team did to create this 2.0 version that is really responsive, and effectively and efficiently made updates to better align with CHW practice and workforce development needs. So, I think this product is only getting stronger as we continue to put it out in the field with CHWs. And like I mentioned, we know quality improvement is lifelong, it's an iterative process, so we're really excited to see where this can go and to continue working directly with CHWs in the future, because we want to make this course as strong as possible for such a vital public health workforce.

 

SHEEHAN: 

Well, Corinne Gillenwater, thanks so much.

 

GILLENWATER: 

Thank you.

 

SHEEHAN: 

Corinne Gillenwater is senior analyst for Chronic Disease and Health Improvement at ASTHO.

 

As we just discussed, community health workers, or CHWs, are pivotal in advancing health equity and improving population health, especially for marginalized communities. Today, there is increasing federal investment to better integrate CHWs into the healthcare system, spurred by post-COVID-19 federal legislation. While the benefits of CHW integration are well documented, sustainable funding remains a challenge. An ASTHO brief developed in partnership with the Center for Health Care Strategies, or CHCS, explores Medicaid coverage for CHW-led services and highlights opportunities for state and territorial health agencies to collaborate with Medicaid to support CHWs. Find a link to this ASTHO brief in the show notes.

 

A new study in the Journal of Rural Health, co-authored by ASTHO's Marta McMillion, explores how rural public health leaders in Wisconsin experienced and sustained resilience during the COVID-19 pandemic. The study highlights the role of trusted relationships, peer networks, staff teams, and supportive governing officials in helping leaders navigate crises and sustain the rural public health workforce. Learn more through the link in the show notes.

 

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.