{"doi":"10.1681/asn.2022030319","title":"Culturally Concordant Community-Health Workers: Building Sustainable Community-Based Interventions that Eliminate Kidney Health Disparities","abstract":"Community-Health Workers Community-health workers (CHWs), such as patient navigators and promotoras, are lay, nonmedical individuals who are trusted and share the lived experience and characteristics of the community they serve (e.g., race and ethnicity, language, immigration status, socioeconomic challenges, medical illness).1CHWs typically provide support with social- and health-related challenges. CHW interventions became an important community-based strategy to address health disparities after landmark research demonstrated their efficacy in reducing breast cancer screening and treatment disparities.1 CHW interventions deserve consideration to reduce kidney health disparities, particularly for individuals who experience poverty, and members of racial and ethnic minority groups who face a disproportionate burden of social and structural challenges. Characteristics and Training of CHWs Ideally, CHWs should mirror the demographics and language characteristics of their target community, and share experiences in facing social and structural challenges. A culture- and language-concordant CHW may more easily earn an individual’s trust, serve as a source of information, and provide a bridge to health care clinicians and services. A CHW with personal experience with kidney disease may be valuable, because they can empathize with patients and understand the health challenges imposed by kidney disease. The preferability of support from someone with personal experience with kidney disease was confirmed with qualitative findings that assessed the needs and preferences of Latinx individuals with kidney failure, and of interdisciplinary clinicians on how to best support Latinx individuals with kidney failure.2,3 Training for CHWs should be guided by, and specific to, the target community and intended outcomes. Training may include: (1) social risk assessment and how to identify resources and support for individuals with social and structural challenges; (2) behavioral training such as motivational interviewing and patient activation; (3) basic CHW skills (e.g., professional conduct, health promotion, care coordination, health care system overview, electronic health record, or computer training); (4) kidney-specific education and experience that may include clinical shadowing of interdisciplinary clinicians treating kidney disease.4 Opportunities for CHWs to Reduce Kidney Health Disparities Health disparities in using home dialysis and receiving kidney transplant are especially prevalent among racial and ethnic minority groups and individuals who experience poverty.5 Challenges to increasing home dialysis and transplant include clinician, health-system, and patient-related factors. The Advancing American Kidney Health Initiative is a 2019 executive order that challenged the community to increase the number of individuals with kidney failure who receive either home dialysis or a kidney transplant.6 In response, the Centers for Medicare and Medicaid Services implemented the ESRD Treatment Choices and the Kidney Care Choices models.7 CHWs trained in RRT options can provide emotional support, educate patients with low health literacy, support them in dealing with competing social challenges and language interpretation, accompany patients to key encounters, such as the first transplant center visit, or home-based clinician evaluation for home dialysis. CHWs can use their training in motivational interviewing and patient activation to strengthen a patient’s engagement in preparing for, and responding to, the demands related to RRT choice. CHWs can also be active in: (1) supporting efforts to screen patients at risk for kidney disease to reduce the prevalence; (2) connecting patients with kidney disease to clinical care to reduce the progression of kidney disease to kidney failure; (3) providing support to patients with advanced kidney disease for shared decision-making regarding choice of RRT; and (4) improving the transition to transplant or d","journal":"Journal of the American Society of Nephrology","year":2022,"id":251766,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":24,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9557,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":128787,"name":"Bruce M. Robinson","orcid":null,"position":1,"is_corresponding":false},{"id":450752,"name":"John F. Steiner","orcid":"0000-0002-6514-6057","position":2,"is_corresponding":false},{"id":454466,"name":"Larissa Myaskovsky","orcid":"0000-0002-7268-1517","position":3,"is_corresponding":false},{"id":312607,"name":"Lilia Cervantes","orcid":"0000-0002-9912-5684","position":0,"is_corresponding":true}],"reference_count":4,"raw_metadata":null,"created_at":"2026-07-19T00:24:41.993282Z","pmid":"35474023","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}