CHWS cheat sheet

WHO definition of health: a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.

Dimensions of wellness commonly used in CHW practice: physical, emotional, social, intellectual, occupational, spiritual, environmental, and financial.

Social determinants of health (SDOH) domains: economic stability, education access and quality, health care access, neighborhood and built environment, and social and community context.

Primary, secondary, and tertiary prevention refer respectively to preventing onset, detecting disease early, and reducing complications or disability.

Incidence counts new cases in a period; prevalence counts all existing cases at a point or over a period; prevalence rises when incidence rises or survival lengthens.

Health equity means everyone has a fair and just opportunity to be as healthy as possible; health disparities are differences linked to social or economic disadvantage.

The ecological model nests influence at individual, interpersonal, organizational, community, and policy levels; interventions at multiple levels tend to be more durable.

Upstream approaches target root causes such as housing, income, and food access; downstream approaches target individual treatment and behavior.

Transtheoretical (stages of change) model stages: precontemplation, contemplation, preparation, action, maintenance; relapse is a normal return to an earlier stage, not failure.

Stage-matched tasks: raise awareness in precontemplation, tip the balance in contemplation, secure commitment in preparation, reinforce gains in action, plan for relapse in maintenance.

Motivational interviewing core spirit: partnership, acceptance, compassion, evocation; the four processes are engaging, focusing, evoking, and planning.

OARS skills: open questions, affirmations, reflections, summaries; reflections should outnumber questions in a typical MI conversation.

Change talk (desire, ability, reasons, need, commitment) predicts behavior change; sustain talk predicts maintenance of the status quo; respond to change talk by evoking elaboration.

SMART goal criteria: specific, measurable, achievable, relevant, time-bound; action plans pair a cue with a concrete response (implementation intentions).

Social cognitive theory constructs: self-efficacy, observational learning, outcome expectations, behavioral capability, reinforcement, reciprocal determinism.

Health belief model constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy.

Self-determination theory identifies autonomy, competence, and relatedness as basic needs; satisfying them supports intrinsic motivation.

Dietary Guidelines for Americans key patterns emphasize vegetables, fruits, whole grains, lean protein, low-fat dairy or fortified alternatives, and limited added sugars, sodium, and saturated fat.

Physical activity guidelines for adults: at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes of vigorous activity, plus muscle-strengthening on 2 or more days per week.

Children and adolescents need about 60 minutes of moderate-to-vigorous physical activity daily, including bone- and muscle-strengthening activity.

Caloric density and nutrient density are distinct: a food can be high in calories but low in nutrients (empty calories) or the reverse.

Added sugars should generally stay under 10% of daily calories; saturated fat under 10%; sodium under 2,300 mg per day for most adults.

Food label reading: start with serving size, then calories, added sugars, sodium, saturated fat, and fiber; percent daily value is based on a 2,000-calorie diet.

BMI is weight in kilograms divided by height in meters squared; it is a screening tool, not a diagnosis, and misclassifies some people with high muscle mass.

Food insecurity is limited or uncertain access to adequate food; screening tools include the two-item Hunger Vital Sign and the six-item USDA short form.

Sedentary behavior is distinct from physical inactivity: meeting activity guidelines does not fully offset long sitting time.

General adaptation syndrome stages: alarm, resistance, exhaustion; chronic stress keeps the body in resistance and raises allostatic load.

Acute stress activates the sympathetic-adrenal-medullary axis (rapid catecholamines); chronic stress engages the hypothalamic-pituitary-adrenal axis and cortisol.

Eustress is stress that motivates growth; distress is stress that impairs functioning; the appraisal of a stressor shapes the response.

PHQ-9 screens for depression severity (0-27); GAD-7 screens for anxiety severity (0-21); higher scores indicate greater severity and prompt further assessment.

C-SSRS and ASQ are screening tools for suicide risk; positive screens require direct, compassionate safety assessment and referral, not reassurance alone.

Sleep duration recommendations: 7-9 hours for adults, 8-10 hours for teens, 9-12 hours for school-age children.

Sleep hygiene components include consistent sleep-wake times, dark and cool room, limited caffeine late in the day, and reduced screens before bed.

Obstructive sleep apnea signs include loud snoring, witnessed pauses in breathing, and daytime sleepiness; it is a medical condition requiring clinical evaluation.

Burnout comprises emotional exhaustion, depersonalization or cynicism, and reduced sense of accomplishment; it is an occupational phenomenon, not a clinical diagnosis.

Leading modifiable risk factors for chronic disease include tobacco use, unhealthy diet, physical inactivity, harmful alcohol use, and obesity.

Hypertension is generally defined as systolic 130 mm Hg or higher or diastolic 80 mm Hg or higher; confirm with repeated readings before labeling.

Prediabetes ranges include A1c 5.7-6.4%, fasting glucose 100-125 mg/dL, or 2-hour glucose 140-199 mg/dL; structured lifestyle programs reduce progression to diabetes.

The Diabetes Prevention Program showed that modest weight loss (about 7%) and 150 minutes per week of activity reduced type 2 diabetes incidence substantially.

Tobacco cessation: combining counseling with pharmacotherapy is more effective than either alone; brief advice follows the Ask-Advise-Refer pattern.

Cardiovascular risk reduction includes blood pressure control, lipid management, smoking cessation, physical activity, and healthy dietary patterns.

Cancer screening is age- and risk-based; CHWs support informed decision-making and navigation to screening rather than recommending tests independently.

Vaccination reduces complications of chronic disease (for example, influenza and pneumococcal vaccines in older adults and people with chronic conditions).

Medication adherence barriers include cost, side effects, complexity, and health literacy; refill data and pill counts are common adherence proxies.

Plain language targets roughly a sixth-grade reading level or lower; use short sentences, common words, and active voice.

Teach-back: ask the learner to explain or demonstrate the information in their own words; it verifies understanding, not the learner's intelligence.

Health literacy includes print literacy, numeracy, oral literacy, and navigation skills; low health literacy is common and not a proxy for intelligence.

Chunk information into small pieces and check comprehension after each; limit to three to five key messages per session.

Motivational interviewing reflections and open questions support two-way communication better than closed questions and warnings.

Cultural tailoring of messages improves relevance; translation alone does not ensure cultural fit or accuracy.

Numeric risk communication: use absolute risks and consistent denominators; natural frequencies (for example, 3 in 100) are understood better than percentages alone.

Documentation should be objective, timely, and behaviorally specific; avoid judgmental language and unverified conclusions.

Interpreters should be trained and qualified; using family members, especially children, raises privacy and accuracy concerns.

Needs assessment methods include key informant interviews, focus groups, surveys, and secondary data review; triangulate sources to strengthen findings.

Logic models link inputs, activities, outputs, short-term outcomes, intermediate outcomes, and long-term impact.

Formative evaluation assesses program design and implementation; summative evaluation assesses outcomes and impact.

Process evaluation measures reach, dose delivered, dose received, fidelity, and participant satisfaction.

Outcome evaluation measures changes in knowledge, behavior, or health status; impact evaluation measures long-term population-level change.

SMART objectives specify a measurable indicator, baseline, target, and timeframe; process objectives describe activities, outcome objectives describe results.

Common evaluation designs include pre-post, post-only, quasi-experimental, and randomized designs; pre-post without a comparison group cannot establish causality.

RE-AIM framework dimensions: reach, effectiveness, adoption, implementation, and maintenance.

Program sustainability depends on funding diversification, workforce capacity, stakeholder engagement, and institutionalization of practices.

CHW scope varies by employer and jurisdiction; core functions include outreach, education, navigation, advocacy, and social support, not diagnosis or prescribing.

Role boundaries: CHWs do not diagnose, prescribe, interpret diagnostic tests, or provide clinical treatment; they refer and bridge to licensed professionals.

Informed consent requires disclosure of purpose, risks, benefits, alternatives, and the voluntary right to decline or withdraw.

Confidentiality is limited by legal reporting duties (for example, suspected abuse or imminent danger) and by program policy; explain limits at the start.

Mandatory reporting duties vary by state and by profession; verify local requirements before promising absolute confidentiality.

Dual relationships and conflicts of interest should be disclosed and managed; boundaries protect both worker and participant.

Ethical principles: autonomy, beneficence, nonmaleficence, justice, and fidelity; apply them to everyday decisions such as privacy and resource allocation.

Documentation and referral should be timely and specific, noting the reason for referral, who was contacted, and the outcome.

When a participant discloses a medical emergency, follow emergency protocols and connect to emergency services rather than attempting clinical management.

Cultural humility is a lifelong process of self-reflection, redressing power imbalances, and institutional accountability, distinct from cultural competence as a fixed endpoint.

Cultural competence models describe knowledge, skills, and attitudes about specific groups; cultural humility emphasizes ongoing learning and partnership.

Implicit bias is an automatic association that can influence decisions without conscious intent; mitigation strategies include counter-stereotypic exposure and structured decision tools.

Health disparities are measured by comparing rates across groups; common axes include race and ethnicity, income, education, geography, disability, and sexual orientation.

Language access requires qualified interpreters and translated materials at appropriate reading levels; Title VI obligations apply to federally funded programs.

Social identity and intersectionality describe how overlapping identities shape health risks and access to care.

Community engagement principles include shared decision-making, compensation for community partners, and returning results to the community.

Avoid deficit framing: describe community strengths and assets alongside needs, and involve community members in defining priorities.

Cultural tailoring addresses values, beliefs, family roles, and communication norms; it should be developed with the community, not assumed.