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Peer-reviewedCC BY-NC 4.0BMJ Open

Integration of community health workers (CHWs) and lay/peer workers in universal healthcare systems: a scoping review of high-income countries using the Lévesque conceptual framework of access to healthcare

  • Audrey Steenbeek1,2
  • Noah Doucette1
  • Kimberley Okafor1
  • Alyssa Indar3
  • Fareha Khan4
  • Seema Rani4
  • Shilpi Sarkar4
  • Melissa Rothfus2,5
5 affiliations
  1. 1Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
  2. 2JBI Centre, Dalhousie University, Halifax, Nova Scotia, Canada
  3. 3University Health Network, Toronto, Ontario, Canada
  4. 4Nursing, Jamia Hamdard University, New Delhi, India
  5. 5W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract

Background: Community health workers (CHWs) are trained lay individuals embedded within and trusted by their communities who help address health system gaps across diverse settings. While CHW models are well established in low- and middle-income countries, their integration in high-income countries with universal healthcare systems remains limited and inconsistent and has not yet been comprehensively synthesised.

Objectives: To map available evidence on the integration of CHWs in high-income countries with universal healthcare systems, including Canada. Specifically, it examined the tools, strategies, training approaches, organisational features, policies, frameworks and programmes supporting CHW integration and summarised their key characteristics and reported or anticipated outcomes.

Eligibility criteria/ setting: We included all relevant studies and grey literature on the integration of CHWs into high-income countries with universal healthcare systems. It encompassed all types of CHWs, or similar roles, defined as trained laypersons providing health-related services, with full-text articles available in any language.

Sources of evidence: Medline (Ovid), Embase (Elsevier), Scopus (Elsevier), CINAHL (EBSCO), PsycINFO (EBSCO), Academic Search Premier (EBSCO), Business Source Complete (EBSCO), ProQuest Dissertations and Theses Global from inception until 31 December 2025.

Charting methods: All identified records from the selected databases and supplementary sources were imported into the online review management platform Covidence, where duplicates were removed. The review followed JBI methodology and was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Findings were organised using the Lévesque conceptual framework of access to healthcare.

Results: A total of 27 514 records were retrieved from all databases. After removal of duplicates, 16 538 records were screened, 352 full-text articles were assessed for eligibility and 23 studies were included in the review. The included literature described diverse CHW and related peer-based interventions spanning consultation and co-design, education and training, workforce integration and service delivery models. A substantial proportion of studies focused on peer-based roles, particularly within mental health settings. Findings highlighted the importance of organisational readiness, role clarity and collaborative, person-centred approaches in supporting integration. Reported outcomes included improved service access, care experiences and perceived quality; however, evidence varied across settings and outcomes.

Conclusion: Guided by the Lévesque framework, CHW and related peer workforce integration was associated with improved healthcare access, particularly through enhanced approachability, acceptability, continuity, collaboration and person-centred, recovery-oriented approaches. However, evidence was predominantly focused on supply-side dimensions of access, while affordability and other demand-side dimensions were underreported. Persistent structural barriers, including stigma, role ambiguity, inconsistent training and funding instability, limited sustainability, underscoring the need for supportive organisational structures, clear roles and aligned policy and funding mechanisms.

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Cite

BibTeXRIS
BibTeX
@article{steenbeek2026integration,
  title = {{Integration of community health workers (CHWs) and lay/peer workers in universal healthcare systems: a scoping review of high-income countries using the Lévesque conceptual framework of access to healthcare}},
  author = {Audrey Steenbeek and Noah Doucette and Kimberley Okafor and Alyssa Indar and Fareha Khan and Seema Rani and Shilpi Sarkar and Melissa Rothfus},
  journal = {BMJ Open},
  year = {2026},
  month = oct,
  doi = {10.1136/bmjopen-2026-122444},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-122444},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Integration of community health workers (CHWs) and lay/peer workers in universal healthcare systems: a scoping review of high-income countries using the Lévesque conceptual framework of access to healthcare
AU  - Audrey Steenbeek
AU  - Noah Doucette
AU  - Kimberley Okafor
AU  - Alyssa Indar
AU  - Fareha Khan
AU  - Seema Rani
AU  - Shilpi Sarkar
AU  - Melissa Rothfus
PY  - 2026
DA  - 2026/10/06
JO  - BMJ Open
DO  - 10.1136/bmjopen-2026-122444
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-122444
AB  - Background: Community health workers (CHWs) are trained lay individuals embedded within and trusted by their communities who help address health system gaps across diverse settings. While CHW models are well established in low- and middle-income countries, their integration in high-income countries with universal healthcare systems remains limited and inconsistent and has not yet been comprehensively synthesised.  Objectives: To map available evidence on the integration of CHWs in high-income countries with universal healthcare systems, including Canada. Specifically, it examined the tools, strategies, training approaches, organisational features, policies, frameworks and programmes supporting CHW integration and summarised their key characteristics and reported or anticipated outcomes.  Eligibility criteria/ setting: We included all relevant studies and grey literature on the integration of CHWs into high-income countries with universal healthcare systems. It encompassed all types of CHWs, or similar roles, defined as trained laypersons providing health-related services, with full-text articles available in any language.  Sources of evidence: Medline (Ovid), Embase (Elsevier), Scopus (Elsevier), CINAHL (EBSCO), PsycINFO (EBSCO), Academic Search Premier (EBSCO), Business Source Complete (EBSCO), ProQuest Dissertations and Theses Global from inception until 31 December 2025.  Charting methods: All identified records from the selected databases and supplementary sources were imported into the online review management platform Covidence, where duplicates were removed. The review followed JBI methodology and was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Findings were organised using the Lévesque conceptual framework of access to healthcare.  Results: A total of 27 514 records were retrieved from all databases. After removal of duplicates, 16 538 records were screened, 352 full-text articles were assessed for eligibility and 23 studies were included in the review. The included literature described diverse CHW and related peer-based interventions spanning consultation and co-design, education and training, workforce integration and service delivery models. A substantial proportion of studies focused on peer-based roles, particularly within mental health settings. Findings highlighted the importance of organisational readiness, role clarity and collaborative, person-centred approaches in supporting integration. Reported outcomes included improved service access, care experiences and perceived quality; however, evidence varied across settings and outcomes.  Conclusion: Guided by the Lévesque framework, CHW and related peer workforce integration was associated with improved healthcare access, particularly through enhanced approachability, acceptability, continuity, collaboration and person-centred, recovery-oriented approaches. However, evidence was predominantly focused on supply-side dimensions of access, while affordability and other demand-side dimensions were underreported. Persistent structural barriers, including stigma, role ambiguity, inconsistent training and funding instability, limited sustainability, underscoring the need for supportive organisational structures, clear roles and aligned policy and funding mechanisms.
SN  - 2044-6055
SN  - 2044-6055
ER  -