Community Health Workers as Accelerators of Community Engagement and Structural Competency in Health

  • Chau Trinh-Shevrin
  • MD Taher
  • Nadia Islam


Asian Americans are the fastest growing minority population in the United States. Asian Americans are portrayed as uniformly hardworking, affluent, and healthy, leading to the “model minority” stereotype that is often promoted in the American culture and media. However, there are substantial differences in language, migration, and social experiences across more than 30 Asian subgroups; and their health concerns and risks vary across and within these communities. From our personal experiences as refugees and immigrants, we know firsthand the cultural, linguistic, and social barriers that Asian Americans face in navigating the healthcare system. The trauma associated with war, migration, and social isolation, as well as cultural differences and language barriers, make it challenging to seek preventive and timely healthcare services. Similarly, providers also have poor understanding of the stress and mental health concerns associated with migration and displacement, and how that is manifested in health outcomes. These issues are complicated in miscommunication due to language differences and misconceptions of the experience of pain or symptoms among their Asian American patients. Decades later, we have learned from our research that our families’ experiences were not unusual; doctors are less likely to follow evidence-based guidelines and meet standards of care with their Asian American patients compared with other racial groups in preventing and managing chronic conditions. We have also learned that times have not changed dramatically in the care of Asian American patients even though there is now increasing recognition that Asian Americans face just as many health challenges, including an increasing rate of diabetes and certain cancers. Community health workers (CHW) can play an important role in bridging the communication gap, engaging low income Asian immigrant and refugee communities, helping them navigate a complex healthcare system, and, ultimately, improve health outcomes. CHWs are the frontline health workers who are indigenous and trusted members of the community. With the right balance of training and guidance, CHWs can be effective leaders and change agents in empowering and helping Asian American communities develop meaningful solutions for healthful behavior change.


Immigrants Community-based participatory research Community health workers Asian Americans 


  1. 1.
    Trinh-Shevrin C, Sacks R, Ahn J, Yi SS. Opportunities and challenges in precision medicine: improving cancer prevention and treatment for Asian Americans. J Racial Ethn Health Disparities. 2018;5(1):1–6.CrossRefGoogle Scholar
  2. 2.
    Hastings KG, Jose PO, Kapphahn KI, Frank ATH, Goldstein BA, Thompson CA, et al. Leading causes of death among Asian American subgroups (2003–2011). PLoS One [Internet]. 2015;10(4). Available from:
  3. 3.
    King GL, McNeely MJ, Thorpe LE, Mau MLM, Ko J, Liu LL, et al. Understanding and addressing unique needs of diabetes in Asian Americans, native Hawaiians, and Pacific Islanders. Diabetes Care. 2012;35(5):1181–8.CrossRefGoogle Scholar
  4. 4.
    Tung EL, Baig AA, Huang ES, Laiteerapong N, Chua K-P. Racial and ethnic disparities in diabetes screening between Asian Americans and other adults: BRFSS 2012–2014. J Gen Intern Med. 2017;32(4):423–9.CrossRefGoogle Scholar
  5. 5.
    Islam NS, Kwon SC, Wyatt LC, Ruddock C, Horowitz CR, Devia C, et al. Disparities in diabetes management in Asian Americans in New York City compared with other racial/ethnic minority groups. Am J Public Health. 2015;105(Suppl 3):S443–6.CrossRefGoogle Scholar
  6. 6.
    Yi SS, Kwon SC, Sacks R, Trinh-Shevrin C. Commentary: persistence and health-related consequences of the model minority stereotype for Asian Americans. Ethn Dis. 2016;26(1):133–8.CrossRefGoogle Scholar
  7. 7.
    Bureau UC. Projections of the size and composition of the U.S: 2014–2060 [Internet]. [cited 2018 Oct 3]. Available from:
  8. 8.
    Bureau USC. American FactFinder – results [Internet]. [cited 2018 Oct 3]. Available from:
  9. 9.
    DuBard CA, Gizlice Z. Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. Am J Public Health. 2008;98(11):2021–8.CrossRefGoogle Scholar
  10. 10.
    Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002;40(1):52–9.CrossRefGoogle Scholar
  11. 11.
    Kandula NR, Lauderdale DS, Baker DW. Differences in self-reported health among Asians, Latinos, and non-Hispanic whites: the role of language and nativity. Ann Epidemiol. 2007;17(3):191–8.CrossRefGoogle Scholar
  12. 12.
    Bureau UC. The Asian Population: 2010 [Internet]. [cited 2018 Oct 3]. Available from:
  13. 13.
    U.S. Census Bureau. American Fact Finder: 2015 American community survey 1 year estimates, comparative demographic estimates (CP05). 2015; Accessed 5/1/17, 2017.
  14. 14.
    Mayor’s Office of Operations. CEO poverty measure 2005–2014. New York; 2016.Google Scholar
  15. 15.
    Asian American Federation. Profile of New York City’s Bangladeshi Americans: 2013 Edition. 2013.Google Scholar
  16. 16.
    Islam N, Riley L, Wyatt L, Tandon SD, Tanner M, Mukherji-Ratnam R, et al. Protocol for the DREAM Project (Diabetes Research, Education, and Action for Minorities): a randomized trial of a community health worker intervention to improve diabetic management and control among Bangladeshi adults in NYC. BMC Public Health. 2014;14:177.CrossRefGoogle Scholar
  17. 17.
    Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3(3):141–6.CrossRefGoogle Scholar
  18. 18.
    Gupta LS, Wu CC, Young S, Perlman SE. Prevalence of diabetes in New York City, 2002–2008: comparing foreign-born South Asians and other Asians with U.S.-born whites, blacks, and Hispanics. Diabetes Care. 2011;34(8):1791–3.CrossRefGoogle Scholar
  19. 19.
    Yi SS, Kwon SC, Wyatt L, Islam N, Trinh-Shevrin C. Weighing in on the hidden Asian American obesity epidemic. Prev Med. 2015;73:6–9.CrossRefGoogle Scholar
  20. 20.
    NYU Center for the Study of Asian American Health. DREAM Project Materials.
  21. 21.
    Islam NS, Tandon D, Mukherji R, Tanner M, Ghosh K, Alam G, et al. Understanding barriers to and facilitators of diabetes control and prevention in the New York City Bangladeshi community: a mixed-methods approach. Am J Public Health. 2012;102(3):486–90.CrossRefGoogle Scholar
  22. 22.
    Trinh-Shevrin C, Kwon SC, Park R, Nadkarni SK, Islam NS. Moving the dial to advance population health equity in New York City Asian American populations. Am J Public Health. 2015 Jul;105(Suppl 3):e16–25.CrossRefGoogle Scholar
  23. 23.
    Islam N, Shapiro E, Wyatt L, Riley L, Zanowiak J, Ursua R, et al. Evaluating community health workers’ attributes, roles, and pathways of action in immigrant communities. Prev Med. 2017;103:1–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Chau Trinh-Shevrin
    • 1
  • MD Taher
    • 1
  • Nadia Islam
    • 1
  1. 1.Department of Population HealthNYU School of MedicineNew YorkUSA

Personalised recommendations