Community health worker-led models for chronic disease prevention and management in the United States: A narrative review of evidence, implementation science, and policy implications

Background: Chronic diseases account for seven of every ten deaths and nearly 90% of the United States’ annual healthcare expenditure. Community health workers (CHWs)—trusted, culturally concordant frontline workers embedded within underserved communities—have emerged as a promising strategy for addressing chronic disease disparities. However, evidence regarding their effectiveness, implementation of models, and policy implications remains fragmented.
Objective: To evaluate the effectiveness of CHW-led interventions in the prevention and management of diabetes mellitus, hypertension, and cardiovascular disease (CVD) in the United States.
Methods: A literature search was conducted in PubMed, CINAHL, and PsycINFO using predefined Medical Subject Headings (MeSH) terms. Eligible studies were English-language publications (2010–2026) examining CHW-led or CHW-supported interventions in U.S. community or clinical settings targeting chronic disease outcomes. Seminal pre-2020 studies were included when essential for methodological context. Data were extracted using a structured template and synthesized thematically.
Results: CHW interventions were associated with clinically meaningful improvements across all disease domains. Hemoglobin A1c reductions ranged from 0.4–2.4 percentage points, hypertension control improved by 7%–27%, and cardiovascular risk scores declined at the population level. Successful programs commonly featured integration within health systems, electronic health record support, sustained patient engagement (≥10 contacts), culturally concordant CHW-patient relationships, and multidisciplinary care coordination. Economic evaluations demonstrated cost savings of up to $3,576 per participant and quality-adjusted life year gains of 0.16–0.36.
Conclusions: Health-system-integrated CHW programs provide an effective and cost-efficient approach to chronic disease management in underserved U.S. populations. Their adaptability during the COVID-19 pandemic further highlights their value as resilient, community-based healthcare delivery models.