Behind the Silence: Training CHWs to Identify and Respond to Social Isolation

TL;DR

This study shows that training community health workers to identify and address social isolation in older adults improves their knowledge and confidence, leading to better patient outcomes.

Contribution

A structured training program for CHWs to address social isolation, with measurable improvements in knowledge, confidence, and real-world application.

Findings

CHWs showed 18–26% knowledge gains and 12–32% confidence gains in 11 social isolation domains after training.

CHWs used the SI component in 55% of older adult interactions at two months, connecting patients to community resources.

Barriers to sustained use included patient resistance, cognitive decline, and workflow integration challenges.

Abstract

Social isolation (SI) is a critical social determinant of health that disproportionately affects older adults, increasing the risk of chronic disease, cognitive decline, and mortality. Community health workers (CHWs) are well-positioned to address SI due to their trusted relationships and community-based roles; however, most lack formal training specific to SI. This quality improvement project implemented and evaluated a structured SI training for CHWs at a rural tertiary medical center, guided by Kirkpatrick’s Four Levels of Learning Model. Six CHWs completed pre-training, post-training, and one- and two-month follow-up surveys assessing self-reported knowledge, confidence, and application of an SI component within the Aging Wellness Pathway. The two-hour, case-based training covered distinguishing SI from loneliness, identifying risk factors, communication strategies, connecting to community resources, and integrating interventions into electronic health record workflows. Results demonstrated knowledge gains of 18–26% and confidence gains of 12–32% across 11 SI-related domains, with improvements largely sustained at follow-up. CHWs reported using the SI component in an average of 55% of older adult interactions at two months, facilitating connections to senior centers, companion care, transportation, and the Dartmouth Aging Resource Center. Reported barriers included patient resistance, cognitive decline, and workflow integration challenges. Findings indicate that structured SI training can enhance CHW capacity to identify and respond to SI among older adults, supporting early intervention and connection to evidence-based resources. Sustained use may require ongoing reinforcement, workflow alignment, and strategies to address patient-level barriers.