Residents of rural Kentucky have unusually high levels of certain diseases, including cancer, heart disease, hypertension, asthma, and diabetes. Lifestyle choices, environmental factors, inadequate health insurance, and general lack of understanding of the healthcare system are often cited as contributing factors. To help address these issues, Kentucky Homeplace began in 1994 as a demonstration project in 14 Appalachian Counties. After more than two decades, Kentucky Homeplace CHWs have linked tens of thousands of rural Kentuckians with medical, social, and environmental services they otherwise might have gone without. Kentucky Homeplace lay health workers have the job title of community health worker (CHW), which has become the preferred term for lay health workers. Homeplace CHWs are selected from the communities in which they live, usually being born and reared there. CHWs know their community and, because of this trust, develop and assure cultural sensitivity to the health disparities and special needs of the clients they serve and the values of health providers with whom they coordinate services. CHWs are employed from the communities they serve and are trained as advocates to provide access to medical, social and environmental services and to deliver education on prevention and disease self management. Homeplace CHWs, as do most CHWs, have the objective of overcoming health inequities across physical, economic, social and cultural dimensions. Kentucky Homeplace CHWs strive to overcome these barriers to improve access to health care for their clients and to assist them in acquiring crucial resources such as eyeglasses, dentures, home heating assistance, food, diabetic supplies, and free medical care. In all of their roles, Homeplace CHWs provide an important bridge between clients with the greatest needs and the primary care physicians and other health providers in the community. They facilitate communication between these clients and primary care physicians, help the clients learn to effectively comply with medical care instructions, and help educate clients to improve their health behaviors, such as improved nutrition, increased physical activity, better weight management, smoking cessation, and improved diabetes self-management.
