Abstract
This article explores West Virginia's history with the complex interactions between primary care services, community engagement, and the role of community health workers (CHWs). Using archival research and oral histories, this article looks at four historical time periods marked by the Great Depression, the War on Poverty, Community Health Centers, and the Affordable Care Act. Key findings include the need for sustained investment in outreach by the primary care system and parallel engagement of communities. Outreach-centered roles more recently held by CHWs and performed by other primary care workers improve engagement and health outcomes when they are led from and adapted to each local context. Flexible and inclusive policy environments that aim to provide evidence-based services in rural communities can enable CHW programs to provide continuous care and iteratively improve their effectiveness. These findings can inform approaches for the primary care system to engage communities and the use of CHWs in the state and in other rural, low-income populations in the United States.
