Supporting community health workers during extreme heat events: A CFIR-ERIC guided scoping review of implementation strategies in low- and middle-income countries

Background Community health workers (CHWs) are essential to healthcare delivery in low- and middle-income countries (LMICs) yet face increasing threats from extreme heat events (EHEs) due to climate change. Occupational health policies for CHWs remain fragmented globally, with CHWs receiving less attention than workers in other industries despite their critical frontline role. This scoping review aimed to identify barriers and facilitators affecting CHWs during EHEs and determine implementation strategies to support heat safety. Methods We conducted a scoping review by performing a systematic search across PubMed, Scopus, Web of Science, and grey literature published between 2000 and 2024, yielding 1,386 records. After screening, 20 studies met the inclusion criteria. Data synthesis applied the Consolidated Framework for Implementation Research (CFIR) to categorize barriers and facilitators, while the CFIR-ERIC matching tool mapped these to implementation strategies from the Expert Recommendations for Implementing Change (ERIC) taxonomy. Results CHWs in LMICs are central to climate-health responses, and also uniquely vulnerable to heat exposure. Widespread barriers to safe and effective service delivery during EHEs include physical challenges (such as dehydration, heat stress, and exhaustion), psychological stress linked to community expectations, inadequate infrastructure (notably poor cooling and inconsistent utilities), chronic underfunding restricting salaries and supplies, insufficient climate-health training, limited policymaker awareness of heat-health issues, and poor community health-seeking behaviors. Key facilitators that support CHWs include their strong community commitment and trust, deep contextual knowledge, disaster preparedness capabilities, and growing grassroots engagement in heat resilience efforts. However, CHWs remain frequently excluded from intervention design and strategic decision-making. The review identified 43 ERIC implementation strategies tailored to address the unique challenges and opportunities for supporting CHWs during EHEs. Of these, 65% served dual functions: mitigating barriers and reinforcing facilitators. Top-priority cross-cutting strategies included resource-sharing agreements, continuous training, promoting system adaptability, offering clinical supervision, creating educational materials, and coalition-building among stakeholders. Conclusions Many implementation strategies exist to both facilitate CHWs’ responding during EHEs and to protect them during those events. However, success depends on contextual adaptation, with interventions addressing local heat-health risks and socio-political contexts. These findings underline the need to take action to support CHWs during EHEs.