‘A poverty in understanding’: Assessing the structural challenges experienced by community health workers and their clients

Logan, Ryan I.

doi:10.1080/17441692.2019.1656275

Cited by 12 publications

(10 citation statements)

References 38 publications

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“…Populations living in rural settings suffer from many of the same social determinants of health as those in urban settings. However, in rural settings, these may become exacerbated through a lack of financial capital, lack of transportation, geographic isolation, high rates of chronic disease, high rates of health risk behaviors, low rates of health insurance, and a lack of providers [3,5,37]. Additional factors, such as a lack of access to technology (e.g., the Internet), further complicate issues [38].…”

Section: Role Of Chws and Promotoresmentioning

confidence: 99%

“…However, these workers are also affected by a variety of their own structural constraints, such as restrictions in the professional workforce, condescension from other medical professionals, and a general lack of awareness by the broader public [37]. Lack of investment in CHWs negatively affects their ability to do their job, thereby affecting their potential contributions to the health care landscape [37,57]. While these workers can address significant issues in the pursuit of health and well-being in rural settings, they cannot alone be the solution themselves when overarching systemic change is often needed [58].…”

Section: Chws Promotores and Social Determinants Of Health In Ruralmentioning

confidence: 99%

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Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud

Logan

Castañeda

2020

IJERPH

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Rural populations in the United States are faced with a variety of health disparities that complicate access to care. Community health workers (CHWs) and their Spanish-speaking counterparts, promotores de salud, are well-equipped to address rural health access issues, provide education, and ultimately assuage these disparities. In this article, we compare community health workers in the states of Indiana and Texas, based on the results of two separate research studies, in order to (1) investigate the unique role of CHWs in rural communities and (2) understand how their advocacy efforts represent a central form of caregiving. Drawing on ethnographic, qualitative data—including interviews, photovoice, and participant observation—we analyze how CHWs connect structurally vulnerable clients in rural areas to resources, health education, and health and social services. Our primary contribution to existing scholarship on CHWs is the elaboration of advocacy as a form of caregiving to improve individual health outcomes as well as provoke structural change in the form of policy development. Finally, we describe how CHWs became especially critical in addressing disparities among rural populations in the wake of COVID-19, using their advocacy-as-caregiving role that was developed and well-established before the pandemic. These frontline workers are more vital than ever to address disparities and are a critical force in overcoming structural vulnerability and inequities in health in the United States.

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Section: Role Of Chws and Promotoresmentioning

confidence: 99%

Section: Chws Promotores and Social Determinants Of Health In Ruralmentioning

confidence: 99%

Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud

Logan

Castañeda

2020

IJERPH

Self Cite

View full text Add to dashboard Cite

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“… 6 Training helps CHWs to gain understanding of underlying complex structural, disease and individual factors related to patient non-adherence to recommended medical regimens, rather than attributing treatment failures solely to poor patient-level motivation. 7 , 8 Structural competence has been defined as ‘the capacity for health professionals to recognise and respond to health and illness as the downstream effects of broad social, political and economic structures. 6 Community health workers who by definition are trusted members of the communities they serve 9 understand and are knowledgeable about the environmental, social and political factors and the interpersonal networks community members encounter.…”

Section: Introductionmentioning

confidence: 99%

“… 6 Community health workers who by definition are trusted members of the communities they serve 9 understand and are knowledgeable about the environmental, social and political factors and the interpersonal networks community members encounter. 8 Community health workers’ intimate knowledge of these social determinants, coupled with their role as community advocates, enable CHWs to play a vital two-prong role: (1) to contribute to policy change 10 to redress imbalances in health care and (2) to foster long-term well-being of communities. 11 Community health workers have first-hand knowledge and information about local structural factors impeding community health position.…”

Section: Introductionmentioning

confidence: 99%

Challenges experienced by community health workers and their motivation to attend a self-management programme

Johnson

Schopp

Waggie

et al. 2022

African Journal of Primary Health Care & Family Medicine

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Background: Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours.Aim: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme.Setting: The study was conducted in a low socio-economic urban area of the Western Cape, South Africa.Methods: This study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basis.Results: Five themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspective.Conclusion: The challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status.

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“…Through those relationships, CHWs serve as a critical link between marginalized populations and healthcare resources. 10,12 By effectively engaging medically underserved communities, CHWs contribute to improved health outcomes and reductions in health disparities. 2,4,13 The stigma and fear associated with HIV infection and pervasive mistrust of the healthcare system are also diminished by the earned credibility of CHWs, who often may be members of the prioritized populations themselves.…”

Section: Introductionmentioning

confidence: 99%

A Community Health Worker Approach for Ending the HIV Epidemic

Hammack

Bickham

Gilliard

et al. 2021

American Journal of Preventive Medicine

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Introduction:In the second half of 2019, East Baton Rouge Parish, Louisiana was selected as 1 of the 3 jump-start pilot jurisdictions for the Centers for Disease Control and Prevention−funded Ending the HIV Epidemic in the U.S. Initiative. An innovative community health worker program was among the strategies developed to reduce the number of new HIV infections. In addition to testing for HIV/sexually transmitted infections in nontraditional settings, community health workers provided integrated services, including linkage for people with HIV, pre-exposure prophylaxis navigation, sterile injection supplies and referrals to syringe services programs, and other social services. Methods:The 5-member community health worker team was representative of the populations they intended to reach. They conducted outreach, from October 2019 to December 2020, within areas known to have a high incidence of new HIV infections. Results:The community health worker team documented 977 encounters with individuals in their communities. The vast majority of encounters were among Black clients; 9% were among White clients. In total, 48% were among cisgender women, 50% were among cisgender men, and 2% were among transgender women. People who inject drugs represented 7% of the sample. Community health workers conducted rapid testing for HIV (n=320), hepatitis C (n=274), and syphilis (n=280). In addition, they successfully linked 10 people with HIV to HIV medical care and 20 people who inject drugs to a syringe services program and assisted 19 people at risk of HIV infection with preexposure prophylaxis initiation. Conclusions:The community health worker team successfully facilitated access to HIV prevention and treatment for priority populations in East Baton Rouge Parish.

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‘A poverty in understanding’: Assessing the structural challenges experienced by community health workers and their clients

Cited by 12 publications

References 38 publications

Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud

Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud

Challenges experienced by community health workers and their motivation to attend a self-management programme

A Community Health Worker Approach for Ending the HIV Epidemic

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