The quest for diffusible community health worker projects and the pitfalls of scaling culture

Abstract

The quest for diffusible community health worker projects and the pitfalls of scaling culture Researchers of community health worker (CHW) models in many countries are looking for ways to scale without losing one of their main advantages, their context-sensitivity. This paper looks at one research strategy to make CHW projects scalable, namely by developing a generic notion of culture-sensitivity. Based on in-depth qualitative analysis, we reconstruct how 'culture' has been enshrined in a US-based CHW project and specifically in the artefact of a binder with teaching materials for vulnerable mothers. The inscription of generalized, culture-sensitive spaces into the binder did allow the Project to comply with standards of evidence-based medicine while respecting community self-determination and made space for creative and competent CHW practices. Yet at the same time, it took away from more substantive conceptions of community engagement and from community empowerment through CHWs. Our analysis highlights how the focus on culture can invisibilise and displace the importance of competent CHW practice and processes of community engagement.

The Power of Tailoring a Government-Funded Heart Health Program for Marginalized Women: Lessons from WISEWOMAN and Mujer Poderosa/Powerful Woman

“…This work bolsters evidence that tailoring can improve care delivery and mitigate inequities in care among Latinas 14. In order to scale MP/PW, space must be held for community- and cultural-specific tailoring in engagement approaches rather than trying to deliver curriculum with set ideas of one broad Latino culture 15

Implications for Policy & Practice

CHWs’ commitment, responsiveness, and availability to participants beyond health coaching were critical to building trust within communities and recruiting participants.

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“…14 In order to scale MP/PW, space must be held for community-and cultural-specific tailoring in engagement approaches rather than trying to deliver curriculum with set ideas of one broad Latino culture. 15…”