The Community Health Worker's Perception: A Contribution to Minority Health Research

Purpose: Latinos are of the largest ethnic minority in the U.S. and are increasingly moving into rural areas. Latinos living in rural communities may encounter cultural, language, economic and social challenges. These challenges may contribute to their overall health of physical, mental, acute and chronic diseases.  For these communities, the use of a Community Health Worker (CHW) has been instrumental in alleviating these challenges by promoting community resources, enhancing cultural appropriate interventions and encouraging community participation in research. The literature demonstrates CHWs in the roles of educator, conducting outreach activities, translator, interventionist and case manager. CHWs have the potential of being in expanded roles, by actively participating in the community-based participatory research (CBPR) team. In the U.S. the full potential and utilization of the CHW is currently being recognized, but there are still significant gaps in the literature about the CHWs role as a research collaborator. Specifically, the use and potential benefits of CHWs as research collaborators for health disparities in minority communities. The purpose of this study was to examine the CHW’s perception in their role of a research collaborator for rural Latino families’ CBPR study.

 Methods: This is a secondary data analysis of a larger mixed-method study. CHW’s logs were recorded during research data collection with Latino families (N=52), living in rural Florida, U.S. The log included 12 items with the last being an open ended question, with a free text area. This last question focused to elicit the CHW’s perceptions about additional needs or general information about the family. The free text area of the logs were recorded in Spanish (N= 17) or English (N= 35). The responses on the logs were thematically analyzed by two coders; data were analyzed in the original language. Themes were discussed among the co-coders for agreement. Dimensions of the Ecological Model were used as a framework for a final thematic analysis.

Results: Results showed seven emerging themes; viewed through the Ecological Model at all environmental levels. Specifically, the Individual Level includes three categories: health care concerns, acculturation and sense of hope. The Family Level includes one category: family conflict. The Community Level includes two categories: economic concerns and lack of community resources. The Societal Levelincludes one category: legal issues. The legal issues theme crossed over all levels of the ecologic model. Other themes of economic concerns and lack of community resources crossed the three levels of the ecologic model. In addition the CHW’s responses provided an excellent source of information regarding the process of and environment for participant observation research methods. This information facilitated the identification of lessons learned and challenges with the utilization of participant observation methods. 

Conclusion: Findings of this study add to the previous literature discussing the appropriateness of the different roles of CHWs, specifically as research collaborator with minority underserved hard-to-reach populations. Participant observation methods offer data about people, processes, and cultures. For this study, the CHW’s perception contributes as insight into the family’s additional needs and families reactions to the research. This insight was elicited through the CHW’s interpretation of their observation of the family’s living experiences. This study suggest that the CHW’s role can expand to be active members of a research team, ensuring cultural appropriateness of research data collection methods in minorities’ communities.