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Background: Narrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives., Objective: To document how CHWs apply specific NM concepts in Brazil's Family Health Strategy (FHS), the key component of Brazil's Unified Health System., Design: We used a semi-structured interview, grounded in Charon's (2001) framework, including four types of NM relationships: provider-patient, provider-colleague, provider-society, and provider-self. A hybrid approach of thematic analysis was used to analyze data from 27 patients., Key Results: Sample: 18 females; 13 White, 12 "Pardo" (mixed races), 12 Black. We found: (1) provider-patient relationship-CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider-colleague relationship-CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider-society relationship-CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider-self relationship-patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources., Conclusion: This study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider-colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider-self relationship. Public education on CHWs' roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs' personality traits may influence their ability to apply NM., (© 2021. The Author(s).)

Within the United States, there is an absence of a national community health worker (CHW) program. There is substantial regional and state-based variability in the population served by CHWs, their disease focus, and availability of training, supervision, and other supports. This article seeks to respond to the call in the literature to work collaboratively with CHW professional associations to identify, reflect, and respond to CHW workforce development and sustainability issues. We partnered with 8 member organizations of the Association of Perinatal Networks of New York and conducted 2 focus groups with 7 executive directors and 6 supervisors. Data were analyzed using thematic analysis. Policy barriers included funding, accessibility of evidence-based practices, and credentialing. Organizational barriers included recruitment and high turnover and interorganizational referral processes and management. This study offers recommendations for supports needed to sustain CHWs, with an emphasis on greater investment in recruitment and training, higher compensation, and interorganizational collaboration., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

While the integration of community-based providers within interprofessional health teams has been recommended by policymakers worldwide, there is limited research on how medical and community-based providers inform and participate in health research. Our study uses cross-sectional data from 169 Community Health Workers (CHWs), 62 nurses, and 31 physicians within Brazil's Family Health Strategy Program. Using an integrated framework of social cognitive theories and Theory for Planned Behavior, a reliable and valid instrument was developed to examine differences in past research involvement, and opinions about health and public health research (research efficacy and perceptions of research process). Descriptive frequencies and ANOVA F-tests were performed. Results indicated that CHWs has greater mistrust in the research process, and were not involved in substantive aspects of research (specification of aims, data collection, analysis, dissemination). Nurses compared to CHWs recruited participants to research studies, and had greater willingness to learn, participate and implement research initiatives. Physicians compared to CHWs and nurses developed survey instruments and disseminated research. For community-based and medical providers to be involved in all aspects of research, researchers ought to set up structured infrastructures of community collaborative boards. Furthermore, researchers can test our scale with other providers working within health teams globally., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Brazil has a unique mental health care system, characterized by universal coverage delivered by interdisciplinary teams both in the community and in specialized centros de atenção psicossocial (CAPS-psychosocial care centers). Provision of patient-centered mental health care is an important principle of Brazilian mental health care, but this topic has not been well-studied. We analyzed data from a cross-sectional survey of 151 community health workers (CHWs), nurses, and physicians in Santa Luzia, Minas Gerais State, Brazil. Chi-squares, t-tests and multivariate regression analyses examined differences in socio-demographics, caseload, engagement in evidence-based practices (EBPs), and transdisciplinary collaboration between providers who reported providing high levels of patient-centered mental health care and those who did not. In multivariate regression models, components of transdisciplinary collaboration were significantly associated with providers' perceptions of patient-centered mental health care (p < 0.05). CHWs were also significantly more likely to report providing patient-centered care than physicians and nurses. EBP engagement and sociodemographics were not associated with perceptions. Results suggest that training efforts to improve patient-centered mental health care in Brazil could build upon CHWs' skills and focus on transdisciplinary collaboration. Findings may inform practice in other countries with similar health care systems.

Background: Brazil's "family health strategy" (ESF), provides primary care, mostly to individuals in impoverished communities through teams of physicians, nurses, and community health workers (CHWs). ESF workers are called upon to offer drug use services (e.g., referrals, counseling) as drug use represents an urgent public health crisis. New federal initiatives are being implemented to build capacity in this workforce to deliver drug use services, yet little is known about whether ESF workers are providing drug use services already. Guided by social cognitive theory, this study examines factors associated with ESF workers' provision of drug use services., Methods: Cross-sectional surveys were collected from 262 ESF workers (168 CHWs, 62 nurses, and 32 physicians) in Mesquita, Rio de Janeiro State and Santa Luzia, Minas Gerais State., Outcome Variable: provision of drug-use services., Predictors: capacity to engage in evidence-based practice (EBP), resource constraints, peer support, knowledge of EBP, and job title. Logistic regression was used to determine relative influence of each predictor upon the outcome., Results: Thirty-nine percent reported providing drug use services. Younger workers, CHWs, workers with knowledge about EBP and workers that report peer support were more likely to offer drug use services. Workers that reported resource constraints and more capacity to implement EBP were less likely to offer drug use services., Conclusion: ESF workers require education in locating, assessing and evaluating the latest research. Mentorship from physicians and peer support through team meetings may enhance workers' delivery of drug use services, across professional disciplines. Educational initiatives aimed at ESF teams should consider these factors as potentially enhancing implementation of drug use services. Building ESF workers' capacity to collaborate across disciplines and to gain access to tools for providing assessment and treatment of drug use issues may improve uptake of new initiatives., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Although burnout has been increasingly well studied among medical (nurses, physicians, residents) and mental health providers (psychologists, psychiatrists, social workers), there continues to be a lack of attention on the well‐being of community‐based providers, such as Community Health Workers (CHWs), within the United States. Using cross‐sectional data from 75 CHWs employed in 14 agencies funded through the Maternal and Infant Community Health Collaboratives Initiative (MICHC) in New York, our study examined predictors (anxiety, physical health, adverse childhood experiences, job satisfaction, role certainty, demographic and work characteristics) of burnout, compassion fatigue (CF) and compassion satisfaction (CS). Descriptive statistics were used to characterize our sample and linear regression was employed to investigate the correlates of burnout, CF and CS. Results indicated that CHWs with higher levels of anxiety and lower job satisfaction were more likely to have higher burnout scores. CHWs with higher levels of anxiety, lower job satisfaction and fewer days of poorer health were more likely to report higher CF. Those who worked more than 35 h per week were less likely to report higher CS. The study provides recommendations for organizational‐level interventions to address risk factors of burnout and CF and promote CS among CHWs, such as bolstering supervision, encouraging greater communication, offering recognition/appreciation of CHWs and creating opportunities for self‐care. Findings should be considered when designing organizational‐level preventive measures that mitigate burnout and CF and promote CS. [ABSTRACT FROM AUTHOR]

Background: Narrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives. Objective: To document how CHWs apply specific NM concepts in Brazil's Family Health Strategy (FHS), the key component of Brazil's Unified Health System. Design: We used a semi-structured interview, grounded in Charon's (2001) framework, including four types of NM relationships: provider–patient, provider–colleague, provider–society, and provider–self. A hybrid approach of thematic analysis was used to analyze data from 27 patients. Key Results: Sample: 18 females; 13 White, 12 "Pardo" (mixed races), 12 Black. We found: (1) provider–patient relationship—CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider–colleague relationship—CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider–society relationship—CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider–self relationship—patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources. Conclusion: This study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider–colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider–self relationship. Public education on CHWs' roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs' personality traits may influence their ability to apply NM. [ABSTRACT FROM AUTHOR]

COVID-19 has served to exacerbate existing health disparities and inequities, most—if not all—of which can be traced to the social determinants of health (SDOH) that affect specific populations and communities. Essential to health and health systems long before, community health workers are experts in addressing SDOH in community-based settings; however, they have yet to be mobilized as part of the COVID-19 response both in the US and internationally. We use data from our mixed-methods study with supervisors (n=6), Executive Directors (EDs) (n=7), and CHWs (n=90) to describe the critical role that CHWs can play to assist in response to COVID-19 using New York State's (NYS) as a case example. Building on these findings, we raise specific CHW workforce issues and propose recommendations for how to mobilize this workforce in national pandemic response efforts. [ABSTRACT FROM AUTHOR]

Expansion of the Community Health Worker (CHW) workforce has become a national priority. It is critical to understand CHW strengths and individual challenges, associated professional development needs, and the utility of specific strategies that may meet needs from the perspectives of those who employ, manage, and supervise this growing workforce. Through a community-partnership with eight member organizations of the Association of Perinatal Networks of New York, we conducted two focus groups with 7 Executive Directors and 6 CHW Supervisors. Data were analyzed according to the six steps of thematic analysis. Analyses revealed seven salient themes across three superordinate categories of strengths, individual challenges, and mechanisms of support. Two strengths-related themes pertained to shared lived experiences/identities and commitment to client engagement, acquiring concrete resources and making referrals. Three themes emerged in the individual challenges category: boundary management, client empowerment, and documentation/reporting. Two support-related themes emphasized the need for skills-based training and supervision. CHWs are a critical component of the US health workforce given their core strengths, c2ommitment, and community connections. Challenges related to navigating boundaries, use of empowerment-focused approaches and effective documentation require skills-based training and trauma-informed workplace-based supports. Supervision is an effective mechanism through which CHWs receive support needed to optimize job performance. [ABSTRACT FROM AUTHOR]

• Perinatal maternal depression, interpersonal violence, (IPV) substance use and poor sexual health are critical public health concerns with significant negative impacts on child development. • Despite widespread calls for service integration at the systems/organizational level and well-documented benefits to children and families, predictors to service integration by community-based providers (Community Health Workers and Home Visitors) are not well understood. • Our findings elucidate areas for future investment for human services agency administrators and point to future areas of intervention that can bolster integrated service provision, thereby improve efficiency, cost effectiveness, and optimal maternal and child health care outcomes for at-risk populations. Perinatal maternal depression, interpersonal violence, (IPV) substance use and poor sexual health are critical public health concerns with significant negative impacts on child development. Despite widespread calls for service integration at the systems/organizational level and well-documented benefits to children and families, predictors to service integration are not well understood. Using cross-sectional data from 159 community-based providers (CBPs) who identify as community health workers (CHWs) or home visitors (HVs) in New York State, United States, our study aims to examine organizational and individual level predictors to service integration. Service integration in this study is defined as the screening, delivery and referral-making of two or more services over the course of six months. Services of interest in this study include mental health, IPV, sexual health, mental health, and substance abuse services. Descriptive statistics were performed to characterize our sample and show the distribution of service types. Multivariable logistic regression was used to identify salient organizational (job satisfaction: communication, contingent rewards, fringe benefits, operating conditions, and coworker; and training helpfulness) and individual characteristics (self-efficacy) that are associated with service integration, while controlling for demographic characteristics. Forty-four percent of participants (n = 70) integrated all four of the services: mental health, IPV, sexual health and mental health services. Training helpfulness (b = −2.48, p = 0.01), self-efficacy (b = 0.07, p < 0.01), and job satisfaction (b = −0.04, p = 0.01) were significantly associated with provision of integrated services. Specifically, elements of job satisfaction that were associated with integrated service provision included satisfaction with communication (b = −0.28, p < 0.01), coworkers (b = −0.29, p < 0.01), and pay (b = −015, p = 0.02). Findings elucidate areas for future investment for human services agency administrators and point to future areas of intervention that can bolster integrated service provision, thereby improve efficiency, cost effectiveness, and optimal maternal and child health care outcomes for at-risk populations. [ABSTRACT FROM AUTHOR]