Moving from Transaction to Transformation to Address Non-Medical Drivers of Health: A thematic analysis of case notes from Community Health Workers

Abstract

Abstract Background Community Health Workers (CHWs) are frontline public health workers who are trusted community members and vital connectors to services that can address the major non-medical drivers of health. This study aims to examine the experiences of CHWs who are providing immediate and critical support to clients with health and social service needs to better understand how CHWs are supporting clients' development of strategies to address non-medical drivers of health. Methods Case notes from 95 high-risk clients who were seen by six community-based CHWs were included in the sample. All clients seen by these CHWs between March 2021 to July 2022 are included. Reflexive thematic analysis was used to identify themes that connected the experiences of CHWs. Results Two themes were identified. The first theme highlights the importance of trust between the CHW and the client to support change in non-medical social drivers of health. Case notes suggest trust is built in multiple ways including maintaining existing relationships within the community, approaching clients with compassion, and having a deep knowledge of the community. Trust between the CHW and the client allowed the CHW to better support the client to receive or enroll in services that could provide long-term change. The second theme focuses on the need for CHWs to move from a focus on crisis intervention to long-term behavior change among clients. Instances of long-term change are present in the data, yet it does not happen as frequently as it could or as frequently as CHWs hope that it would. Conclusions CHWs are providing instrumental support, while still struggling to function as agents of behavior change for clients. To improve the ability of CHWs to facilitate clients’ long-term behavior change, CHWs need to feel supported and encouraged to take time for trust building. Trust allowed CHWs to make the greatest impact and transformation of non-medical drivers of health.