Features and impact of trust-based relationships between community health workers and low-income pregnant women with chronic health conditions: A focus group study

Abstract

Abstract Background Pregnancy can be a particularly stressful time for women with underlying chronic conditions. Chronic health conditions such as hypertension, cardiovascular disease, and diabetes are associated with obstetric morbidity and mortality and poor birth outcomes, and are becoming more prevalent among pregnant women in the United States. In light of the American Public Health Association’s call to increase the reach of community health worker (CHW) interventions, the aim of this paper is to better understand how to effectively support women with chronic disease during pregnancy by examining the impact of CHW support from the perspective of pregnant women.Methods Clients and CHWs were recruited from three community-based organizations in the eastern United States running Merck for Mothers-funded interventions to support pregnant women in urban settings. Nine focus groups and eight interviews were conducted with 40 low-income clients with chronic conditions and 18 CHWs and program staff. Focus group and interview data were analyzed using grounded theory-informed thematic analysis.Results Clients reported that CHWs contributed to their well-being during pregnancy in numerous ways and credited CHWs with improvements in mental health and health behaviors. Services like providing guidance around nutrition appeared to play a role in improving client management of chronic disease. CHWs’ ability to build trust-based relationships through emotional attendance, authenticity, and prioritization of clients’ needs facilitated the stress reduction and salubrious behavioral change reported by clients.Conclusions CHWs provide care for the whole woman during pregnancy, an approach that is unique within healthcare and confers multiple benefits. CHW intervention is particularly valuable for women facing challenges such as chronic disease and limited access to resources. Additional municipal, state, and federal resources should be devoted to expanding programs that provide vulnerable mothers with comprehensive care.