Abstract
BackgroundInterventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs). CHWs can effectively advocate for healthier lifestyles and may be pivotal in addressing such mental health conditions as depression and anxiety. The goal of this study was to characterize the relationship dynamics between Latino participants and CHWs, from the participant’s perspective. We aimed to determine if CHW-delivered community interventions effected behavior change, especially among participants who reported anxiety and depression.MethodsSemi-structured interviews were conducted with a purposive sample of 28 Latino participants that was based on a mental health scoring strata. Participants completed a lifestyle intervention that included multiple home visits from CHWs to promote physical activity and healthful food choice. Interviews were conducted in the participant’s preferred language (English or Spanish). Transcribed interviews were analyzed using a grounded theory approach until concept saturation was achieved.ResultsThe sample was primarily female (82%), lower socioeconomic status (64%), and mean age of 50 years. Participants discussed the rapport building and professionalism of CHWs as a feature that facilitated strong, positive relationships and lifestyle behavior changes. Participants described how CHWs patterned their change approaches, which were similar to commonly used therapeutic techniques in the treatment of anxiety and depression. While anxiety and depression were described as having an impact on behavior change, most, but not all, participants who reported negative mood states said that the CHW relationship helped in changing that state to some extent.ConclusionsParticipants’ perceptions indicated that positive personal changes were influenced by CHWs. Only participants who reported consistently poor scores for depression, anxiety or both reported negative or neutral experiences with the CHWs. This study lends qualitative support to the use of CHWs as extenders of care, particularly in areas that have a shortage of primary and mental health care providers.
Highlights
Interventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs)
This study provides qualitative insight into participants’ perceptions of their interactions with CHWs who delivered a home visit–based intervention to understand the dynamics of the relationship and behavior change, among participants who reported anxiety and depression measured by standard instruments
We provided insight into what facilitates a close relationship between a participant and a CHW and the behavioral change process
Summary
Interventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs). Research indicates that compared with their white counterparts, Latinos, especially immigrant populations, are far less likely to receive treatment for mental illness [3, 4] Exacerbating these disparities is the shortage of mental health care workers nationally [5,6,7], and it is even more pronounced along the US-Mexico border [8, 9]. We see continued dependence on community, family, and traditional healers as limiting participation in formal systems of care [10] These practices can inhibit diagnosis, and as a result, depression is often underdiagnosed among Latinos or misattributed to other etiologies, like temporary social strains or stressors [11, 12].
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