Community-based Workers Research Articles

Moving the needle further and faster: Policy and leadership opportunities to support early career nurse faculty and build resilience in establishing and growing their programs of research

Nurse scientists play a critical role in advancing the nursing field and improving health, but early career faculty can enter the academic ranks with little training in how to effectively establish, manage, and grow a program of research (POR) or weather the storms that accompany a research-intensive academic path. This can lead many nurse scientists to leave academic positions or even abandon their POR altogether. This is problematic at a societal level because nurse scientists bring a unique and valuable holistic perspective to scientific inquiry and an orientation towards community-based work, team science, intersectionality, and participatory approaches essential to address urgent health challenges. To enhance the impact of nurse scientists as a collective on academic research and human health, more attention should be given to the concept of resilience in the context of a research-focused career and the necessary structural changes that effectively support early career faculty in establishing thriving PORs. This article offers considerations relevant to administrative leaders, policymakers, and established faculty, at both the institutional and disciplinary level, to support early career faculty in establishing PORs that take root and flourish.

Social networks, empowerment, and wellbeing among Syrian refugee and Jordanian women: Implications for development and social inclusion

In response to large-scale refugee crises, frameworks for development assistance have promoted women’s empowerment, wellbeing, and social inclusion. A productive research agenda lies in analyzing social networks: it is unknown how women structure their social ties within refugee and host communities, and whether social networks matter for their sense of empowerment and wellbeing. In 2022, we surveyed Syrian refugee (n = 106) and Jordanian (n = 109) women from poor households across five neighborhoods in Amman. We implemented a standard network survey instrument (PERSNET) to assess network structure and composition. We tested associations with six measures (PE, MRS, MTL, Cantril, PWB, MSPSS) of psychological empowerment and wellbeing. We then conducted participatory network mapping (Net-Map) to assess local meanings of empowerment and visually map the pathways between social actors, community-based work, and psychological outcomes. Survey data show that networks were highly homogeneous, smaller for Syrians than Jordanians (p = 0.0001), and smaller for women in very poor households (p < 0.0001). As network size increased, so did levels of psychological empowerment (p = 0.02), motivation to lead (p = 0.007) and perceived social support (p = 0.001). Notably, as networks became increasingly kin-based, empowerment levels decreased (p = 0.003). Networks were more diverse for community volunteers, who named fewer female, married, and kin-based peers (p ≤ 0.05), and reported higher levels of resourcefulness (p = 0.01) and psychological wellbeing (p = 0.002). Qualitative data show that women, who described empowerment as “ability” and “proof of existence,” drew upon volunteering work to diversify their networks outside the home. Such evidence matters for development initiatives that build programs for women to work, learn, and socially interact. We conclude that expanding opportunities for volunteer work is one way of diversifying social networks and empowering urban poor women. Our research helps better understand how women can be supported to diversify their social ties, take community leadership roles, and respond to social change.

Troubling White Women’s Desire for Innocence in Community-Based Social Work Practice: A Foucauldian Discourse Analysis

Understanding the effects of White femininity on social work practice is a worthy endeavour provided the disproportionate numbers of White women that have built and occupied the professional role of social worker from the origins of colonization to present. Mainstream accounts of social work history narrate the profession to be a pursuit of well-intentioned middle- and upper-class White women, concealing the colonial operations that underpin the formation of social work as a White feminine project. While Whiteness and its effects within social work have been a subject of study, the intersection of gender and Whiteness has been minimally addressed, disregarding significant nuances that inform the relationship between the project of colonization and social work. This paper provides a detailed analysis of semi-structured interviews with eight White, woman-identified social workers who have practiced community-based social work for a minimum of two years in Alberta, Canada. Foucauldian discourse analysis is used to trace the ways the participants perform the dominant discourse of White femininity. The findings illuminate the social work profession's ongoing complicity with its colonial origins, which collude with White femininity and ultimately foster practices steeped in racism. A vital need to disentangle social work from its colonial and racist scripts is emphasized.

Effect of the SPRING home visits intervention on early child development and growth in rural India and Pakistan: parallel cluster randomised controlled trials.

Almost 250 million children fail to achieve their full growth or developmental potential, trapping them in a cycle of continuing disadvantage. Strong evidence exists that parent-focussed face to face interventions can improve developmental outcomes; the challenge is delivering these on a wide scale. SPRING (Sustainable Programme Incorporating Nutrition and Games) aimed to address this by developing a feasible affordable programme of monthly home visits by community-based workers (CWs) and testing two different delivery models at scale in a programmatic setting. In Pakistan, SPRING was embedded into existing monthly home visits of Lady Health Workers (LHWs). In India, it was delivered by a civil society/non-governmental organisation (CSO/NGO) that trained a new cadre of CWs. The SPRING interventions were evaluated through parallel cluster randomised trials. In Pakistan, clusters were 20 Union Councils (UCs), and in India, the catchment areas of 24 health sub-centres. Trial participants were mother-baby dyads of live born babies recruited through surveillance systems of 2 monthly home visits. Primary outcomes were BSID-III composite scores for psychomotor, cognitive and language development plus height for age z-score (HAZ), assessed at 18 months of age. Analyses were by intention to treat. 1,443 children in India were assessed at age 18 months and 1,016 in Pakistan. There was no impact in either setting on ECD outcomes or growth. The percentage of children in the SPRING intervention group who were receiving diets at 12 months of age that met the WHO minimum acceptable criteria was 35% higher in India (95% CI: 4-75%, p = 0.023) and 45% higher in Pakistan (95% CI: 15-83%, p = 0.002) compared to children in the control groups. The lack of impact is explained by shortcomings in implementation factors. Important lessons were learnt. Integrating additional tasks into the already overloaded workload of CWs is unlikely to be successful without additional resources and re-organisation of their goals to include the new tasks. The NGO model is the most likely for scale-up as few countries have established infrastructures like the LHW programme. It will require careful attention to the establishment of strong administrative and management systems to support its implementation.

To democratize or not to democratize AI? That is the question

AbstractThis paper advances the debate surrounding whether to democratize AI and explores some of the challenges and benefits of democratization through community-based work and direct democracy. We contend that community-based strategies can incorporate local knowledge and control, thereby providing more effective AI solutions that are human-centric and less harmful. However, democratization needs to be approached with caution and care, since this process requires a deeper understanding of who participates, the decision domain, and the different realities at stake. Moreover, we highlight the importance of participation in AI development to ensure its legitimacy, considering the capacity of this technology to shape reality. We emphasize that participation should be more than just involving stakeholders or seeking input from users. Rather, participation should involve local narratives that generate knowledge and shape information landscapes, thereby producing a different, anti-Cartesian scene. We conclude by underscoring that the success of democratizing AI hinges on the careful delineation of the boundaries of participation, which should include the specific needs of the immediate context, the decision domain, and the various participants involved.

Readiness assessment to use of digital tools to deliver rural health community services among Lubombo region community-based health voluntary workers in Eswatini in 2022

Readiness assessment to use of digital tools to deliver rural health community services among Lubombo region community-based health voluntary workers in Eswatini in 2022

Community health workers and the communicative transformation of work-life interrelationships during the COVID-19 pandemic

Abstract This study focuses on work-life interrelationships for community health workers (CHWs) during the COVID-19 pandemic. CHWs serve as liaisons between marginalized communities and health and human service organizations to facilitate access to services. Required physical distancing transformed their work from embodied, face-to-face interaction to almost wholly mediated by communication technologies. Interviews were conducted with 52 participants to identify CHWs’ adaptive strategies for communication, consequences of their adaptations for their experience of work and work-life interrelationships, and their communicative management of negative unintended consequences. Communicative practices that were emergent from participant accounts are examined through the lenses of four mutually informing research frameworks: the impact of technologically mediated remote work on work-life interrelationships, technological capital and differentiated digital inequalities, the text work/body work continuum, and gendered emotional work. Implications for the future of community-based care workers and for other workers with respect to communication, technology, and managing work-life boundaries are examined.

Examining Community Engagement Research Strategies Used in Flint, Michigan: The Church Challenge.

The ways in which researchers may need to adapt traditional community-based participatory research engagement strategies during ongoing community trauma are understudied. We describe our efforts to engage the Flint, Michigan community in community-based participatory research in the aftermath of the Flint Water Crisis. This manuscript describes 1) recruitment strategies selected before the Flint Water Crisis, 2) engagement lessons learned in the context of the Flint Water Crisis, and 3) barriers and facilitators encountered while engaging African American churches. Researchers collaborated with community partners to engage and recruit a traumatized Flint community into the Church Challenge, a multilevel intervention to reduce chronic disease burden. Recruitment and engagement strategies must be flexible, innovative, and may require nontraditional methods. Flexibility and adaptability are crucial for engaging with a traumatized community. Community-based participatory research work in traumatized communities must acknowledge and respond to community trauma to be successful.

Struggles For/With/Through Ethnic Studies in Texas: Third Spaces as Anchors for Collective Action

Background/Context: Ethnic Studies is an umbrella term for a group of academic disciplines attentive to identifying oppression, restorying history, and creating liberatory futures. These disciplines were born from social movements, with students, educators, and community members demanding educational spaces guided by people who looked like them, curriculum that told their stories, and pedagogies that could transform their communities. Around the country, elementary and secondary schools are expanding Ethnic Studies offerings at the school, district, and state levels. Ethnic Studies work is deeply local, and, as such, different approaches to expanding access to Ethnic Studies have been taken across localities and states. The power and potential of Ethnic Studies to shift social reality beyond the classroom is both a strength in the struggle for just, liberatory futures and a factor that draws the disciplining eyes of the state. Purpose/Objective/Research Question/Focus of Study: Like the discipline of Ethnic Studies, Ethnic Studies research is activist, transformative, and community embedded. In this article, we illustrate the ways that our research about the movement for Ethnic Studies in Texas is inextricable from our community-based work to expand access to Ethnic Studies, which is itself woven in and guided by the theories that ground the disciplines of Ethnic Studies. We write with the theories, thinkings, and actions of feminists of color, sharing vignettes that braid together our research and advocacy, highlighting community fostered organic third spaces, in what we call decolonial policy praxis. Research Design: We use digital and auto-ethnography methods to build our vignettes. Conclusions/Recommendations: We note the critical importance of building coalitions and of remaining committed/connected to the liberatory theories of Ethnic Studies in our research and in the collaborative development of culturally sustaining policy. This means building with community, in community, and for community in pursuit of liberatory, Ethnic Studies futures.

Mental health rehabilitees’ agency construction and promotion in community-based transitional work programme

ABSTRACT Purpose The integration of mental health rehabilitees into the labour market is an important policy objective everywhere in the world. The international Clubhouse organization is a third-sector actor that offers community-based psychosocial rehabilitation and supports and promotes rehabilitees’ state of acting and exerting power over their lives, including their (re)employment. In this article, we adopt the perspective of discursive psychology and ask how mental health rehabilitees’ agency is constructed and ideally also promoted in the Clubhouse-based Transitional Employment (TE) programme. Methods The data consisted of 26 video-recorded TE meetings in which staff and rehabilitees of one Finnish Clubhouse discussed ways to further their contacts with potential employers. The analysis was informed by discursive psychology, which has been heavily influenced by conversation analysis. Results The analysis demonstrated how rehabilitees adopt agentic positions in respect to TE-related future activities, and how Clubhouse staff promote and encourage but also discourage and invalidate these agentic positionings. The analysis demonstrated the multifaceted nature of agency and agency promotion in the TE programme. Conclusions Although ideally, Clubhouse activities are based on equal opportunities, in everyday interaction practices, the staff exercise significant power over the question whose agency is promoted and validated in the TE programme.

What and How are we Measuring When we Research Gendered Divisions of Domestic Labor? Remaking the Household Portrait Method into a Care/Work Portrait

The porous and shifting boundaries within and between care and work concepts, and practices and their related measurement complexities call for innovative conceptual and methodological approaches to research on work and care. This article details how we reconfigured the Household Portrait – a qualitative, participatory, visual, creative method that engages couples in mapping and discussing their household and care tasks and responsibilities – into a Care/Work Portrait. Informed by conceptual shifts in care theories, the Care/Work Portrait offers theoretical and methodological advantages for studying gendered divisions and relations of household work and care. It attends to unpaid care work/paid work/paid care work intra-connections, moves outside the household to include community-based work, deepens distinctions between tasks and responsibilities, and considers wider forms and contexts of care. This method goes beyond who does what tallies to bring forth relational, temporal, spatial stories about people’s complex care/work configurations and the specific contexts, constraints, supports, and structuring conditions of their lives.

Leveraging a community-based participatory approach to improve linkage to care for HBV.

Leveraging a community-based participatory approach to improve linkage to care for HBV.

Development of the generic Community Infant and Young Child Feeding Counselling Package.

Infant and young child feeding (IYCF) promotion is a key component in the set of high impact interventions to improve nutrition. The literature provides evidence of the positive impact of IYCF promotion through various platforms, including communities. In 2009, UNICEF and WHO agreed that a global, "generic" IYCF package of resources and tools to plan, implement, and monitor community-based IYCF programmes and to build skills of community-based workers was needed. In 2010, the UNICEF Community Infant and Young Child Feeding Counselling Package was finalized and field tested under a strategic collaboration between UNICEF New York and Nutrition Policy and Practice and the Center for Human Services/University Research Company. The Package includes 11 tools to guide adaptation of the materials, the design, planning, and implementation of IYCF programmes and the training, monitoring, supervision, and mentoring of community workers, using an interactive and experiential adult learning approach. The Package was rolled out from 2011 onwards and by 2017 was implemented in 87 countries. In 2013, UNICEF and the United States Agency for International Development-funded Strengthening Partnerships, Results, and Innovations in Nutrition Globally project started planning the evaluation, and a study site was selected in Nigeria to assess the efficacy and effectiveness of the Package on IYCF practices, knowledge, and worker skills. This article describes the need for and development of the Package, its content and approach to skills building, as well as its current implementation. Finally, it makes the case for the evaluation of the Package, which is covered in the other papers in the Supplement in relation to the Nigeria evaluation.

Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi.

Malawi has made progress in expanding access to modern contraceptive methods over the last decade, including the introduction of depot-medroxyprogesterone acetate subcutaneous (DMPA-SC) in 2018. DMPA-SC offers women the option to self-inject at home and may benefit adolescents with unmet need for contraception due to its discretion. This qualitative study was conducted to assess perspectives and preferences of adolescents with unmet need for contraception regarding the self-injection option of DMPA-SC in Malawi. Six focus group discussions were conducted involving 36 adolescents with unmet need for contraception (aged between 15 and 19 years, married and never-married) in October 2021 in three districts in Malawi. Data were coded inductively and analyzed thematically, using Dedoose software. Two validation workshops were conducted with other adolescents with unmet need in February 2022 to elucidate the preliminary findings. DMPA-SC attributes such as discretion and reduced facility visits were ranked most appealing by both married and never-married adolescents, particularly for adolescents needing covert contraception use. Concerns about self-injection included fear of pain, injury, and doubt in ability to self-inject. Never-married adolescents had additional concerns around privacy at home if using covertly, and fears of affecting long-term fertility. Overall, health surveillance assistants (community-based healthcare workers) were voted to be the most private, convenient, and affordable sources for potential DMPA-SC self-injection training. Self-injection of DMPA-SC may offer an appealing option for adolescents in Malawi, aligning most closely to the needs of married adolescents who may wish to delay or space pregnancies conveniently and discreetly, and who also may face fewer access barriers to receiving self-injection training from health care providers. Access barriers including stigma and concerns about privacy at home for adolescents needing to use contraception covertly would need to be adequately addressed if never-married adolescents were to consider taking up this option.

Understanding Men's Engagement and Disengagement When Seeking Support for Mental Health.

Men are less likely to utilize health care services compared with women. When it comes to mental health, men have been reported to hold more reluctant attitudes toward engaging with mental health services. Current studies have predominantly been quantitative and focused on understanding effective strategies to promote men's engagement and why men may avoid help-seeking or may not seek help early; few studies exist of men's disengagement from services. Much of this research has been undertaken from the services' perspective. The study reported here attempts to gain better insight into the reasons men give for their disengagement from mental health services and what men say will reengage them back into the system. This research was a secondary analysis of data collected by a national survey conducted by Lived Experience Australia (LEA). Responses of 73 male consumers were gathered and analyzed. Analysis of the responses was split into two themes with associated subthemes: (1) Why men disengage: (1.1) Autonomy; (1.2) Professionalism; (1.3) Authenticity; and (1.4) Systemic Barriers; and (2) What will help men reengage: (2.1) Clinician-driven reconciliation, (2.2) Community and Peer Workers; and (2.3) Ease of reentry. Findings highlight strategies to prevent disengagement such as creating open and honest therapeutic environments and improving men's mental health literacy while providing care. Evidence-based approaches to reengage male consumers are suggested along with an emphasis on men's strong preferences for community-based mental health services and peer workers.

Community Engagement in Co-designing an Innovative Health Equity Program: A Case Report

INTRODUCTION Community-based interprofessional education is a promising strategy for socializing students into team-based care and centering the voices of community members in health equity-focused work. Particularly in resource limited areas, it is vital to collaborate across institutions, professions, and constituents to plan and implement interprofessional education offerings. However, little is known about the factors that support the process of co-designing an interprofessional health equity program centering the community. METHODS Using a convergent, case study framework, this mixed methods project used quantitative data (Wilder Collaboration Factors Inventory) and qualitative data from working group feedback forms, to evaluate our collaborative process. RESULTS Quantitative analysis reveals collaborative strengths that include skilled leadership, unique group purpose, and mutual respect. Collaborative challenges include appropriate cross-section of members and sufficient funds. Qualitative themes (analyzed to further illuminate quantitative results) include sense of purpose, importance of thoughtful leadership, and community engagement. DISCUSSION Building sustainable academic-hospital-community relationships and centering the community in health equity work are keys to success in co-designing an interprofessional health equity curriculum. Committed funding also supports sustainability and sends an important message about the value of community members and community-based work. While these recommendations may be common sense, they are not yet common practice.

Contending for Invented Space in African Context and Biblical Text: Intersecting Gender, Sexuality, Ethnicity and Economics

The Ujamaa Centre for Community Development and Research, through the work of Sithembiso Zwane, has theorised a continuum of contested space, including invited space (controlled by dominant sectors), invigorated space (whereby marginalised sectors contend for space within invited space) and invented space (as marginalised sectors transform these spaces into space they control). In this article, we extend our conceptualisation of contested space to the biblical text itself, recognising within biblical text these three forms of space, both in terms of socio-historical text and narrative text. We use the book of Ruth as our biblical text, recognising, first, the production of the canonical text as a contestation of space, following the hermeneutic of Itumeleng Mosala by working backwards away from the canonical form towards marginalised textual remnant voices and second, that literary-narrative setting within the book of Ruth can be read as a contestation of space. Socio-historically, we argue that the canonical text co-opts marginalised textual voices (in terms of gender, sexuality, ethnicity, and economics). Narratologically, we argue that the Ruth narrative includes traces of both socio-historical contestation and narrative contestation of space through Ruth's struggle for invented space. Alongside this focus on the biblical text, we reflect on how the Ujamaa Centre's community-based work might use these resources for re-reading Ruth with local Southern African communities (in both South Africa and Mozambique) struggling for redemptive invented space in the intersection of gender, sexuality, ethnicity and economics.

Implications of Undocumented Status for Latinx Families During the COVID-19 Pandemic: A Call to Action

ABSTRACT Background A disproportionate number of COVID-19 cases and deaths have been reported among Latinxs in the U.S. Among those most affected by the pandemic are marginalized families, including those that are undocumented and mixed-status, in which some, but not all members are undocumented. Undocumented and mixed-status families face multiple and chronic daily stressors that compromised their health and wellbeing. Salient stressors faced by undocumented Latinx families include poverty, social disadvantage, discrimination, dangerous living and working conditions, and limited access to healthcare. These stressors are frequently compounded with trauma, fear of detention, deportation, and family separation. Purpose Informed by the literature and insights from our community-based work to address the health needs of undocumented and mixed status Latinx families during the pandemic, this paper uses a social determinants of health lens to present a narrative summary that highlights four primary psychosocial stressors faced by these families and their implications for mental health. Discussion These include stressors pertaining to (a) anti-immigrant rhetoric and actions; (b) family stressors and disruptions in family dynamics; (c) economic changes and financial losses; and (c) limited access to healthcare. Implications of the aforesaid stressors on the mental health of undocumented families and youth are also discussed. In addition, recommendations are provided for the provision of mental health services, best practices, and resources from a strengths-based approach.

Pathways to paid work for youth with severe disabilities: Perspectives on strategies for success

BACKGROUND: Paid work during high school serves as a steppingstone to postsecondary employment for young adults with severe disabilities. Yet, youth with significant cognitive impairments rarely have the opportunity to experience paid work during high school. OBJECTIVE: The purpose of this study was to identify the range of facilitators that promote paid employment for youth with severe disabilities during high school. METHODS: We conducted individual and focus group interviews with 74 special educators, adult agency providers, school district leaders, parents of youth with severe disabilities, and local employers. RESULTS: Participants discussed 36 facilitators spanning nine major categories: collaboration, training and information, attitudes and mindsets, supports for youth, youth work experiences, knowledge and skill instruction, staffing, individualization, and transportation. We identified similarities and differences in the factors emphasized by each of the five stakeholder groups. CONCLUSION: Renewed attention should be focused on key practices and partnerships needed to facilitate community-based work experiences for youth with severe disabilities prior to graduation.

North Carolina MedServe : A Research Team Hiding in Plain Sight.

Context: MedServe is a two-year AmeriCorps fellowship for college graduates pursuing careers in primary care medicine. Fellows are placed at primary care practices in underserved parts of North Carolina and split their time between clinic- and community-based work. MedServe fellows work in over thirty clinics across the state, including Federally Qualified Health Centers, free clinics, and private practices. Primary care practitioners often face human resource limitations when conducting research, especially in rural North Carolina. While research is not typically an aspect of the MedServe fellowship, many fellows may be enthusiastic about opportunities to contribute to medical research. Furthermore, involving students in primary care research aligns with MedServe's mission of promoting health equity and filling human capital needs in underserved areas. Objective: Describe the experiences of MedServe Fellows engaging in and implementing a small-scale research project. Study Design and Analysis: Observational and Implementation design Setting: Four primary care clinics in North Carolina participating in the research study. Population Studied: MedServe Fellows who served as research champions for the study Intervention/Instrument: Participation in research studied measured through meeting notes and observations, qualitative interviews, and surveys Outcome Measures: Value of MedServe Fellows' contribution to the study and Fellows' interest in gaining research experience Results: MedServe Fellows assisted with study design, data collection( by enrolling patients and helping patients complete their baseline and six-months post baseline survey), and dissemination of results by participating in abstract development and presentation review. MedServe fellows valued the opportunity to take an active part in medical research. The majority of the MedServe Fellows indicated an interest in continuing with research when their fellowship was complete. Conclusions: MedServe Fellows can be active participants in designing and completing small-scale primary care research projects in North Carolina. This serves as a model for other primary care practices to utilize this population in their research.