Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.
Department of Sociology, University of Kansas, Lawrence, KS, USA.
Sociol Health Illn. 2021 Feb;43(2):299-315. doi: 10.1111/1467-9566.13219. Epub 2020 Nov 19.
Community health care workers (CHWs), lay community members with basic health care training, have been charged with providing appropriate care for vulnerable populations, addressing social determinants and improving population health. Frequently, CHWs lack the economic or cultural capital to accomplish these goals. Through analysis of 17 semi-structured interviews with CHWs and supervisors at a CHW programme in the United States, we draw on Bourdieu's theory of practice to examine how the exchange of cultural and social capital impact CHW effectiveness. We found that CHWs' reliance on bonding capital was perceived to effectively build social networks and mutual trust among marginalised communities. But, over-reliance on embodied cultural capital and bonding capital reduced integration into the health care field; limited access to bridging capital; and limited social standing. We highlight how the exchange of cultural to bonding and bridging capital presented structural limitations. Overall, the demonstrated tension demarcates and reinforces longstanding divisions between social issues and health care issues. Future efforts should focus on promoting the unique skills of CHWs within health care settings to avoid compromising CHWs' ability to advance population health.
社区卫生工作者（CHWs）是经过基本医疗培训的基层社区成员，负责为弱势群体提供适当的护理，解决社会决定因素问题并改善人口健康状况。但他们往往缺乏经济或文化资本来实现这些目标。通过对美国一个 CHW 项目中的 17 名 CHW 和主管进行半结构化访谈的分析，我们借鉴布迪厄的实践理论，研究了文化和社会资本的交换如何影响 CHW 的效果。我们发现，CHWs 对联系资本的依赖被认为可以有效地在边缘化社区中建立社会网络和相互信任。但过度依赖体现文化资本和联系资本会减少与医疗保健领域的融合；限制了桥接资本的获取；并限制了社会地位。我们强调了文化资本向联系资本和桥接资本的交换如何带来结构性限制。总的来说，这种紧张关系突出并强化了社会问题和医疗保健问题之间长期存在的分歧。未来的努力应集中在促进 CHWs 在医疗保健环境中的独特技能，以避免损害 CHWs 改善人口健康的能力。
