Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium.
Int J Environ Res Public Health. 2022 Feb 22;19(5):2496. doi: 10.3390/ijerph19052496.
(1) Background: Community health workers (CHWs) are an essential public health workforce defined by their trustful relationships with vulnerable citizens. However, how trustful relationships are built remains unclear. This study aimed to understand how and under which circumstances CHWs are likely to build trust with their vulnerable clients during the COVID-19 pandemic. (2) Methods: We developed a program theory using a realist research design. Data were collected through focus groups and in-depth interviews with CHWs and their clients. Using a grounded theory approach, we aimed to unravel mechanisms and contextual factors that determine the trust in a CHW program offering psychosocial support to vulnerable citizens during the COVID-19 pandemic. (3) Results: The trustful relationship between CHWs and their clients is rooted in three mental models: recognition, equality, and reciprocity. Five contextual factors (adopting a client-centered attitude, coordination, temporariness, and link with primary care practice (PCP)) enable the program mechanisms to work. (4) Conclusions: CHWs are a crucial public health outreach strategy for PCP and complement and enhance trust-building by primary care professionals. In the process of building trustful relationships between CHWs and clients, different mechanisms and contextual factors play a role in the trustful relationship between primary care professionals and patients. Future research should assess whether these findings also apply to a non-covid context, to the involvement of CHWs in other facets of primary healthcare (e.g., prevention campaigns, etc.), and to a low- and middle-income country (LMIC) setting. Furthermore, implementation research should elaborate on the integration of CHWs in PCP to support CHWs in developing the mental models leading to build trust with vulnerable citizens and to establish the required conditions.
(1) 背景：社区卫生工作者（CHWs）是一种重要的公共卫生人力资源，其特点是与弱势公民建立值得信赖的关系。然而，建立信任关系的方式仍不清楚。本研究旨在了解在 COVID-19 大流行期间，CHWs 如何以及在何种情况下可能与弱势客户建立信任关系。(2) 方法：我们使用现实主义研究设计制定了一个方案理论。通过焦点小组和 CHWs 及其客户的深入访谈收集数据。我们采用扎根理论方法，旨在揭示在 COVID-19 大流行期间为弱势公民提供心理社会支持的 CHW 计划中，决定对 CHW 计划的信任的机制和背景因素。(3) 结果：CHWs 与其客户之间的信任关系源于三个心理模型：认可、平等和互惠。五个背景因素（采取以客户为中心的态度、协调、临时性和与初级保健实践（PCP）的联系）使计划机制得以发挥作用。(4) 结论：CHWs 是 PCP 的重要公共卫生拓展策略，补充并增强了初级保健专业人员的信任建设。在 CHWs 与客户之间建立信任关系的过程中，不同的机制和背景因素在初级保健专业人员与患者之间的信任关系中发挥作用。未来的研究应评估这些发现是否也适用于非 COVID 背景、CHWs 参与初级保健的其他方面（例如，预防运动等）以及中低收入国家（LMIC）的情况。此外，实施研究应详细说明 CHWs 在 PCP 中的整合，以支持 CHWs 发展建立信任的心理模型与弱势公民，并建立所需的条件。
