Department of Health Occupation, Mission College, Santa Clara, California, USA.
School of Nursing, University of California, Davis, Davis, California, USA.
J Community Health Nurs. 2023 Jul-Sep;40(3):219-231. doi: 10.1080/07370016.2023.2168124. Epub 2023 Mar 31.
This article examines how Community Health Workers (CHWs) build trust with low-income women of color who have a historical distrust of the healthcare system, and are at risk for maternal-child health disparities. This qualitative study used a grounded theory methodology guided by Charmaz's inductive social constructivist approach. Data were collected using open-ended semi-structured interviews and focus groups with CHWs who worked in community-based and hospital-based programs in California, Oregon, Illinois, Texas, South Carolina, New York, and Maine. Thirty-two CHWs participated, with 95% of participants being of Latinx and African American ethnicity. They served women from Latinx, African American, and Migrant communities. The CHW communication strategies represent aspects of respect and client-centered care and are applied in the development of a theoretical framework. CHWs were able to build and sustain trust at the initial encounter through these specific strategies: 1) addressing immediate needs related to social determinants of health; 2) embodying mannerisms and dress; 3) speaking appropriately to the client's age, culture, and knowledge; 4) easing client's fears through locus of control, and 5) allowing for time flexibility. These findings have implications for practice through interventions to train healthcare providers to build trust with low-income women of color who have a historical distrust of the healthcare system and who are at risk for maternal-child health disparities. Future research is recommended to explore how the communication trust-building constructs also benefit all other groups at similar risk, including those with mental health disorders and infectious diseases. The findings indicate specific communication strategies through which trust can be built, beginning at the initial encounter with low-income women at risk for maternal-child health disparities and who have a historical distrust of the healthcare system.
本文探讨了社区卫生工作者（CHW）如何与有色人种的低收入女性建立信任，这些女性对医疗保健系统历史上存在不信任，并且存在母婴健康差距的风险。这项定性研究采用扎根理论方法，以 Charmaz 的归纳社会建构主义方法为指导。数据收集采用开放式半结构式访谈和焦点小组，参与者为在加利福尼亚州、俄勒冈州、伊利诺伊州、德克萨斯州、南卡罗来纳州、纽约州和缅因州的社区和医院项目中工作的 CHW。共有 32 名 CHW 参与，其中 95%的参与者为拉丁裔和非裔美国人。他们为拉丁裔、非裔和移民社区的女性提供服务。CHW 的沟通策略代表了尊重和以客户为中心的护理的方面，并应用于理论框架的发展。CHW 通过以下特定策略在初次接触时能够建立和维持信任：1）解决与健康决定因素相关的即时需求；2）体现举止和着装；3）根据客户的年龄、文化和知识水平进行适当的交流；4）通过控制源减轻客户的恐惧；5）允许时间灵活。这些发现通过培训医疗保健提供者与对医疗保健系统历史上不信任且存在母婴健康差距风险的有色人种低收入女性建立信任的干预措施对实践具有意义。建议进行未来研究，以探讨建立信任的沟通信任构建结构如何使所有其他处于类似风险的群体受益，包括那些患有精神健康障碍和传染病的群体。研究结果表明，在与处于母婴健康差距风险且对医疗保健系统历史上不信任的低收入女性建立信任时，可以采用特定的沟通策略。
