LeBrón Alana M W, Michelen Melina, Morey Brittany, Hernandez Gloria I Montiel, Cantero Patricia, Zarate Salvador, Foo Mary Anne, Peralta Samantha, Chow Jacqueline J, Mangione Julia, Tanjasiri Sora, Billimek John
University of California, Irvine, Department of Health, Society & Behavior, Wen School of Population & Public Health, Irvine, CA, USA.
University of California, Irvine, Department of Chicano/Latino Studies, School of Social Sciences, Irvine, California, USA.
Int J Qual Methods. 2024 Jan-Dec;23. doi: 10.1177/16094069241284217. Epub 2024 Sep 16.
Community Health Workers, promotores, and navigators (henceforth, CHWs) emerged as critical members of the public health workforce addressing social, economic, and health inequities worsened by the COVID-19 pandemic. While there is increasing appreciation for and utilization of CHW models, and recognition of the importance of tailoring and innovating these models during the pandemic, few studies have examined the processes of change by which CHW models operated during the COVID-19 pandemic, and factors that facilitated or constrained CHW health equity efforts. This protocol paper describes and reflects on the research methodology used in our qualitative study focused on CHWs. The CATALYST study aims to examine the roles that CHWs served during the COVID-19 pandemic and facilitators and barriers related to CHW health equity strategies. This qualitative study incorporates the lived experiences of CHWs, low-income communities of color whom CHWs engaged, and institutional representatives and policymakers familiar with locally implemented CHW models during the pandemic. Through a community-based participatory research process, this study involves an abductive qualitative approach to data collection and analysis. We integrate community member expertise alongside CHW and health equity frameworks in designing the research questions and data collection process. Additionally, we use an analytic approach that combines inductive (drawn from qualitative data) and deductive codes (drawn from theoretical frameworks and practice-based evidence integrated through a participatory research process) and nimbly leverages flexible coding to address inductive themes and practice-based questions. Our collaborative process offers concrete strategies to develop qualitative research protocols with community partners, with evidence used to inform policy, programmatic, and relational changes to support and amplify CHW models to promote community health and health equity.
社区卫生工作者、健康促进者和导航员（以下简称社区卫生工作者）已成为公共卫生工作队伍中的关键成员，致力于解决因新冠疫情而加剧的社会、经济和健康不平等问题。尽管人们对社区卫生工作者模式的认可度和使用率不断提高，且认识到在疫情期间调整和创新这些模式的重要性，但很少有研究考察社区卫生工作者模式在新冠疫情期间的运作变革过程，以及促进或制约社区卫生工作者健康公平努力的因素。本方案文件描述并反思了我们针对社区卫生工作者的定性研究中所使用的研究方法。“促进社区健康公平的社区卫生工作者协作行动、学习与系统转型”（CATALYST）研究旨在考察社区卫生工作者在新冠疫情期间所发挥的作用，以及与社区卫生工作者健康公平策略相关的促进因素和障碍。这项定性研究纳入了社区卫生工作者的生活经历、他们所服务的低收入有色人种社区，以及在疫情期间熟悉当地实施的社区卫生工作者模式的机构代表和政策制定者。通过基于社区的参与式研究过程，本研究采用了一种溯因定性方法进行数据收集和分析。在设计研究问题和数据收集过程时，我们将社区成员的专业知识与社区卫生工作者及健康公平框架相结合。此外，我们使用一种分析方法，该方法结合了归纳法（从定性数据中得出）和演绎法编码（从理论框架和通过参与式研究过程整合的基于实践的证据中得出），并灵活运用灵活编码来处理归纳主题和基于实践的问题。我们的协作过程提供了与社区伙伴共同制定定性研究方案的具体策略，所获证据用于为政策、项目和关系变革提供信息，以支持和扩大社区卫生工作者模式，促进社区健康和健康公平。
