Maps of Hope: Situational ANALYSIS of Journeys Toward Empowerment for People Living with HIV/AIDS and THEIR Community Health Workers IN Urban Communities of Color

In addressing significant health disparities in communities of color, many programs have turned to community health workers (CHWs) to reach high-risk marginalized patients (St. James, 1996; Farmer et al., 2001; Behforouz et al., 2004; HRSA, 2007). While effectiveness of CHW interventions has been studied, little research articulates their specific processes. This presentation reports research conducted by a CHW as part of his graduate studies, in partnership with the Prevention and Access to Care and Treatment Project (PACT), a home-based CHW service organization for HIV/AIDS+ patients unable to adhere to medications delivered in standard out-patient visits. Theoretically, this study used ecosystemic models and participatory methods to explore how CHW interventions support diverse patient journeys toward empowerment and wellness. This research conducted semi-structured interviews, analyzing them using situational analysis (Clarke, 2005), a qualitative mapping method extending grounded theory to explore complex health promotion narratives within social contexts. This study generated the theoretical model entitled Map of Hope, articulating situational dimensions and processes associated with PACT CHW efforts to promote patient empowerment. The Map of Hope provides evidence for the utility of interventions highlighting the following features: 1) the foundational quality of developing a patient-centered, culturally-meaningful and transformative CHW-Patient Empowering Relationship; 2) importance of applying a developmentally-sensitive, skill-building, and emancipatory Empowering Pedagogy, and 3) significance of acting as an Empowering Bridge to harness multiple resources through flexibility, accompaniment and advocacy. This research articulates how providing CHW services to individuals with HIV/AIDS struggling with treatment adherence can profoundly impact patient health and empowerment.