An exploration of determinants that impact the capacity of community health workers to integrate breast and cervical cancer control into practice

Community health worker (CHW) interventions have demonstrated value in a variety of settings and health priority areas. There is limited research, however, that elucidates key determinants that impact the capacity of CHWs to serve as effective community change agents. This is especially true for more sensitive health issues such as cancer, which may be subject to pervasive stigma and taboos among both community members and CHWs themselves. This presentation will address this gap in knowledge by presenting findings from a qualitative study designed to explore factors that impact the capacity of American Indian CHWs to integrate breast and cervical health education, outreach and patient navigation services into practice. In-depth interviews were conducted with 43 CHWs, medical providers and health administrators from seven American Indian Tribes and analyzed utilizing grounded theory. Findings revealed a constellation of determinants that facilitate and/or constrain CHW capacity. Interestingly, these factors followed a socioecological pattern where individual, community and system level influences worked synergistically to impact CHW capacity. Three particular domains emerged as highly salient, which have broad implications for future CHW intervention research, including: 1) the unique dual-role of CHWs as community members and health providers, which confers both advantages and challenges to CHWs, 2) the need for continuous capacity development that integrates experiential learning approaches and extends beyond a unilateral, disease-specific emphasis, and 3) the importance of implementing concomitant system-level initiatives to improve access to health care services (e.g. breast and cervical cancer screening exams) and enhance collaboration between CHWs and medical providers.