background: The Navajo Nation Community Health Representatives (CHR) are trained community health workers (CHWs) who provide crucial services for patients and families in the Navajo Nation, including health education and in-home health assessments. CHW programs have revealed the importance of providing support to CHWs, but minimal research has been done to understand the components of the vital CHW-client relationship. methods: In-depth interviews were conducted in English with 16 CHRs in the Navajo Nation from December 2014 to April 2015. Interviews were transcribed and coded according to relevant themes. Final codes were agreed upon and double-coded by two Navajo and two non-Navajo team members. Code summaries were organized into a narrative using grounded theory techniques. results: The analysis revealed four findings that are critical to the development of a long-standing CHR-client relationship. Trust is essential to this relationship and provides the basis for providing quality services to the client. The ability to build and maintain trust is defined by tradition and culture, specifically the Navajo clanship system that defines familial roles (k'e). Accordingly, CHRs are respectful of the diverse traditional and social practices of their clients. Lastly, the passing of clients brings together the CHR, the client's family, and the community through spiritual and traditional practices. conclusion: Understanding the cultural elements of the CHR-client relationship will allow the Navajo Nation CHR program to train CHRs in developing trusting relationships. Such knowledge could inform other CHW programs and obtain positive health outcomes among marginalized indigenous communities.