Yue HuFollow

Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Debbie Humphries

Abstract

CHWs provide valuable support to individuals managing chronic diseases, especially populations encountering stigma, discrimination, and other services barriers. CHWs effectively improve HIV outcomes for PLWH, and innovative approaches are needed to maximize their impact on self-management by strengthening their roles as liaisons between clinical services and community resources. Four clinical providers, five community leaders, six CHWs/supervisors in HIV services, and twelve PLWH from St. Louis, Missouri participated in semi-structured interviews, and twelve front-line health workers participated in one of two focus groups. Discussions explored employing CHWs for enhancing HIV care management and retention. Rapid qualitative analysis methods were used to analyze findings. The study has identified six main challenges that exist at both institutional and systemic levels: (1) CHWs' limited scope of practice, (2) an unsustainable workforce, (3) obstacles in building professional relationships, (4) structural racism in healthcare, (5) dominance of the hierarchical Western European model in HIV care, and (6) inconsistent CHW program implementation efforts. Four recurring themes emerged across the identified challenges: (1) unclear and undervalued CHW roles, (2) insufficient infrastructure for a sustainable CHW workforce, (3) power dynamics within the hierarchical healthcare system, and (4) structural racism perpetuating regional racial trauma. These salient themes highlight the complexity and interdependence of the challenges in integrating CHWs and promoting equitable healthcare delivery. Strengthening effectiveness of CHW programs requires improving integration of CHWs into the healthcare system. A systematic, collaborative, contextually appropriate and adaptive response is necessary to scale up CHW programs, ensuring quality service delivery and long-term career viability for CHWs.

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This is an Open Access Thesis.

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