| Titre : | Community Health Workers in Brazil's Unified Health System : A framework of their praxis and contributions to patient health behaviors. (2012) |
| Auteurs : | Rogerio-M PINTO ; DA SILVA (Sueli-Bulhoes) : BRA. Pontificia Universidade Catolica do Rio de Janeiro. Departamento de Serviço Social. Rio de Janeiro RJ. ; Rafaela SORIANO |
| Type de document : | Article |
| Dans : | Social science and medicine (vol. 74, n° 6, 2012) |
| Pagination : | 940-947 |
| Langues: | Anglais |
| Mots-clés : | Santé communautaire ; Agent santé communautaire ; Ouvrier ; Brésil ; Système santé ; Homme ; Malade ; Comportement ; Pronostic ; Evolution ; Amérique ; Amérique du Sud |
| Résumé : | [BDSP. Notice produite par INIST-CNRS 8nR0xDsr. Diffusion soumise à autorisation]. Community Health Workers (CHWs) play a pivotal role in primary care, serving as liaisons between community members and medical providers. However, the growing reliance of health care systems worldwide on CHWs has outpaced research explaining their praxis - how they combine indigenous and technical knowledge, overcome challenges and impact patient outcomes. This paper thus articulates the CHW Praxis and Patient Health Behavior Framework. Such a framework is needed to advance research on CHW impact on patient outcomes and to advance CHW training. The project that originated this framework followed Community-Based Participatory Research principles. A team of U.S. - Brazil research partners, including CHWs, worked together from conceptualization of the study to dissemination of its findings. The framework is built on an integrated conceptual foundation including learning/teaching and individual behavior theories. The empirical base of the framework comprises in-depth interviews with 30 CHWs in Brazil's Unified Health System, Mesquita, Rio de Janeiro. Data collection for the project which originated this report occurred in 2008-10. Semi-structured questions examined how CHWs used their knowledge/skills ; addressed personal and environmental challenges ; and how they promoted patient health behaviors. This study advances an explanation of how CHWs use self-identified strategies - i.e., empathic communication and perseverance - to help patients engage in health behaviors. Grounded in our proposed framework, survey measures can be developed and used in predictive models testing the effects of CHW praxis on health behaviors. Training for CHWs can explicitly integrate indigenous and technical knowledge in order for CHWs to overcome contextual challenges and enhance service delivery. |
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