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.
SUMMARYThis study advances Community-based Participatory Research (CBPR) by presenting a set of triangulated procedures (steps and actions) that can facilitate participatory research in myriad international settings. By using procedural triangulation-the combination of specific steps and actions as the basis for the International Participatory Research Framework (IPRF)-our approach can improve the abilities of researchers and practitioners worldwide to systematize the development of research partnerships. The IPRF comprises four recursive steps: (i) contextualizing the host country; (ii) identifying collaborators in the host country; (iii) seeking advice and endorsement from gatekeepers and (iv) matching partners' expertise, needs and interests. IPRF includes the following sets of recursive participatory actions: (A 1 ) becoming familiar with local languages and culture; (A 2 ) sharing power, ideas, influence and resources; (A 3 ) gathering oral and written information about partners; (A 4 ) establishing realistic expectations and (A 5 ) resolving personal and professional differences. We show how these steps and actions were used recursively to build a partnership to study the roles of community health workers (CHWs) in Brazil's Family Health Program (PSF). The research conducted using IPRF focused on HIV prevention, and it included nearly 200 CHWs. By using the IPRF, our partnership achieved several participatory outcomes: communitydefined research aims, capacity for future research and creation of new policies and programs. We engaged CHWs who requested that we study their training needs, and we engaged CHWs' supervisors who used the data collected to modify CHW training. Data collected from CHWs will form the basis for a grant to test CHW training curricula. Researchers and community partners can now use the IPRF to build partnerships in different international contexts. By triangulating steps and actions, the IPRF advances knowledge about the use of CBPR methods/procedures for international health research.
Violência doméstica como tema de estudo em programas de pós-graduação no estado do Rio de JaneiroResumo: Este artigo discute os resultados de uma pesquisa que objetivou mapear a produção discente (dissertações e teses) no âmbito da violência doméstica, entre 1990 e 2006, em programas de pós-graduação em Serviço Social, Psicologia e Saúde Pública de instituições localizadas no estado do Rio de Janeiro. O estudo, centrado na análise de tendências, avanços e lacunas da referida produção, revelou a prevalência de pesquisas voltadas para o segmento infanto-juvenil, a mudança de foco da caracterização do fenômeno para a discussão de sua dinâmica, e o reduzido número de trabalhos sobre idosos. Palavras-chave: violência doméstica, produção discente, programas de pós-graduação no estado do Rio de Janeiro. Domestic Violence as a Theme of Study in Graduate Programs in Rio de Janeiro StateAbstract: This article discusses the results of a study that sought to map the production of master's and doctoral students concerning domestic violence, from 1990 to 2006, in graduate programs of Social Work, Psychology and Public Health at institutions located in Rio de Janeiro State. The study focused on the analysis of trends, advances and gaps in this production and revealed a prevalence of studies of children and youth, a change of focus from characterization of the phenomenon to a discussion of its dynamic and a reduced number of studies about the elderly.
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