The community health worker role has evolved within the last fifteen years. The conceptualized job functions of community health workers, also known as promotoras, has consisted mostly of community outreach and education. The effectiveness of community health workers in the community became apparent by the success of the entities and programs that included community health workers in their implementation plans.
Early on, the well-intended researchers in their ivory towers riding into the community on their white horses determined to rescue a community from their perils were met with a wall of mistrust and other barriers such as lack of health literacy and monolingual obstacles. The lack of cultural knowledge and sensitivity on behalf of the programs intended to promote health and prevent disparities were failing and it wasn’t clear why. Fortunately through research projects along the border with difficult to reach populations, the community health worker/promotora concept was being utilized as far back as the 1970s. When someone asks me what the key is to the effectiveness of community health workers, I always respond that there are many, but the primary one is that community health workers must possess a cultural awareness about, and a love for, the communities they serve.
In my experience developing, implementing and working with community health workers for the last 20 years, cultural and linguistic sensitivity continues to be the reason community health workers are effective. It is not usually effective to drop a community health worker into a community that they are not familiar with, which is why it is important to recruit community health workers from the community that the program/project intends to serve. Cultural congruence is vital to reaching the members of those communities. If a trust and acceptance already exists between the community and community health workers, the barriers fall away.
Although the role of community health workers can be multifunctional, cultural sensitivity is at the heart of the work CHWs do within the communities they serve. This attribute is pertinent to addressing lifestyle factors that affect difficult to reach populations. Without cultural sensitivity, it can be difficult to, say, visit a marginalized neighborhood in the evening to do an initial home visit. And without trust from that community, it may not be a good idea to do so. Community health workers who have built relationships in these neighborhoods, often where they grew up or currently reside, are able to avoid the cultural differences. Cultural sensitivity also includes understanding and being able to address the unique needs of individuals that reside in those neighborhoods.
Fortunately, current community health workers encapsulate many cultures and backgrounds. Increased recruitment and training intended to include rural communities has been particularly positive and fruitful. The exponential growth of certified community health workers in Texas has made it possible to have a cadre available for recruitment and employment in the many facets of health care.
Bridging the cultural sensitivity gap has been beneficial for both the institutions hiring community health workers and the communities benefiting from the services delivered by community health workers.