Community Health Workers: A Bridge to Healthcare for People Who Inject Drugs
Highlights
- We
explore how CHWs personal experience of drug injecting influences service
delivery.
- CHWs
build trust with PWID clients using their familiarity of language that is
specific to PWID.
- CHWs
enable PWID to be actively involved in decision-making about their health.
- CHWs’
skills enable them to serve as intermediaries between PWID and other
practitioners.
BACKGROUND:
Although
people who inject drugs (PWIDs) have increased healthcare needs, their poor
access and utilisation of mainstream primary healthcare services is well
documented. To address this situation, community health workers (CHWs) who have
personal experience of drug injecting in addition to healthcare training or
qualifications are sometimes utilised. However, the role peer workers play as
members of clinical primary healthcare teams in Australia and how they manage
the healthcare needs of PWID, has been poorly documented.
METHODS:
A
qualitative ethnomethodological approach was used to study the methods used by
CHWs. Data was collected using participant observation of CHWs in a
PWID-targeted primary healthcare centre. CHW healthcare consultations with PWID
were audio-recorded and transcribed verbatim. Transcripts along with field
notes were analysed using membership categorisation and conversation analysis
techniques to reveal how CHWs' personal and professional experience shapes
their healthcare interactions with PWID clients.
RESULTS:
CHWs'
personal experience of injecting drug use is an asset they utilise along with
their knowledge of clinical practice and service systems. It provides them with
specialised knowledge and language--resources that they draw upon to build
trust with clients and accomplish transparent, non-judgmental interactions that
enable PWID clients to be active participants in the management of their
healthcare. Existing literature often discusses these principles at a
theoretical level. This study demonstrates how CHWs achieve them at a
micro-level through the use of indexical language and displays of the
membership categories 'PWID' and 'healthcare worker'.
CONCLUSION:
This
research explicates how CHWs serve as an interface between PWID clients and
conventional healthcare providers. CHWs deployment of IDU-specific language,
membership knowledge, values and behaviours, enable them to interact in ways
that foster transparent communication and client participation in healthcare
consultations. The incorporation of community health workers into clinical
healthcare teams working with IDU populations is a possible means for
overcoming barriers to healthcare, such as mistrust and fear of stigma and
discrimination, because CHWs are able to serve as an interface between PWID and
other healthcare providers.
- 1Population and Social Health Research Program, School of Medicine, Griffith University, Gold Coast, Australia. Electronic address: kirsty.morgan@griffithuni.edu.au.
- 2Population and Social Health Research Program, School of Medicine, Griffith University, Gold Coast, Australia.
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