Community Health Workers As Researchers: An Effective Strategy for Conducting Research with Vulnerable Latino Workers

 

Background and Purpose

Conducting research among vulnerable Latino workers requires an alternative from conventional research methods. Recruitment poses challenges. If recruited from the worksite, workers may fear job loss if posed sensitive questions.  However, workers are hard to locate in community-based recruiting as housing may be geographically dispersed.  Further, workers may not trust outsiders and consequently may not participate nor answer sensitive questions truthfully.  Crafting appropriate research protocols also poses a challenge as linguistic and cultural barriers may exist between the research team and the target population, potentially biasing measures and instruments.  Involving community health workers (CHW) as researchers shows promise as a strategy for engaging hard-to-reach Latino migrant populations in research. This presentation describes the methods used by one research team that successfully engaged CHWs in a study of the occupational safety and health of Latino horse farmworkers.

Methods

Researchers hired, trained, and supervised four native Spanish-speaking CHW to recruit 225 Latino thoroughbred farmworkers and administer an interview-assisted survey.  Training included four 2.5-hour sessions on human subjects’ protection, research ethics and principles, recruitment methods, and survey administration, including a question-by-question review of the survey instrument.  In addition, each interviewer completed 5 observed pilot surveys.  Each completed survey was reviewed by the project manager and statistician. Open-ended questions to the interviewer at the end of each survey enabled the collection of contextual information regarding the interview. Further, CHW met weekly with the project manager who ensured quality control, gave feedback, raised any questions based on survey reviews, helped troubleshoot potential problems, and provided tips on survey administration. Additional observed interviews were conducted halfway through data collection to ensure consistency. We used a process evaluation to assess the efficacy of utilizing this approach to meet research aims.

Results

Process evaluation results showed that employing CHW as researchers helped ensure that research materials were linguistically and culturally appropriate and that community trust and buy-in was obtained, and that recruitment goals with a hard-to-reach Latino worker population were met. Unexpected results were also achieved. As members of the target community, CHW were able to capture additional information from workers that otherwise may not have been obtained. This information was shared with the project manager at weekly meetings.  Their presence in the community helped to build their capacity as occupational health advocates—which also helped to build the capacity of the project to administer future interventions.  Their affiliation with the university also helped establish the university’s reputation among this population as a partner in health.  Finally, although the primary role of the CHW was to administer surveys, their presence in the community for this purpose furthered their reach as lay health educators when participants had non-research, health-related questions.  

 

Implications and Conclusions

Engaging CHW as field researchers helped this project to reach its recruitment and data quality goals. It also served as a means to build the capacity of the research program by establishing a network of trained health educators/researchers to involve in future research and outreach with this hard-to-reach, vulnerable study population.