Narrative Medicine By Community Health Workers: Implications for Social Work

Background: Narrative medicine encourages health care providers to draw on their personal experiences to establish therapeutic alliances with their patients. This approach is very similar to how Community Health Workers (CHWs) worldwide operate, and much can be learned by more in-depth research on this subject. While narrative medicine as practiced by nurses and physicians has been studied in hospital and other clinical settings, there is a lack of understanding on how social workers practice narrative medicine. Jobs that are filled by CHWs worldwide rarely require a bachelor’s or a master’s degree; nonetheless CHW’s job responsibilities often overlap with those of social workers. The current study aimed to evaluate, from the perspectives of community residents, how CHWs in Brazil practice narrative medicine. For this study, we derive recommendations applicable to social work practice.

Methods: We conducted in-depth interviews with 27 community residents randomly selected from nine Primary Health Care Units (PHCU) in Brazil’s Family Health Strategy (FHS) in a southeastern city. We used a semi-structured interview guide for the key questions. The interview included one question asking about the types of services CHWs provided to residents, followed by twelve open-ended questions based on the key concepts derived from the Praxis and Patient Health Behavior Framework (Pinto et al., 2012). A deductive approach was used to analyze the data, involving open coding, and the construction of a codebook which was used to code all interviews.

Results: Our sample included 27 residents (F=18, M = 9; White = 13; Pardo = 12; Black = 2). Participants identified four domains reflecting narrative medicine: provider–patient, provider–provider, provider–community, and provider–self.

Provider–patient: Residents reported that CHWs used several components of narrative competence while imparting health education - interpersonal strategies of concern, trustworthiness, empathy, perseverance, patience, attentiveness to consumers’ stories, friendly demeanor, and communication that is free of medical jargon

Provider–provider: Residents commented on this domain by discussing the lack of CHW credibility as perceived by physicians, impacting the effectiveness of CHWs.

Provider–community: Participants validated that CHWs acquired a sense of ownership of community problems by identifying emerging health needs within the catchment area they serve and creating awareness of the issues in the community.

Provider–self: Participants residents were unable to comment about provider-self but did insinuate the need for CHWs to engage in self-care practices due to the labor intensive work they engage in and the lack of equipment that can contribute towards work-related stressors.

Implications: Our study demonstrates how narrative medicine can be empowering and fulfilling for clients by soliciting their experience with CHWs. CHWs worldwide share overlapping roles as social workers; in some places social workers are supervisors of CHWs and in some CHWs are informal social workers. Our study, vis-à-vis narrative medicine, offers insight into the need for greater organizational supports to facilitate provider-provider relationships and provider-self relationships through greater investment in team-building skills and wellness initiatives in the workplace. Future research should examine CHWs and social workers ability to practice narrative medicine given their varying personality traits.