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.