Achieving Health Equity: The Role of Community Health Workers in Latinx Communities during the COVID-19 Pandemic in Arizona

Background and Purpose: Latinx communities in Arizona face disproportionate challenges while seeking COVID-19 related testing, medical care, and financial support. A promising innovation to address those barriers is leveraging the community embeddedness and trust built by community health workers (CHWs) within the Latinx communities of Arizona. CHWs have a long history of advocating for and with underserved Latinx consumers within the health care system. Soon after barriers to access to COVID-19 testing and medical care had emerged, CHWs swiftly joined the state-wide efforts to address the unmet needs of the Latinx communities of Arizona. There is a need to document the voice of CHWs who supported Latinx communities and better understand their roles, observation and challenges.

Methods: Five focus groups were conducted with a total of 27 CHWs that worked across three counties in Arizona: Yuma, Maricopa, and Pima. All the CHWs are Latinx and predominantly work with Latinx communities during COVID-19 pandemic. The sample is predominantly (92.5%) female. Participants were recruited through snowball sampling with the assistance of leading CHWs. A semi-structured focus group elicit their narratives about 1) their role within the community, 2) the main challenges they faced as CHWs during the pandemic, 3) burdens and satisfactions of their work, 4) strategies to leverage the skills of CHWs in future pandemics, and 5) recommendations on how to make the health care system more inclusive. A narrative analysis was used to discover common themes and sub-themes that appeared across the different focus groups.

Findings: Overall, CHWs viewed themselves being puentes/bridges, whereby their community embeddedness and trust built prior the COVID-19 pandemic ensured a link between the Latinx community and providers of health care and social services. Other themes emerging from the focus groups included deep understanding of the Latinx experience, CHW’s pivotal roles in response to challenges posed by COVID-19 pandemic, and building CHW’s capacity to address needs of Latinx community. Those themes are supported by several sub-themes. The findings confirmed the significance and value of CHWs for health care providers in responding to COVID-19 pandemic and addressing unmet needs. CHWs reiterated the need for more resources in leveraging the skillset of CHWs. CHWs reported examples of the traumatic stress and compassion fatigue experienced while supporting Latinx community members. They indicated the need for health care providers to also attend to CHWs’ mental health and occupational stress. CHWs expressed strong willingness to build their expertise and assume more clinical responsibilities to better serve Latinx communities.

Conclusion and Implications: Findings highlight the importance of supporting CHWs through and beyond COVID-19. While varied in age, gender, and work experience, they all had an unfaltering passion that lit up inside of them even amidst the stressors of the pandemic. This study holds implications for health policy, healthcare delivery, health equity research, and general recognition of CHWs. Given their insight and effectiveness reaching out to the community, it will be important to continue integrating them into the larger healthcare model as opposed to short term deployments like during the COVID-19 pandemic.