What Is Distinctive About CHWs?

[SPEAKER]

We noted earlier that the occupation of CHW is different from conventional occupations, even within health care and public health. The first distinction is that CHWs generally do not provide clinical care, beyond some simple screening tasks such as measuring blood pressure and demonstrating medical devices like blood glucose meters. CHWs typically are not allowed to give any form of medical advice, and often refer patients to a clinical supervisor when detailed clinical questions arise. A few exceptions exist, mainly in remote rural areas, such as certain tribal Community Health Representatives and the Community Health Aide/Practitioners in Alaska.

The next three points, however, begin to get at the essence of the occupation. CHWs are effective because of their ability to create trusting relationships with community members. This quality is more important than their clinical knowledge, which is generally limited to the essentials of their specific job.

CHWs do, however, have what might be termed “experience- based expertise,” and their understanding of the culture and social structure of the community is helpful to the system as well as to the client. This understanding is usually based on sharing cultural background and similar life experience with the community, rather than on sociological theory or advanced social work methods.

Another distinction, and a strength of CHWs, is their ability to relate to community members as peers rather than viewing them as patients or clients. The conventional professional-to-client relationship can create barriers to communication based on differences of power, status, and culture. A CHW can avoid these distinctions and, in many cases, can engender greater trust, candor, and cooperation on the part of the patient.

And finally, although some licensed nurses, social workers, and foreign-trained and other medical professionals choose to practice as CHWs, the vast majority of CHWs do not hold a license in another profession—hence the common use of the term “lay workers” to describe them. That term is falling out of favor, however, because CHWs wish to be known as possessing expertise – it is simply not clinical expertise.