On the Ground with Community Health Workers

Dr. Pinto has developed partnerships with universities and community-based health-service units through which Brazil’s Family Health Strategy operates.

In 2012 he published a paper that emerged from this research (Pinto, Spector et al., 2012). The International Participatory Research Framework was included in Public Responsibility in Medicine & Research, a Web-based center advancing ethical standards in biomedical and social science research. He and his colleagues then published case studies of this framework’s utility in Brazil, Mongolia, and Kazakhstan (Pinto, Spector, Witte, & Gilbert, 2014).

Dr. Pinto chose Brazil because its Unified Health System employs community health workers (CHWs) to work with physicians and nurses who rely on these CHWs to identify consumers at risk for disease. Consumers, in turn, rely on CHWs for services, such as HIV testing and primary care.

The mixed-methods study examined CHWs’ roles in service delivery (Pinto, Soriano, & Bulhões, 2012). CHWs’ methods are taken from daily experience. Dr. Pinto isolated key variables that characterized CHW success—e.g., empathic communication and perseverance. CHWs support the research-into-practice process by, for example, using empathic communication (language free of medical jargon) and perseverance (e.g., repetition of prevention messages) to convey research-based information to consumers.

The quantitative phase of this research used a survey developed from interviews with CHWs, physicians and nurses and administered to 168 CHWs, 62 nurses, and 32 physicians. Dr. Pinto used structural equation modeling (SEM) to deduce whether integration of CHWs’ experiential knowledge with physicians’ and nurses’ professional knowledge improved research-informed practice.

He found that each type of practitioner made a unique contribution (Pinto, Wall, Yu, Penido, & Schmidt, 2012) and that interprofessional collaboration did improve CHWs’ research-informed practice. This analysis highlighted variables from qualitative interviews that positively influenced evidence-based practice, including: on-the-job experience; familiarity with the community; endorsement of interprofessional meetings; and access to and consultations with colleagues.