Focus groups of community health workers bring out fears, resilience.
The coronavirus pandemic amplified mental health stressors long experienced by vulnerable Hispanic populations but also fortified members’ coping strategies, according to focus groups of 43 community health workers (CHWs) embedded within these communities. The research is from The University of Texas Health Science Center at San Antonio and its Center for Research to Advance Community Health (ReACH).
Published in the journal Health and Social Care in the Community, the article lists six mental health stressors described by the CHWs:
- economics (related to job insecurity)
- immigration (e.g., undocumented immigration legal status)
- family stress (pertaining to changes in family dynamics and the home environment)
- health (concerns such as limited health care access), and
- social isolation.
Coping skills of the community were categorized into four themes:
- behavioral strategies (such as identifying reliable information)
- cognitive strategies (e.g., collectivistic thinking)
- social support, and
“The idea for this project came from the community health workers who were contacting us and asking for resources,” said first author Luz M. Garcini, PhD, MPH, a ReACH Scholar who specializes in understanding trauma, loss and grief among Hispanic immigrants. “Community health workers are the eyes and the heart of the community. They know what’s happening.”
Fear and distrust
CHWs provided input in two focus groups conducted in English and Spanish in July 2020. At the time, Hispanic community members were concerned about discrimination and stigmatization, both if they were tested for COVID-19 and if they tested positive, the CHWs said.
This fear exacerbated Hispanic communities’ concerns over immigration legal status. “According to the community health workers, those that were undocumented made statements such as, ‘I can’t trust anyone with my information because I don’t know how that will be used. What if I get detained?” Dr. Garcini said. “And even legal residents were afraid that if they had a positive diagnosis, it would go on their record and their green card might be taken away.”
Financial stressors also multiplied.
“For these communities, an important way to express love and care to their family is through the means of providing,” Dr. Garcini said. “The majority are workers. And when their work is taken away or changes, or they have to learn new skills on the spot, it becomes very stressful.”
As people lost sources of income, multiple families began living in one place, with older and younger generations sharing households. Communications gaps and disputes also caused stress.
Ways to cope
In the midst of it all, the communities proved to be very resilient, Dr. Garcini said.
“The community health workers found that people were using basic skills, what we call in psychology ‘behavioral activation,’” she said. “Gardening, cooking, cleaning the house, these were lifesaving skills for them.”
Hispanic communities also sought refuge in spirituality. “A lot of praying was taking place,” Dr. Garcini said.
Community members also counted their blessings by looking not so much at those who were better off than them, but at others who experienced greater losses. As the journal article pointed out from a separate study, while Hispanics represent 18% of the U.S. population, they accounted for 26% of adult COVID-19 deaths. “There has been a lot of death and dying in these communities,” Dr. Garcini said.
Value of community health workers
The study pointed out the great advantages of using CHWs to assess needs and deliver health care to distressed Hispanic communities.
“In the focus groups, the community health workers helped us understand the huge pressure that they have, but also the huge opportunity that they can bring in helping us, as a nation, do a better job of reaching our underserved populations,” Dr. Garcini said.
The ReACH Center team provided training on how CHWs can meet the mental health needs of the Hispanic communities. Another training focused on how these workers can take care of themselves.
Finding funds for training of CHWs is a crucial policy recommendation, Dr. Garcini said. “We need to create programs that give them a licensing pathway to integrate them into the medical field, and provide continued sources of funding and training so that they can start being elevated as health care providers in a way that is culturally and contextually appropriate to reach the communities that they love,” she said.