“I promised them I would be there”: A qualitative study of the changing roles of cultural health navigators who serve refugees during the COVID-19 pandemic

• Published in: Social sciences & humanities open Vol. 10; p. 101002
• Main Authors: Schuster, Roseanne C., Wachter, Karin, McRae, Kenna, McDaniel, Anne, Davis, Olga I., Nizigiyimana, Jeanne, Johnson-Agbakwu, Crista E.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 2024; Elsevier
• Subjects: community health worker (CHW); Core Consensus (C3 Project); culturally-centered healthcare; outreach; patient navigation; refugee; patient navigation; culturally-centered healthcare; Core Consensus (C3 Project); refugee; outreach; community health worker (CHW)
• ISSN: 2590-2911; 2590-2911
• DOI: 10.1016/j.ssaho.2024.101002

Cultural health navigators (CHNs) are one type of community health worker (CHW), a front-line cadre critical to mitigating the COVID-19 pandemic among marginalized communities. Yet little is documented about the roles of CHNs serving resettled refugees both before and during the pandemic. The objective of this study was to examine shifts in how CHNs carried out their work with refugee patients at a particular time point in the COVID-19 pandemic. In August 2020, we conducted virtual and serial semi-structured interviews with ten CHNs at a U.S. healthcare system serving ethnically and linguistically diverse refugee communities. We used a thematic analysis approach to code and interpret data. The analysis indicated that CHNs’ descriptions of their work with refugee clients and communities largely mapped onto established CHW roles: cultural mediation, care coordination, system navigation, education, and outreach and social support; however, how CHNs fulfilled their roles shifted dramatically during the pandemic. CHNs were unable to physically navigate patients through the system due to safety measures and telemedicine and deeply felt the loss of providing in-person outreach and social support. To offset constraints, CHNs increased the number and scope of virtual contacts with patients and launched novel education, outreach, and social support strategies. Through their adapted strategies, CHNs nurtured a strong foundation of trust to provide continuous care under challenging circumstances, although they were concerned that the lack of in-person interactions decreased patients' sensitive disclosures. The analysis illuminates the important and often unrecognized work of CHWs and informs ongoing efforts to prioritize community health work in U.S. healthcare policy and practice.
•Cultural health navigators (CHNs) expanded their roles to serve vulnerable refugee patients in new modalities during the COVID-19 pandemic.•CHNs navigated new physical, virtual, and informational barriers to culturally mediate COVID-19 and standard care.•Their inability to conduct in-person outreach and social support hampered their connection with patients.•Still, CHNs maintained patient engagement to deliver high-quality services through these challenges.•Formalizing community health workers into the health system is important to mitigating effects of future pandemics and emergencies on vulnerable communities.