Document Type

Dissertation

Date of Degree

Fall 11-29-2023

Primary Advisor

Gaetano R. Lotrecchiano, EdD, PhD

Keywords

Community Health Workers; Primary Care; Team Science; Interprofessional Care; Translational Health Science

DOI

https://doi.org/10.4079/THS2023.06

Abstract

Background: Expanding primary care (PC) has emerged as a national priority to transform health care delivery (Pittman et al., 2015). This requires that PC teams become highly functioning interprofessional teams. Community Health Workers (CHWs), frontline health care workers who are seen as trusted members of their community, act as links between the community and care teams, providing a crucial means to increase access to health services, reduce health care costs and address social determinants of health (SDH) (American Public Health Association, 2021). CHWs are increasingly becoming part of PC teams (Franklin et al., 2015; Herman, 2011). Despite decades of research highlighting the effectiveness of CHWs, these individuals are still not integrated into PC teams in a systematic or sustainable fashion often leading to fragmented services and a narrowed ability to provide continuity of care (Kangovi et al., 2016; McCarville et al., 2021). For CHWs to be effective, they need to be integrated within the healthcare system, yet there is not a clear definition of “CHW-integration” and the mechanisms explaining how CHW-integration is achieved within the healthcare team are not well understood (Franklin et al., 2015; McCarville et al., 2021; Washburn et al., 2021). In this study, integration was explored through “interpersonal integration” defined as interprofessional teamwork and collaboration and how integration occurs was understood through social mechanisms, or the patterns of behaviors, processes and interactions overtime among team members (Hedström & Ylikoski, 2010). Guided by a team science approach, this study utilized an overarching input-mechanisms-outcome (IMO) model, which explored how specific inputs, such as team composition, influenced the social mechanisms underlying interpersonal integration, contributing to the outcomes of team effectiveness and well-being.

Study Population: Roots Community Health Center (Roots) is an organization that has been successful at integrating CHW-type roles, called Roots Health Navigators (RHNs), into their primary care services. Roots provides a whole health model of care for a historically marginalized community in the Northern California. Therefore, this study explored the social mechanisms underlying interpersonal integration among Roots team members and how this relates to the team’s effectiveness and well-being. A better understanding of how interpersonal integration occurs can support the growth of roles similar to the RHNs, expanding their ability to support care teams and address critical patient needs.

Methods: An explanatory mixed methods approach was conducted in three phases among Roots team members: 1) quantitative cross-sectional survey, 2) qualitative semi-structured interviews, and 3) integrating findings to inform the development of a model of interpersonal integration. Quantitative data collected included team dynamic factors contributing to interpersonal integration and well-being, defined as Professional Fulfillment and Burnout. Semi-structured interviews were conducted to explore the social mechanism underlying interpersonal integration. Descriptive and correlational analyses were conducted for the quantitative data. The qualitative data was analyzed for emergent themes. Findings from the quantitative and qualitative phases were integrated to inform the development of a model of interpersonal integration among Roots.

Results: Twenty-five team members responded to the cross-sectional survey. High levels of team dynamic factors including Shared Understanding (Mean = 4.05, SD = 0.80) and Acting and Feeling Like a Team (Mean = 4.07, SD = 0.96) were reported. There is a statistically significant strong correlation between Perceived Team Effectiveness and Burnout (r = -0.655, p < 0.001).

Ten of the 25 survey respondents completed an interview. Qualitative data revealed six underlying social mechanisms expressed through varying core team processes contributing to development of two team emergent states: Shared Team Identity and Shared Team Mental Models. RHNs were defined as integral to building community trust and fostering an inclusive team culture. Team members also described opportunities to enhance and sustain the Roots’ team-based model of care. Joint findings highlighted the importance of the RHN role to the development of Shared Team Mental Models and the value of a diverse interprofessional care team to team effectiveness.

Conclusion: As PC shifts to focusing on the upstream causes of health conditions, roles similar to RHNs will be imperative PC-based roles. With a deeper understanding of the teamworking factors that contribute to team outcomes, like team effectiveness and well-being, this model of care can be replicated to support broader access to PC services.

Comments

©2023 by Alexandria Marie Blacker. All rights reserved.

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