Use of Preventive Maternal and Child Health Services by Latina Women

Home Visits for Postpartum Depression Intervention among Low-Income Latinas: Results from the PST4PPD Project

Research shows that U.S. Latinas are at risk for high rates of postpartum depression (PPD) but have low rates of treatment compared to non-Hispanic White mothers. This study examined the feasibility of a multi-site home-visiting intervention (PST4PPD) conducted by bilingual community health workers (CHW) among low-income Latina mothers. A one-group, pre/posttest design and paired sample's t-test were used to measure changes in depressive symptoms and self-efficacy for participants (n = 76) across five sites. The Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were used to assess depression; the New General Self-Efficacy Scale and the Maternal Efficacy Questionnaire measured general self-efficacy and parenting self-efficacy. Depression scores decreased significantly from pretest to posttest. Participants' general self-efficacy, maternal self-efficacy, and PPD knowledge increased. With a 76% completion rate, demonstrable improvements were seen in participants' depression and self-efficacy. Implications for addressing modifiable factors such as self-efficacy and stress management are discussed.

Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review

Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were considered. Fifteen studies describing a range of interventions met the inclusion criteria. Data were extracted on population and intervention characteristics; study design; definitions and data for relevant outcomes; and the contexts and conditions in which interventions occurred. Because most of the included studies focus on antenatal care outcomes, evidence of impact is particularly limited for care seeking for birth and after birth. Evidence in this review is clustered within a small number of countries, and evidence from low- and middle-income countries is notably lacking. Interventions largely had positive effects on uptake of skilled maternity care. Cultural factors are often not the sole factor affecting populations' use of maternity care services. Broader social, economic, geographical and political factors interacted with cultural factors to affect targeted populations' access to services in included studies. Programmes and policies should seek to establish an enabling environment and support respectful dialogue with communities to improve use of skilled maternity care. Whilst issues of culture are being recognized by programmes and researchers as being important, interventions that explicitly incorporate issues of culture are rarely evaluated.

Birth Experiences of Immigrant Latina Women in a New Growth Community

A woman's birth experience can impact the physical and mental well-being of mothers long after the birth of their child. Little is known about the experiences of Latina women in areas with small, yet growing Latino populations. To understand Latina's perceptions of their childbirth experience and to see how insurance status impacts that experience, we conducted in-depth, semi-structured interviews with a non-proportional quota sampling of ten Latina women, five with and five without health insurance. Most women reported a positive global experience; the birth of a healthy child was the most important factor influencing birth experiences for all of them. Locus of control and support from medical providers and loved ones also shaped experiences. Uninsured women reported lower levels of perceived control and support, which did impact their birthing experience. These differences could be influenced by social status and position. Medical provider, hospital, and policy recommendations are made which could lead to improvements in uninsured Latinas' childbirth experiences.

The impact of the State Children's Health Insurance Program's unborn child ruling expansions on foreign-born Latina prenatal care and birth outcomes, 2000-2007

The 2002 "unborn child ruling" resulted in State Children's Health Insurance Program (SCHIP) expansion for states to cover prenatal care for low-income women without health insurance. Foreign-born Latinas who do not qualify for Medicaid coverage theoretically should have benefited most from the policy ruling given their documented low rates of prenatal care utilization. This study compares prenatal care utilization and subsequent birth outcomes among foreign-born Latinas in six states that used the unborn child ruling to expand coverage to those in ten states that did not implement the expansion. This policy analysis examines cross-sectional pooled US natality data from the pre-enactment years (2000-2003) versus post-enactment years (2004-2007) to estimate the effect of the UCR on prenatal care utilization and birth outcome measures for foreign-born Latinas. Then using a difference-in-difference estimator, we assessed these differences across time for states that did or did not enact the unborn child ruling. Analyses were then replicated on a high-risk subset of the population (single foreign-born Latinas with lower levels of education). The SCHIP unborn child ruling policy expansion increased PNCU over time in the six enacting states. Foreign-born Latinas in expansion enacting states experienced increases in prenatal care utilization though only the high-risk subset were statistically significant. Birth outcomes did not change. The SCHIP unborn child ruling policy was associated with enhanced PNC for a subset of high-risk foreign-born Latinas.

Region of birth, sex, and reproductive health in rural immigrant latino farmworkers: the MICASA study

PURPOSE

Characterize sexual and reproductive health among immigrant Latino farmworkers.

METHODS

We surveyed 806 immigrant Latino farmworkers from Mexico and Central America in a rural agricultural community in California's Central Valley.

FINDINGS

A total of 556 respondents were born in Mexico (272 men, 284 women) and 250 in Central America (135 men, 115 women). The majority entered the United States as young adults, with median age at immigration ranging from 20 (Mexican-born men) to 24 (Central American-born women). Nearly 95% of respondents were married or cohabiting. Median age for sexual debut was 18 for women and was younger for men (adjusted mean difference: -2.1 years, 95% CI: -2.6 to -1.7). Median number of lifetime sexual partners was 1 for women and greater for men (adjusted mean difference: 2.0 partners, 95% CI: 1.3-2.7). Contraception use was less likely among men and among Central American women compared to Mexico-born women. Among sexually active persons not using contraception, the most common reasons for nonuse were "Don't want to"/"Don't like any" followed by desire to become or being pregnant. Women reported a median of 3 pregnancies; there were no significant differences based on respondents' region of birth.

CONCLUSIONS

This group of Latino immigrants demonstrated behaviors conducive to reproductive health: late sexual debut, few lifetime sexual partners, and high prevalence of marriage. Preventive education campaigns should focus on maintaining healthy behaviors, especially in men. Identifying groups with common provenance and cultural heritage may aid in maximizing acceptability and effectiveness of prevention programs.

The association of health literacy, social support, self-efficacy and interpersonal interactions with health care providers in low-income Latina mothers

OBJECTIVE

We explored relationships between maternal health literacy (HL), communicative self-efficacy (SE), social support (SS) and maternal perception of interactions with health care providers (HCPs).

METHODS

Using a cross-sectional, correlational design, we assessed sociodemographic characteristics, maternal HL, social support, communicative self-efficacy, and interpersonal interactions with HCPs among 124 low-income Latina mothers of young children.

RESULTS

Informal SS significantly predicted maternal SE in interactions. SE predicted maternal perception of a HCP's ability to "elicit and respond to her concerns."

DISCUSSION

Interventions to improve maternal self-efficacy in interacting with HCPs among low health literate Latina mothers may positively impact pediatric health outcomes.

Perinatal depression treatment preferences among Latina mothers

The study described here was designed to determine treatment preferences among Latinas to identify treatment options that meet their needs and increase their engagement. Focus group interviews were conducted with 22 prenatal and postpartum Latinas at risk for depression. The group interviews were conducted in Spanish and English using a standardized interview protocol. Focus group transcripts were analyzed to identify themes regarding perinatal depression coping strategies, preferred approaches to treating perinatal depression, and recommendations for engaging perinatal Latinas in treatment. The results suggest that Latinas' treatment preferences consist of a pathway (i.e., hierarchical) approach that begins with the use of one's own resources, followed by the use of formal support systems (e.g., home-visiting nurse), and supplemented with the use of behavioral therapy. Antidepressant use was judged to be acceptable only in severe cases or after delivery. The data indicate that to increase health-seeking behaviors among perinatal Latinas, practitioners should first build trust.

Developing a culturally appropriate preconception health promotion strategy for newly immigrated Latinos through a community-based program in South Carolina

Maternal and Child Health (MCH) experts emphasize the importance of preconception health (PCH) in achieving healthy pregnancies and positive birth outcomes. Research demonstrates that Latinas face significant PCH disparities, yet no comprehensive PCH promotion strategy exists to reach them. As a trusted community-based organization that uses culturally competent strategies to promote MCH in the Latino community, PASOs is well-positioned to address PCH among Latinos in South Carolina. With the input and support of Latino community members, PASOs is pioneering a PCH strategy using its successful model of education, outreach, partnerships and resource navigation.

Effect of health care disparities on screening

Significant declines in the incidence and mortality rates of cervical cancer have occurred in the United States since the introduction of the Papanicolaou (Pap) test. Unfortunately, a reduction in the burden of cervical cancer is not equal across all ethnic and racial groups; significant disparities exist. Disparities are reflected not only in mortality and incidence rates, but also in screening rates. We review barriers to screening and effective approaches towards overcoming them. As minority populations increase over the next few decades, it becomes ever more urgent to employ interventions that will reduce the burden of cervical cancer among diverse groups.

Using Promotores Programs to Improve Latino Health Outcomes: Implementation Challenges for Community-based Nonprofit Organizations

Promotores are community lay health workers, who provide outreach and services to Latinos. Little research on the promotores programs exists and the focus of this article is to identify the challenges faced by community-based nonprofits when implementing promotores programs. To explore this type of program telephone interviews were conducted with ten promotores academic experts and nonprofit executives. The results suggest that implementation challenges fall into three major categories: the lack of standardized information on promotores programs, labor issues, and organizational costs. Future recommendations are made which highlight promotores recruitment and retention strategies, and the development of a clearinghouse of programmatic implementation information for community-based nonprofits.

Characterizing Fatigue: The Effects of Ethnicity and Acculturation

It is unknown if fatigue measures like the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF; Stein, Jacobsen, Blanchard, & Thors, 2004) appropriately describe fatigue in Hispanics or if acculturation plays a role in fatigue. This study compared fatigue in community samples of Hispanics and Anglos. The MFSI-SF and pertinent questionnaires were administered to adults in San Diego County via telephone survey. Some differences in fatigue were observed in initial comparisons between Hispanics and Anglos, including when acculturation was considered. When age and education were controlled, Hispanics reported less general fatigue than Anglos, regardless of acculturation status, p = < .01. Exploratory factor analyses indicate that the MFSI-SF general-fatigue subscale was problematic for Hispanics. Implications, limitations, and future directions are discussed.

Increasing cervical cancer screening in a Hispanic migrant farmworker community through faith-based clinical outreach

OBJECTIVE

Partnerships between academic medical centers and faith-based community organizations have been associated with increased screening rates in low-income minority women. We describe clinical outcomes of an outreach partnership between a cancer center and a faith-based outreach clinic offering gynecologic screening services in central Florida to increase cervical cancer screening adherence in a priority population of primarily Hispanic farmworker women.

METHODS

Data sources included a retrospective chart review. This descriptive study examined patterns of cervical cancer screening behavior among the patient population of the faith-based outreach clinic.

RESULTS

Findings suggest that among this group of patients, the demographic factors that predict adherence with cervical cancer screening recommendations are number of years having lived in the United States and marital status. Women residing in the United States for more than 5 years were significantly more adherent with cervical cancer screening recommendations compared with women who have resided in the United States for 5 years or less (p = .05), and married women were more likely to be adherent than unmarried women (p = .02).

CONCLUSIONS

The partnership was successful in increasing cervical cancer screening adherence in this medically underserved population. When enabling barriers to screening adherence are removed through faith-based clinical outreach and engaged continuously for a number of years, uninsured, low-income Hispanic women are more likely to receive recommended preventive services.

Postpartum depression and help-seeking behaviors in immigrant Hispanic women

OBJECTIVES

To describe perceptions of immigrant Hispanic women experiencing symptoms of postpartum depression (PPD) and to identify barriers to seeking mental health services.

DESIGN

Qualitative descriptive.

SETTING

Community health clinic.

PARTICIPANTS

Twenty immigrant Hispanic women scoring positive for symptoms of PPD receiving health care at a community health clinic who declined mental health services participated in audiotaped interviews held in their homes.

METHODS

Following Institutional Review Board approval and informed consent, interviews were conducted with study participants. Transcribed data were analyzed as appropriate for qualitative inquiry.

RESULTS

Some of the women did not recognize and/or denied their symptoms attributing their sadness to financial concerns, family relationships, and/or work stressors. Study participants articulately described their symptoms and identified personal barriers including beliefs about emotional health, the perceived stigma of mental illness, hesitancy to seek treatment for symptoms of PPD, and cultural beliefs about motherhood and the role of women. Social barriers included inadequate social support, immigration status, and limited English proficiency. Health care delivery barriers included financial and time constraints and lack of child care and transportation.

CONCLUSION

Limited social networks and barriers to health care should be addressed to foster positive outcomes. Mental health services should be embedded with primary health care or obstetric care clinics to facilitate access. Personal and professional support can make a significant contribution to the reduction of symptoms of PPD.

Exploring the sexual health priorities and needs of immigrant Latinas in the southeastern United States: a community-based participatory research approach

Latinas living in the United States are disproportionately affected by HIV/AIDS and sexually transmitted infections. However, few effective interventions currently exist that are designed to meet the priorities and needs of recently arrived and less acculturated immigrant Latinas who are settling in the southeastern United States. To identify sexual health priorities, gaps in information and skills, and key intervention characteristics to improve sexual health among immigrant Latinas, a community-based participatory research partnership conducted four focus groups with Latinas, in central North Carolina. Findings revealed a lack of knowledge about sexual health, shame and embarrassment related to clinical exams and conversations about sex, multilevel barriers to sexual health, and disease transmission misinformation. Findings also suggested that interventions should include information about a broad range of sexual and reproductive health topics and skill building. Such interventions could serve to assist in diminishing health disparities experienced among this vulnerable population.

Prenatal care among immigrant and racial-ethnic minority women in a new immigrant destination: exploring the impact of immigrant legal status

Despite the rising share of undocumented immigrants in the US population, research has been quite limited regarding immigrant legal status and how it may limit healthcare access, especially research involving direct identification of undocumented populations. Drawing upon the Utah Population Database, a unique, comprehensive linked system of vital, medical, and administrative records, we analyze the prenatal care utilization in a large and recent cohort of births to mothers residing in the pre-emerging immigrant gateway state of Utah. Our analyses focus on the racial-ethnic, nativity and legal status of mothers as factors that influence prenatal care utilization. State administrative records are used to assess legal status among foreign-born mothers, specifically driver privilege cards made available to undocumented migrants. Our results indicate the importance of disaggregating the expansive categories of Hispanics and the foreign born to better understand health outcomes and healthcare utilization among immigrants. In particular, we find that the legal status of immigrant mothers is one of several important factors influencing prenatal care utilization. Undocumented women are among the least likely to obtain adequate levels of prenatal care. However, undocumented women's prenatal care utilization is enhanced among those using the state's integrative driver privilege program, and among those residing in neighborhoods with high concentrations of immigrants. Results are discussed in light of theory on immigrant integration and healthcare access, and in terms of public policies, such as those extending driver privileges to unauthorized immigrants, which aim to facilitate immigrants' access to institutions within destination communities.

Interventions that increase use of Pap tests among ethnic minority women: a meta-analysis

OBJECTIVE

Although a variety of intervention methods have been used to promote Pap test screening among ethnic minority women in the US, the effectiveness of such interventions is unclear. We performed a meta-analysis to examine the overall effectiveness of these interventions in increasing Pap test use by ethnic minority women in the US.

METHODS

A search of databases (MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Science Citation Index-Expanded) and review articles for articles published between 1984 and April 2009 identified 18 randomized and non-randomized controlled trials. The primary study outcome was the difference in the proportion of Pap tests between the treatment and comparison groups.

RESULTS

The pooled mean weighted effect size (d) for the 18 studies was 0.158 (95% confidence interval [CI]=0.100, 0.215), indicating that the interventions were effective in improving Pap test use among ethnic minority women. Among the intervention types, access enhancement yielded the largest effect size (0.253 [95% CI=0.110, 0.397]), followed by community education (0.167 [95% CI=0.057, 0.278]) and individual counseling or letters (0.132 [95% CI=0.069, 0.195]). Combined intervention effects were significant for studies targeting Asian (0.177 [95% CI=0.098, 0.256]) and African American women (0.146 [95% CI=0.028, 0.265]), but not Hispanic women (0.116 [95% CI=-0.008, 0.240]).

CONCLUSIONS

Pap test use among ethnic minority women is most likely to increase when access-enhancing strategies are combined. Further research is needed to determine whether more tightly controlled trials of such interventions might reveal an improved rate of cervical cancer screening in Hispanic women as well.

Family-based health needs along the Texas-Mexico border

BACKGROUND

The population in the Texas-Mexico border is rapidly increasing and exacerbating a number of public health problems and healthcare services. The needs of this area have been predominantly assessed through a professional lens. To better inform public policy and serve the area, this study assessed the needs of families living along the Texas-Mexico border.

METHODS

Approximately 2000 households along the Texas-Mexico border were interviewed for their basic demographic information and health needs.

RESULTS

It was found that children's healthcare services were the highest reported need among families along the border. The probability of reporting healthcare needs increased by 43% among families with children under the age of 5, whereas the probability of reporting healthcare needs decreased by 40% among families with children 13 and older.

CONCLUSION

The findings from this study suggest child healthcare services, particularly for families with young children, is the most pressing need of the area.

Exploring attitudes, beliefs, and communication preferences of Latino community members regarding BRCA1/2 mutation testing and preventive strategies

PURPOSE

To inform development of a culturally sensitive hereditary breast and ovarian cancer communication initiative and related clinical genetic services.

METHODS

Five focus groups were conducted with 51 female and male Latinos. Educational materials were designed to communicate information about hereditary breast or ovarian cancer and availability of relevant clinical services or prevention strategies. Focus groups explored participants' knowledge, attitudes, and beliefs about hereditary breast and ovarian cancer, BRCA1/2 testing, and communication preferences for hereditary breast and ovarian cancer health messages.

RESULTS

Overall, awareness of familial breast and ovarian cancer and availability of genetic risk assessment was low. Once informed, participants held favorable attitudes toward risk assessment and counseling services. Critical themes of the research highlighted the need to provide bilingual media products and use of a variety of strategies to increase awareness about hereditary cancer risk and availability of clinical genetic services. Important barriers were identified regarding family cancer history communication and cancer prevention services. Strategies were suggested for communicating cancer genetic information to increase awareness and overcome these barriers; these included both targeted and tailored approaches.

CONCLUSION

This research suggests that cancer genetic communication efforts should consider community and cultural perspectives as well as health care access issues before widespread implementation.

Preventing cervical cancer in the Latina population

Cervical cancer causes great morbidity and mortality worldwide and in the United States. Infection with oncogenic human papillomavirus (HPV), the etiological agent of almost all cervical cancer cases, is common among sexually active women in the United States. Over the past 5 decades, the implementation of Papanicolaou screening programs in the United States has led to a significant decrease in cervical cancer cases. However, notable disparities in the incidence and mortality of cervical cancer and cervical screening rates among Hispanics in the United States remain. If current disparities persist without intervention, the Latina population in the United States may remain at a higher risk of developing and dying from cervical cancer. We discuss disparities in cervical cancer screening, incidence, and mortality among the Latina population, as well as the barriers that may propagate these disparities. We also address how these barriers can be overcome through the coordination of outreach programs and widespread prophylactic HPV vaccination to reduce cervical cancer disparities in Latinas.

Research opportunities with curanderos to address childhood overweight in Latino families

Curanderos are consulted as an adjunct or alternative to biomedical health care in the greater southwest, although the extent of their involvement in obesity prevention and treatment is poorly understood. Seven curanderos participated in audiotaped interviews about their work with families and beliefs about childhood feeding and overweight. Themes reflected curanderos' beliefs about their practice and childhood obesity. Curanderos approach their work as a calling, emphasizing elements from nature in etiology and cure. From the curandero's standpoint, essential elements of obesity management must acknowledge the socially marginalized experiences of Latinos. We encountered working with curanderos as problematic, and this likely reflected our differing personal characteristics and a tension between our healing professions. Curanderos could serve as collaborators in childhood obesity interventions if we craft health messages and delivery modes that resonate with Latino families and address ethical and communication issues on the research team.

Public health issues related to HPV vaccination

The human papillomavirus (HPV) is clearly established as the cause of cervical cancer, and vaccines targeting oncogenic forms of the virus are important as a primary method of prevention. However, barriers to cervical screening and vaccination such as a lack of knowledge of HPV, access to healthcare, and poor follow-up prevent the acceptance and utilization of HPV vaccines. Strategies for prevention of disease and implementation of vaccination are in development, but the importance of primary prevention of HPV infection needs to be stressed. This review assesses the potential impact of vaccination for cervical cancer, barriers to vaccination, and the methods used to increase coverage. With the advent of prophylactic vaccines, HPV, a common infection in the United States, can be prevented in most women.

A meta-analysis of interventions to promote mammography among ethnic minority women

BACKGROUND

Although many studies have been focused on interventions designed to promote mammography screening among ethnic minority women, few summaries of the effectiveness of the interventions are available.

OBJECTIVE

The aim of this study was to determine the effectiveness of the interventions for improving mammography screening among asymptomatic ethnic minority women.

METHODS

A meta-analysis was performed on intervention studies designed to promote mammography use in samples of ethnic minority women. Random-effects estimates were calculated for interventions by measuring differences in intervention and control group screening rates postintervention.

RESULTS

The overall mean weighted effect size for the 23 studies was 0.078 (Z = 4.414, p < .001), indicating that the interventions were effective in improving mammography use among ethnic minority women. For mammography intervention types, access-enhancing strategies had the biggest mean weighted effect size of 0.155 (Z = 4.488, p < .001), followed by 0.099 (Z = 6.552, p < .001) for individually directed approaches such as individual counseling or education. Tailored, theory-based interventions resulted in a bigger effect size compared with nontailored interventions (effect sizes = 0.101 vs. 0.076, respectively; p < .05 for all models). Of cultural strategies, ethnically matched intervention deliveries and offering culturally matched intervention materials had effect sizes of 0.067 (Z = 2.516, p = .012) and 0.051 (Z = 2.365, p = .018), respectively.

DISCUSSION

Uniform improvement in mammography screening is a goal to address breast cancer disparities in ethnic minority communities in this country. The results of this meta-analysis suggest a need for increased use of a theory-based, tailored approach with enhancement of access.

Latinos and HIV/AIDS: examining factors related to disparity and identifying opportunities for psychosocial intervention research

Latinos maintain an AIDS case rate more than 3 times higher than whites, a greater rate of progression to AIDS, and a higher rate of HIV/AIDS-related deaths. Three broad areas are reviewed related to these disparities: (1) relevant demographic, socioeconomic, and socio-cultural factors among Latinos; (2) drug abuse and mental health problems in Latinos relevant to HIV/AIDS outcomes; and (3) opportunities for psychosocial intervention. Latinos living with HIV are a rapidly growing group, are more severely impacted by HIV than whites, and confront unique challenges in coping with HIV/AIDS. A body of research suggests that depression, substance abuse, treatment adherence, health literacy, and access to healthcare may be fruitful targets for intervention research in this population. Though limited, the current literature suggests that psychosocial interventions that target these factors could help reduce HIV/AIDS disparities between Latinos and whites and could have important public health value.

Promotores as partners in a community-based diabetes intervention program targeting Hispanics

Promotores, community health workers, are a pivotal component of LA VIDA, a diabetes intervention program targeting Hispanics who have or are at risk for diabetes. The purpose of this qualitative study was to evaluate the role of LA VIDA promotores in reducing diabetes health disparities among Hispanics in southwestern New Mexico. Interviews with 17 promotores revealed that they effectively relate to their clients as fellow community members who understand the culture and often know clients and their families. Promotores facilitate access to healthcare and social services, enroll participants in educational and physical activities, support lifestyle changes, and conduct LA VIDA intervention and prevention activities. Through their education and advocacy for clients, promotores act as healthcare navigators for numerous health and social services while providing support for personal and family issues. Their role transcends that of educator and advocate for clients as they develop community partnerships and collaborate with community groups to implement health-related activities. In essence, promotores become community partners in their efforts to build capacity and promote healthy Hispanic communities.

The disparity of cervical cancer in diverse populations

Significant disparities in cervical cancer incidence and mortality rates among minority groups have been documented in the United States, despite an overall decline in these rates for the population as a whole. Differences in cervical cancer screening practices have been suggested as an explanation for these disparities, as have differences in treatment among various racial and ethnic groups. A number of factors are attributed to these observed differences. As minority populations continue to grow in size over the next 50 years, persistent disparities will place an ever increasing burden on these populations and on the national healthcare system. Strategies to reduce cervical cancer disparities need to be employed in order to reverse these trends.

An ethical framework for community health workers and related institutions

The aim of this article is to provide practical ethical guidance and to foster further critical reflection on ethical issues in the work, education, and training of community health workers. The analysis includes implications for associated institutions. We first summarize the roles of community health workers and some evaluations of their work. After next highlighting ethical elements from the literature, we then give a justification for the ethical framework that follows. The article then provides a detailed discussion of a set of basic ethical principles for the field of community health work. Among the principles, we argue that the following 3 should have a foundational role: equal and substantial respect, justice, and care. Among these, respect is most fundamental.