Advancing health equity through collaboration and community partnerships

^{Amanda Davis says the opportunities to partner with scholars in other fields helped shape her doctoral research on a community health worker program that serves patients who are resettled Somali refugees now living in Minnesota.}

Amanda Davis, MSN, RN, believes everyone benefits when nurses forge connections and partnerships beyond the profession.

The desire for interdisciplinary collaboration was one factor that drew Davis to the University of Minnesota School of Nursing for her PhD. As a nursing student, Davis joined the U’s Center for Bioethics last fall through the Interdisciplinary Doctoral Fellowship, and she’s also minoring in health equity through the School of Public Health — giving Davis numerous opportunities to partner with scholars in other fields. Those connections are helping shape her doctoral research on a community health worker program that serves patients who are resettled Somali refugees now living in Minnesota.

“Health care can be so siloed,” the Minnesota native says. That’s one reason she successfully applied to the Advanced Pathways to Research Program (A-Prep) in 2022. Coordinated through the University’s Clinical and Translational Science Institute, A-Prep brings together graduate students from a wide range of scientific disciplines. 

In her mentored summer project through A-Prep, Davis assisted Sarah Hoffman, PhD, MPH, RN, on a study of mindfulness-based interventions addressing intergenerational trauma. Hoffman, an associate professor of nursing, researches the longitudinal health of refugees. She’s also Davis’s PhD adviser.

Shining a light on community health workers

The interventions in that project are delivered via community health workers (CHW): frontline public health workers, typically members of the communities they serve, who provide a wide range of services including health education and system navigation. They’re seen as liaisons between health services and communities/patients, and research shows a host of positive health outcomes of CHW service.

Davis is intrigued by the CHW role, its capacity to improve patients’ health, and the potential to make it more sustainable — for CHWs themselves and for the health organizations seeking to work with them. In many other countries, Davis explains, “it’s a very recognized role in public health that everybody understands.” For her dissertation research she’s conducting focus groups with Somali CHWs and their clients/patients to learn more about the role, its challenges and its impact.

The U.S. has been slower to incorporate CHWs into health care, but recognition is growing — particularly since the COVID pandemic started — that CHW care is one potential way to increase health equity. “A lot of health care systems and nonprofits are now trying to figure out, how do we work this in? How do we make claims and get reimbursement?”

Community health workers in the U.S. are racially and ethnically diverse, and are predominantly female: over 88 percent, according to the National Association of Community Health Workers (NACHW). Pay is typically low; in Minnesota, the average CHW earns around $21 an hour. 

‘You have to earn trust’

Moreover, “Professional development is limited. It’s often a part-time job that’s grant funded,” Davis says. “Is this a sustainable model — for the people who are doing it or for the organizations that are trying to offer it?”

Davis is interested in the question of trust-building as it relates to CHWs — and to health care generally. “There’s this perception that community health workers are already trusted, so we as a health system can use that, and then we’ll be trusted too,” she says. “Especially in this time, when there’s so much understandable distrust in health care, and for a variety of reasons, it doesn’t work that way. You have to earn trust.”

Among the questions she’s exploring: “What does it look like when a community trusts someone? How do you know when you have that, or you don’t have that?” It’s a question that’s relevant, of course, for all health care workers. Davis believes nurses can learn from CHWs, and vice versa.

“Doulas, navigators, patient advocates and victim advocates — these roles often partner with nurses, however we don’t learn about them or how to advocate for them,” Davis says. “For community health workers to be working with nurses in a professional capacity is just a huge benefit and a blessing. They can provide this kind of information and advocacy that nobody else in the health care system is able to.”

In the right place

The U of M was the right choice for her, Davis says — for a host of reasons. She relishes opportunities to collaborate with researchers outside of nursing. And she’s grateful to have found Community Engaged Research 4 Health (CERCH), a nursing school group for scholars approaching research through community partnerships.

CERCH scholars, including nurses and sociologists, anthropologists, and epidemiologists, meet monthly to share research, ideas, and advice. Each member is working with a community partner in developing their research questions and approach, Davis explains.

The meetings are both freewheeling and fruitful: the group has been a boon as she’s developed grant applications for her PhD project, Davis says. “It’s kind of a collective. We’re all in charge,” she explains. “Even if it makes my dissertation take longer, and be a bit messier, it’s been really helpful."