Abstract

Background: The well-documented racial disparity in maternal-child health care delivery and outcomes exists between low-income racial/ethnic minority women and non-Hispanic White women. African American and African American Hispanic women are twice as likely to experience preterm births (PTB) and deliver low birth weight (LBW) infants than non-Hispanic White women. Native American women are 20% more likely to deliver PTB. Maternal mortality among African American women remains the highest at 2-3X in comparison to all racial groups. African American, Native American, and Hispanic women are 3X more likely to experience perceived discrimination than non-Hispanic White women. Chronic experiences of racism during pregnancy have been linked with PTB and LBW- one reason being that women may be reluctant to seek prenatal care. Public health programs address access to care barriers by employing community health workers (CHWs) because of their known success in building trust with at-risk, low-income communities. This study explores the CHW trust-building mechanisms that lower access to care barriers for a theoretical framework.Method: The study uses a grounded theory method with interviews and focus groups of 32 CHWs. Results: Building trust at the CHW-patient initial encounter requires: 1) recognizing social determinants of health (SDH) needs; 2) respectful communication; 3) addressing time and environmental barriers. The theoretical framework includes the initial trust-building mechanisms- addressing SDH needs, embodying mannerisms, speaking appropriate to client’s age, culture, and health literacy, acknowledging patient fears through locus of control and allowing for time flexibility. Conclusion: Community health workers build trust requires understanding the complex interplay of a combination of communication mechanisms