The many ways of one: An analysis of multiple roles and enactment dimensions for community health workers

This dissertation focused on Community Health Workers' (CHWs) discursive enactment in one-on-one client meetings. It investigated the presence of multiple roles within client meetings as well as discursive dimensions that are managed regardless of role. The study considered 12 CHW-client meetings as well as follow-up interviews, including those with four individual CHWs and two CHW supervisors. The role presence aspect of the study applied Rosenthal's (1998) model with actual interaction discourse. The role enactment dimensions of the dissertation were selected because they appeared in previous discourse literature and were thematically relevant to the CHW field. The role presence findings revealed that Rosenthal's (1998) roles were indeed present, largely as originally outlined. Role enactment dimension results related to the direct-indirect tension, the controlling-facilitating tension, and the personal-professional tension, respectively. CHWs were found to be generally indirect when working with newer clients in order to establish a relationship foundation for the successful completion of subsequent tasks. CHWs were found to generally value a facilitating or empowering style but their actual discourse tended to reflect a controlling style. CHWs had philosophical differences reflecting actual discursive differences regarding the use of personal discourse. While the findings are not generalizable, they do offer insights for follow-up studies as well as CHW program design and training conversations.