title: An ethnography of clinic "noise" in a community-based, promotora-centered mental health intervention.
abstract: Community-based health interventions have emerged as a growing focus for anthropological research. The application of ethnographic approaches in clinical practice settings reveals that community-based interventions must grapple with "noise," or unanticipated factors such as patients' own perceptions of illness and treatment, primary care providers' non-adherence to guidelines-based treatment, the social dynamics of the clinic site itself, and incomplete understanding and acceptance of an intervention by a clinic's staff members. Such noise can influence the implementation and quality of treatment. Thus, identifying clinic-based noise is critical in assessments of fidelity to intervention protocols as well as outcomes of community-based interventions. This paper highlights findings from an evaluation of a mental health intervention focusing on the role of promotoras (briefly trained, non-professional community health workers) as mental health practitioners in two urban New Mexico, USA, community health centers. Our research identified three areas of clinic-based noise: the clinics' physical ability to "absorb" the intervention, the challenges of co-worker instability and interpersonal relationships, and balancing extra workplace demands. The findings demonstrate the value of ethnographic approaches in community-based intervention research.
authors.affiliation: Department of Anthropology, University of New Mexico, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Getrich
authors.forename: Shirley
authors.initials: S
authors.lastname: Heying
authors.forename: Cathleen
authors.initials: C
authors.lastname: Willging
authors.forename: Howard
authors.initials: H
authors.lastname: Waitzkin
mesh_terms: D000884:Anthropology, Cultural; D003156:Community Mental Health Services / Q000458:organization & administration*; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D009516:New Mexico; D016526:Workload