title: Therapeutic Relationship and Study Adherence in a Community Health Worker-Led Intervention.
abstract: Community health workers (CHWs) are increasingly utilized to reach low-resource communities. A critical domain influencing success is the CHWs' ability to create and maintain a therapeutic relationship with the participants they serve. A limited evidence base exists detailing this construct, and evaluating CHW-participant relationships in the context of CHW-led programs. In a longitudinal study design, data on this therapeutic relationship were collected [as captured using The Scale to Assess the Therapeutic Relationship in Community Mental Health Care (STAR)] on 141 participants who had been assigned to a CHW during their perinatal period. Results indicate that therapeutic relationship was associated with the participant's psychosocial health, and independently predicted study adherence in the longitudinal intervention. Changes in therapeutic relationship over the months following birth were strongly associated with changes in anxiety and depression symptoms. A trustful relationship is critical in ensuring CHWs can effectively reach the population they serve. The findings offer additional psychometric evidence of the uses and benefits of STAR outside of the traditional clinical setting in the context of public health research.
authors.affiliation: Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. camundorf@gmail.com.
authors.forename: Christopher
authors.identifier: http://orcid.org/0000-0002-8780-9122
authors.initials: C
authors.lastname: Mundorf
authors.affiliation: Department of Biostatistics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
authors.forename: Arti
authors.initials: A
authors.lastname: Shankar
authors.affiliation: Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
authors.forename: Terrance
authors.initials: T
authors.lastname: Peng
authors.affiliation: Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Hassan
authors.affiliation: Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
authors.forename: Maureen Y
authors.initials: MY
authors.lastname: Lichtveld
mesh_terms: D000293:Adolescent; D000328:Adult; D003150:Community Health Workers; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D010349:Patient Compliance / Q000523:psychology; D011247:Pregnancy; D011369:Professional-Patient Relations; D011584:Psychology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D035502:Trust; D055815:Young Adult
keywords: Community health worker; Pregnancy; STAR; Structural equation modeling; Study adherence; Therapeutic relationship