title: Cultural elements underlying the community health representative - client relationship on Navajo Nation.
abstract: Navajo Nation Community Health Representatives (CHR) are trained community health workers (CHWs) who provide crucial services for patients and families. The success of the CHRs' interventions depends on the interactions between the CHRs and their clients. This research investigates the culturally specific factors that build and sustain the CHR-client interaction.
  
  
  
  In-depth interviews were conducted with 16 CHRs on Navajo Nation. Interviews were transcribed and coded according to relevant themes. Code summaries were organized into a narrative using grounded theory techniques.
  
  
  
  The analysis revealed four findings critical to the development of a CHR-client relationship. Trust is essential to this relationship and provides a basis for providing quality services to the client. The ability to build and maintain trust is defined by tradition and culture. CHRs must be respectful of the diverse traditional and social practices. Lastly, the passing of clients brings together the CHR, the client's family, and the community.
  
  
  
  Understanding the cultural elements of the CHR-client relationship will inform the work of community partners, clinical providers, and other indigenous communities working to strengthen CHR programs and obtain positive health outcomes among marginalized communities.
authors.affiliation: Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.|Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gampa
authors.affiliation: Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Casey
authors.initials: C
authors.lastname: Smith
authors.affiliation: Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Olivia
authors.initials: O
authors.lastname: Muskett
authors.affiliation: Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: King
authors.affiliation: Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.|Partners in Health, Boston, MA, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Sehn
authors.affiliation: Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.|Partners in Health, Boston, MA, USA.
authors.forename: Jamy
authors.initials: J
authors.lastname: Malone
authors.affiliation: Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Cameron
authors.initials: C
authors.lastname: Curley
authors.affiliation: Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Brown
authors.affiliation: Department of Health, Navajo Nation, Window Rock, AZ, USA.
authors.forename: Mae-Gilene
authors.initials: MG
authors.lastname: Begay
authors.affiliation: Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA. sshin@partners.org.|Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. sshin@partners.org.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. sshin@partners.org.|Partners in Health, Boston, MA, USA. sshin@partners.org.
authors.forename: Sonya
authors.initials: S
authors.lastname: Shin
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Adrianne Katrina
authors.initials: AK
authors.lastname: Nelson
mesh_terms: D003150:Community Health Workers; D065246:Culturally Competent Care; D005260:Female; D006801:Humans; D007198:Indians, North American; D007407:Interviews as Topic; D008297:Male; D011369:Professional-Patient Relations; D035502:Trust; D014481:United States
keywords: American Indian; Community Health Representatives; Community Health Workers; Culture; Indigenous; Navajo Nation