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An ethnography of clinic "noise" in a community-based, promotora-centered mental health intervention

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  • Getrich, Christina
  • Heying, Shirley
  • Willging, Cathleen
  • Waitzkin, Howard

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.

Suggested Citation

  • Getrich, Christina & Heying, Shirley & Willging, Cathleen & Waitzkin, Howard, 2007. "An ethnography of clinic "noise" in a community-based, promotora-centered mental health intervention," Social Science & Medicine, Elsevier, vol. 65(2), pages 319-330, July.
  • Handle: RePEc:eee:socmed:v:65:y:2007:i:2:p:319-330
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    References listed on IDEAS

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    1. Waitzkin, H. & Williams, R.L. & Bock, J.A. & McCloskey, J. & Willging, C. & Wagner, W., 2002. "Safety-net institutions buffer the impact of medicaid managed care: A multi-method assessment in a rural state," American Journal of Public Health, American Public Health Association, vol. 92(4), pages 598-610.
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    Cited by:

    1. Blair, Thomas R.W., 2012. "“Community ambassadors” for South Asian elder immigrants: Late-life acculturation and the roles of community health workers," Social Science & Medicine, Elsevier, vol. 75(10), pages 1769-1777.

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