https://www.ucl.ac.uk/ioe-writing-centre/critical-reading-and-writing/critical-review/
The purpose of this exercise is to hone your skills in critical thinking, evaluation and comparison. You will write a critical review for each of two journal articles. These should be 1.5 - 2 pages (500 - 750 words) each and following the points on mechanics .
Make sure you relate your chosen article to your
research questionand to the
course materialRemember to edit your work and properly
cite and referenceall sources used.
The two articles you review will be chosen from a selection process as follows:
The exchange and use of cultural and social capital among community health workers in the United States Sociol Health Illn. 2021;43:299–315. | 299wileyonlinelibrary.com/journal/shil Received: 13 November 2019 | Accepted: 21 October 2020 DOI: 10.1111/1467-9566.13219 O R I G I N A L A R T I C L E The exchange and use of cultural and social capital among community health workers in the United States Jarron M. Saint Onge1,2 | Joanna Veazey Brooks1 © 2020 Foundation for the Sociology of Health & Illness 1Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA 2Department of Sociology, University of Kansas, Lawrence, KS, USA Correspondence Jarron M. Saint Onge, Fraser 716, 1415 Jayhawk Blvd, Lawrence, KS, USA. E- mail: jsaintonge@ku.edu Funding information Health Forward Foundation of Kansas City, Grant/Award Number: #FY16- 4785 Abstract Community health care workers (CHWs), lay community members with basic health care training, have been charged with providing appropriate care for vulnerable populations, addressing social determinants and improving population health. Frequently, CHWs lack the economic or cultural capital to accomplish these goals. Through analysis of 17 semi- structured interviews with CHWs and supervisors at a CHW programme in the United States, we draw on Bourdieu's theory of practice to examine how the exchange of cultural and social capital impact CHW effectiveness. We found that CHWs’ reliance on bonding capital was per- ceived to effectively build social networks and mutual trust among marginalised communities. But, over- reliance on embodied cultural capital and bonding capital reduced in- tegration into the health care field; limited access to bridg- ing capital; and limited social standing. We highlight how the exchange of cultural to bonding and bridging capital presented structural limitations. Overall, the demonstrated tension demarcates and reinforces longstanding divisions between social issues and health care issues. Future ef- forts should focus on promoting the unique skills of CHWs within health care settings to avoid compromising CHWs’ ability to advance population health. K E Y W O R D S community health workers, cultural capital, health interventions, population health, social capital, social determinants of health www.wileyonlinelibrary.com/journal/shil mailto: https://orcid.org/0000-0002-0914-4882 mailto:jsaintonge@ku.edu 300 | SAINT ONGE ANd BROOKS INTRODUCTION Community health workers (CHWs), lay community members with limited credentials, serve an in- creasingly important role in meeting the needs of the underserved in the current U.S. health care system. While CHWs are utilised in a wide variety of roles across both community and health care settings, their general role is to link marginalised populations to health care services to improve both individual and population health (Centers for Disease Control 2019). While health systems are rec- ognising a need for CHWs and increasingly hiring or contracting their services, a frequent lack of re- sources and persistent constraints challenge CHWs as they work with health care systems (Malcarney et al. 2017). To be effective in their work, CHWs frequently rely on alternative (i.e. non- material) resources to form a link between clients and the health care system. Drawing on in- depth qualitative interviews with CHWs, their supervisors and organisational leadership we identified the benefits and challenges of utilising various forms of cultural and social capital as important resources in CHW efforts to effectively engage clients and to promote population health. We demonstrate how reduc- ing structural constraints to capital exchange serve as a potential area for future investment in CHW advancement. CHWs and similar lay health workers have a long history in public health by providing and con- necting people to health services, enhancing health care experiences and addressing broad social and economic conditions of individuals and communities (Rosenthal 2009). In the United States, the use of CHWs has re- emerged throughout different periods of history, typically as responses to issues of social inequity (Pérez and Martinez 2008). In the past decade, CHWs have gained recognition and visibility in the U.S., increasingly moving from short- term, grant- funded efforts to more sustained, reimbursable health activities related to provisions in the Affordable Care Act both emphasising cost- cutting and effective patient management (Shah et al. 2014). While CHWs have demonstrated effec- tiveness in multiple areas of care such as specific improvements in managing chronic diseases and improving child birth outcomes, part of their strengths come in the ability to improve general health among groups that are not easily reached through traditional health care structures, including low- income groups (Gibbons and Tyus 2007, U.S. Department of Health and Human Services 2007). CHWs present a low- cost effort to improve population health, minimise health disparities and reduce health care spending by better engaging clients in appropriate care and improving quality of care among low- status groups, especially those with multiple, high- cost health care needs (Fedder et al. 2003, Gurley- Calvez and Williams 2020, Johnson et al. 2012). CHW programmes are effective in promoting health among low income, marginalised populations who frequently lack the resources, skills and experiences to engage and communicate with health care providers (Rosenthal et al. 2011, Viswanathan et al. 2009). CHWs are frequently tasked with assisting clients in becoming independent users of health care through improving their repertoire of cultural skills, self- efficacy and health be- haviour. CHWs also aim to reduce inappropriate care (e.g. emergency department use), reduce social disadvantages (e.g. linking to social services) and increase client independence by serving as conduits to health care services. While CHWs have the potential to fill health gaps, particularly where access to health care is strat- ified by inequities, they remain a limited option in the current U.S. system. Community health work- ers’ ability to enact population health goals and to be effective in their job is limited by their capacity to do so at both institutional and individual levels. Indeed, CHWs and stakeholders are frequently in disagreement, ranging from the appropriate name for these workers (e.g. promatoras, front- line workers, lay health advisors), to the necessary competencies, and the subsequent scope of practice. CHW programmes are frequently under- resourced and CHWs have relatively little formal educational | 301USE OF CAPITAL BY COMMUNITY HEALTH WORKERS training (Scott et al. 2018). Rather, they must rely on a wide repertoire of informal skills and available resources to meet client needs. Building on concepts of cultural and social capital, we demonstrate how CHWs’ practices of exchanging cultural and social capital in the health care field are related to their effectiveness. Specifically, we focus on the relationship between individual resource- based forms of capital by utilis- ing Bourdieu’s (1986, 1998) constructs of fields and habitus. We identify how individuals access col- lective resources across complex social contexts in which social capital is embedded as both bonding and bridging capital (Carpiano 2006, Putnam 2000). We delineate how day- to- day actions to promote population health are linked to the norms, traditions, institutions and objective structures of their set- tings. Importantly, we show discrete examples of how the field of practice restricts the exchange of capital, thereby reproducing inequalities within the practice of health care. The interactions between CHWs and their clients take place within a broad field of practice, that is defined by the institutions and structures where actions and exchanges occur (Bourdieu 1986). In the case of CHWs, the field is particularly important because it exists both within and at odds against the dominant, traditional health care field. By overtly addressing social determinants of health (SDoH), the CHW field includes several contexts including neighbourhoods, social services and community organisations, in addition to health care institutions such as hospitals or care clinics. According to Bourdieu (1986), three forms of capital, economic, cultural and social are individual resources used to situate one’s position in the field. The exchange of capital, through which an indi- vidual’s power to enact change or to improve their relative position, presents opportunities to improve client and population health. The value and exchange of capital are structured by the field. In general, CHWs frequently lack both the economic capital (e.g. high wages) or institutionalised cultural capital (e.g. credentials or expected roles) found in other health care professions. Social capital serves as an attainable resource for CHWs to use in order to overcome these capital deficiencies (Adams 2020). Individual- level social capital includes the resources embedded within social relationships and networks where the access, use and benefits reside in actors, or in this case the CHWs (Bourdieu 1986, Lin 2002). Individual social capital can be as accessed through either bonding or bridging social capi- tal. Bonding capital refers to the shared resources between people in the same social position (Putnam 2000). Bonding capital includes the horizontal ties between members of a shared network (Harpham et al. 2002). Bonding capital has the potential to increase the quality and quantity of social support be- tween CHWs and clients and has the potential to benefit both CHWs and clients through the creation and maintenance of trusting and cooperative relationships (Chiu and West 2007). Bridging capital refers to the shared resources between heterogeneous populations (Putnam 2000). Bridging capital influences health by improving access to health information (Lin 2002), developing social networks (Granovetter 1973), as well as strengthening institutional connections to coordinate collective actions (Shiell et al. 2020). Bridging social capital increases health by offering the connec- tions and resources that ‘explicitly cut across socioeconomic and power differentials’ (Villalonga- Olives and Kawachi 2015: 48). Part of the aim of accumulating bridging capital is to vertically integrate populations to collapse social and economic inequalities (Szreter and Woolcock 2004). By building and utilising bridging capital, CHWS may reduce inherent differentials found in the institu- tions that deliver health care (Brownstein et al. 1992). We explored CHWs’ perceived ability to successfully improve population health. Through analysis of interview data, social capital emerged as a key construct central to the work and an ongoing oc- cupational tension for CHWs. Following, we describe findings pertaining to the exchange of cultural capital between CHWs in the health care field by focusing on bonding capital, bridging capital and the transitions between each. 302 | SAINT ONGE ANd BROOKS METHODS Study context Respondents were recruited from community health workers, CHW supervisors and the leadership of one community health worker programme, all who were employed in a large community health clinic. The organisation operates a well- established community health worker programme and serves as a