Nutrition and Health Sciences, Department of


Document Type


Date of this Version



Qualitative Health Research 30:3 (2020), pp. 423–436.

doi: 10.1177/1049732319855963


Copyright © 2019 Angela L. Palmer-Wackerly, Virginia Chaidez, Caitlyn Wayment, Jonathan Baker, Anthony Adams, and Lorey A. Wheeler. Published by SAGE. Used by permission.


Community Health Workers (CHWs) are often incorporated into efforts to reduce health disparities for vulnerable populations. However, their voices are rarely the focus of research when considering how to increase their job effectiveness and sustainability. The current study addresses this gap by privileging the voices of 28 CHWs who work with Latinx communities in Nebraska through in-depth, semi-structured interviews. Using a multilevel, Culture-Centered Approach (CCA) to Health Communication, we identified two key structural communication issues: (a) increasing language accommodation and (b) increasing (and stabilizing) network integration across three ecological levels of health behavior (individual, microsystem, and exosystem). This study shows the uniquely valuable perspective that CHWs have as they navigate hierarchical health care structures and community cultures to meet the needs of their Latinx clients. Findings suggest that CHWs should be included in health care organization and policy discussions to reduce health disparities for Latinx populations.