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

Christina Getrich, Shirley Heying, Cathleen Willging and Howard Waitzkin

Social Science & Medicine, 2007, vol. 65, issue 2, 319-330

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.

Keywords: USA; Promotoras; Ethnographic; methods; Community-based; intervention; Primary; care; Health; disparities; Mental; health (search for similar items in EconPapers)
Date: 2007
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