Boundary spanning practices of community connectors for engaging 'hardly reached' people in health services. (July 2019)

• Record Type: Journal Article
• Authors: Wallace, Carolyn; Farmer, Jane; McCosker, Anthony
• Is Part Of: Social science & medicine. Volume 232(2019)
• Page Start: 366
• Page End: 373
• Publication Date: 2019-07
• Subjects: Australia -- Health inequalities -- Health services -- Boundary work -- Boundary spanning -- Community connector -- Access -- Case study; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2019.05.034
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Global health policies direct health services to improve access and health outcomes of people who are 'hardly reached' by services. The institutionalised nature of health services with associated professional and organisational boundaries create ongoing challenges to achieving this policy aim. We present an approach to this challenge by exploring how health services can tap into the existing boundary spanning activities of community members we term as 'community connectors' who undertake valuable boundary work within the community to include people who are hardly reached. We address the research questions: what are the behaviours and characteristics of community connectors?; to what extent are they motivated to help out with health?; and how can health service personnel identify community connectors? We conducted an instrumental case study during 2017 in Victoria, Australia in the catchment area of a rural health service. Interviews with 17 key informants and eight staff members led to a further 15 interviews with community connectors. We identified the three key roles of 'noticer and responder', 'connector' and 'provider' that make connectors a valuable asset for health services. Community connectors seek opportunities to negotiate new boundaries with health services that support their boundary spanning with people hardly reached and also enable health services to transgress their own boundaries and access people who are hardly reached. We conclude that by paying attention to their own production, maintenance and transgression of boundaries, health services can apply this approach, noting that the local and iterative nature of identifying community connectors means that each cohort of community connectors will be unique as determined by local boundaries and relationships. Highlights: Community-connectors span socio-cultural boundaries in the community. Their boundary spanning engages people hardly reached by health services. Community connectors are a willing resource aligned with health services. We outline how health services can identify and work with community connectors.