Table 3 Cluster Narrative Examples

Cluster 1: High emotional, minimal tangible & informational

The participant had diabetes. She describes herself as a very active woman who wanted to be self-sufficient. She said that her only fear is having to depend on someone else. She was careful to follow a routine to keep her diabetes under control. She expressed interest in a diabetes class but was reluctant due to her schedule. Over the course of the six months, her routine was disrupted when her son’s family moved in temporarily due to housing issues and the CHW talked with her extensively about how to manage this situation. The participant expressed strong appreciation for the relationship she had developed with the CHW.

The participant was experiencing a recurrence in cancer at age 37 and was in treatment and suffering from the effects of radiation. The CHW talked with the participant about her concern for her 15-year-old son. The CHW provided emotional support and emphasized the client’s personal qualities, describing her strength in facing the cancer and the treatment and her ability to maintain her emotional stability while suffering the effects of treatment.

Cluster 2: High emotional, low appraisal & informational

The major issue facing this participant was the process for applying for citizenship because it required that she take the exam in English. In the first visit, the participant explained that her doctor ignored her request to provide the paperwork that would allow her take the test in Spanish. Over the course of the six months, the CHW provided ongoing emotional support, encouraging her to submit her paperwork. The anti-immigrant sentiment in the news caused the participant further anxiety and the CHW encouraged her to not allow herself to be paralyzed by fear and to have confidence in herself. The participant was providing childcare for her son, but she also wanted to find a job, and the CHW provided resources on different types of work and agencies that could help. The participant stated that she appreciated the CHW support and felt that the CHW understood her.

This participant described many issues in the initial visit. Her husband had renal insufficiency and she had to take him to various doctor’s appointments. He was verbally abusive and she wanted to learn ways to deal with him. Her son was in jail in Mexico and she was worried about his welfare. She had become more isolated after her daughter left town and the CHW offered a variety of different health programs, but the participant felt too busy. The CHW offered her behavioral health resources, but the participant didn’t feel it was a priority. The CHW also provided resources for employment and financial assistance.

Cluster 3: High informational, low emotional & appraisal

The participant was very busy; she was taking care of an ailing parent and worked, making it hard to follow up with her at times. In the midst of those challenges, she did use referrals to medical assistance, hospice care and legal assistance. She showed interest in the diabetes and Tai Chi workshops but ultimately never had time. She mentioned she felt like she ran around most of the day. She said she appreciated the emotional and information support she received from the CHW.

At the first visit, the participant expressed emotional need, but from then on seemed very busy with her job and unable to take advantage of the services the CHW offered. The participant was looking for a job, dealing with health issues and busy with family. It seemed the participant really wanted to learn English, engage in yoga, and complete her GED, but just could not make time to do it. The CHW kept providing resources or alternative ways of getting resources (i.e. yoga via YouTube) should she decide to move forward.

Cluster 4: Balanced emotional, appraisal & informational

The participant was interested in accessing resources and took advantage of CHW referrals to health promotion and computer classes. He was also seeking to reenter the workforce and expressed some anxiety about this. He met a woman who worked in the Mexican consulate in one of the classes who helped him develop a project he had been incubating. He expressed appreciation for the emotional support that the CHW provided over the six months.

The participant had recently separated from his wife and found that he could open up to the CHW and talk about his concern that he might be feeling depressed. The CHW provided referrals for behavioral health and other resources. He engaged with the CHW at the clinic and started taking diabetes education classes, which led to behavior change and desired weight loss. The participant expressed how difficult it was for him to take about his emotions and that he was discouraged when his behavioral health counselor was changed on him.