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Features and Impact of Trust-Based Relationships Between Community Health Workers and Low-Resource Perinatal Women with Chronic Health Conditions



Community health worker (CHW) programs are a promising strategy to improve maternal and child health outcomes, particularly among low-resource women. Yet, little is known about which aspects of CHW-client relationships are most salient for promoting positive change. This paper examines features of the CHW-client relationship that perinatal women with chronic conditions reported as being beneficial for their experience of prenatal care and pregnancy.


Focus groups and interviews were conducted with 18 CHWs and 39 clients from three Merck for Mothers-funded programs in the Eastern United States. Data were analyzed using a grounded theory-informed thematic approach.


CHWs built trust-based relationships through emotional attendance, authenticity, and prioritization of clients’ needs. They provided instrumental, informational, and emotional support that clients reported facilitated greater engagement with the healthcare system, improved health behaviors, and reduced stress. CHWs and clients alike viewed their relationships as having long-lasting impacts, made possible by the trust-based bond between them.


Strong, trusting relationships with CHWs may be one avenue through which to improve maternal and infant health for vulnerable perinatal women. Community health care programs should promote trust-building as an explicit program goal. Trust-based CHW-client relationships may serve as an exemplar for transforming traditional care relationships between providers and clients, leading to greater client engagement in care and improved health.

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De-identified data are available upon request.

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Not applicable.


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This research was supported by funding from Merck through its Merck for Mothers program, known as MSD for Mothers outside the United States and Canada. It was also supported by funding from the National Institute of Mental Health of the National Institutes of Health (T32MH020031-18). The content is solely the responsibility of the authors and does not represent the official views of Merck or the National Institutes of Health.

Author information




LB, JBL, and SDC conceptualized the study. JT and RM assisted with data collection. LB and RM conducted the data analyses. Findings were reviewed and interpreted by all the authors. All authors contributed to the writing and have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Shayna D. Cunningham.

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The authors declare that they have no conflict of interest.

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The study was deemed exempt under 45 CFR 46.101(b)(2) by the Yale School of Medicine Institutional Review Board.

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Verbal informed consent was obtained from all participants prior to their participation.

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Boyd, L.M., Mehra, R., Thomas, J. et al. Features and Impact of Trust-Based Relationships Between Community Health Workers and Low-Resource Perinatal Women with Chronic Health Conditions. Matern Child Health J 25, 1866–1874 (2021).

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  • Community health workers
  • Pregnant and postpartum women
  • Maternal health
  • Trust-based relationships
  • Chronic health conditions