Agents of change: the role of health and nutrition female field technicians in transforming rural extension in the western highlands of Guatemala

Introduction This study explores the leadership roles and knowledge transfer strategies of female health and nutrition field technicians in Guatemala’s Western Highlands, a region marked by high rates of poverty and chronic malnutrition. Grounded in transformational leadership theory, the study investigates how these women act as agents of change in rural extension services and aims to understand their leadership styles, motivations, and the impact of their personal experiences on their work. Female technicians were selected due to their unique position at the intersection of technical expertise and community engagement, particularly in female-led households where gender-sensitive approaches are critical. Methods A qualitative instrumental case study design was employed for this research, utilizing semi-structured interviews, role-playing, participant observation, and visual methods. Data were collected in the Los Cuchumatanes region of Guatemala from 12 female health and nutrition extension workers, purposefully selected based on their experience and roles within rural communities. A constructivist paradigm guided the interpretation of the participants’ motivations, leadership, and experiences. Data analysis followed a systematic qualitative approach, including open and pattern coding. Results Extension workers identified three key leadership approaches: Transformational Growth, Servant Leadership, and Relationship-Oriented. Technicians also highlighted their roles as change agents and mentors, facilitating behavior change and offering indirect support in underserved areas. Effective knowledge transfer methods included home visits, experiential learning, visual aids, and community involvement. Extension workers expressed cautious optimism for the future, emphasizing the need for continued development, professional recognition, and inclusion. Discussion This study underscores the importance of values-based leadership, gender-sensitive approaches, and participatory methods in promoting sustainable community development and enhancing the impact of extension services. It also highlights the emotional labor and resilience of female technicians, whose leadership is grounded in lived experience and relational engagement.