Bridging work: Community health workers’ role as a continuum of building, guiding, sustaining and transforming the path to health equity

Community Health Workers (CHW) are commonly conceptualized as a ‘bridge’ that connects the community to health-related systems and resources for which they have historically and contemporarily experienced systemic barriers to accessing. Nonetheless, the nuances of the bridge role remain underexamined. The bridge metaphor, by the static nature of a bridge, can overlook the dynamic and relational aspects of CHWs’ work beyond simple liaison functions. This qualitative study shows CHWs’ work goes beyond liaison roles, expanding on the bridge metaphor. We evaluated narratives from CHWs from Orange County, California and across California (n=77), as well as Orange County institutional representatives and policy makers (n=15) regarding CHWs roles as bridges through interviews and focus groups conducted between February 2023 - January 2024. Interviews and focus group discussions were recorded, transcribed, and analyzed following a flexible coding approach. Participants provided nuanced details to expand on the CHW role as bridges, well beyond liaising or connecting. Their narratives illuminate the full arc of CHW bridging work, highlighted in three themes: 1) Building: involving working with the community to identify the need for a bridge and building responsive and adaptable bridges accessible to the community, 2) Guiding: encompasses accompanying and guiding the community to access and cross these bridges, and 3) Sustaining and transforming: comprising maintaining a responsive and accessible bridge while working to reduce the structural gaps necessitating such bridges. Such an understanding of CHW roles can provide insights into the efforts needed to sustain this workforce, critical to public health and community wellbeing.