The transformative journey of community health workers in implementing a lifestyle intervention in Brazil: A qualitative study

Introduction: Community health workers (CHWs) stand as critical frontline agents within the Brazilian healthcare system. In this qualitative study, we examined the impact of a community-based behavioral change intervention spearheaded by CHWs. Methods: The intervention focused on promoting healthy behaviors - physical activity, nutrition, and emotional well-being - among individuals aged 50 and older living in a rural community in Brazil. The intervention was designed, implemented, and evaluated in close collaboration with CHWs and local administrators. The implementation of the intervention unfolded in two waves, each lasting 12 months. Interviews with CHWs, health administrators, and intervention participants conducted at post-intervention and 6-year follow-up centered on CHWs as delivery agents and examined the implementation of the intervention in primary care contexts around adoption, implementation, and long-term maintenance. Results: Inductive analysis revealed four themes that highlight CHWs' motivation to take active roles in health promotion and overcoming challenges such as unfamiliarity with new roles or limited training. In addition, enhanced community bonds, job satisfaction, and trust in CHWs gained through the intervention, empowered CHWs to realize their potential and importance. Another important area relates to the CHWs' ability to leverage their deep community ties and cultural insights to enhance the intervention's significance. CHWs' participation in the program also led to personal benefits and self-care practices, setting an example for the community they serve. Conclusions: This study underscores the positive impact of a community-based intervention led by CHWs. Such programs have the potential for nationwide dissemination, leveraging the CHWs' widespread presence and deep community integration.