Women community health workers: A case study of feminine identities and health education in a northern Mexican city.

The objective of this research is to explore the construction of feminine identities in women's activism as community health workers (CHWs). It draws on ethnomethodological approaches, which emphasize the social production of reality through individuals' interpretive practices, and on theories of the social construction of gender identities. The research was conducted using a case study design and ethnographic methods. Participant observation and open-ended interviews with women CHWs and staff members of a non-governmental organization (NGO) in northern Mexico were conducted. Additionally, archival data on CHW programs implemented by the Mexican government from 1970 to 1994 were collected. The analysis focuses on women CHWs' narratives as interpretive practices in which feminine identities and community health work are constituted. Based on the results of this study, the category of CHW as constructed by public health institutions, the development discourse, the Mexican government health programs, and the local NGO is linked to the already existing socially defined work of women as mothers and natural caregivers with the health care system. Yet, the women CHWs interviewed construct a somewhat different self-identity through their narratives of becoming CHWs, their work as CHWs, and the changes brought about by their participation as CHWs. They make sense of themselves and their activism by relying on the resources locally available to them. These resources include the NGO and its interpretative frame, the social categories of woman and mother, the women's particular biographies, their roles in the formal and informal economy, the home, family life, and the organizations they work with such as the Catholic church, political parties, and government health agencies. This case study suggests that particular feminine identities are constructed through women's activism as CHWs and in health education programs in general. Based on the findings of this research, health educators are encouraged to incorporate qualitative research methods, particularly narratives, and reflexivity in the design, implementation, and evaluation of health education programs.Ph.D.Health and Environmental SciencesLatin American historyPublic healthSocial SciencesWomen's studiesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/130804/2/9811165.pd