Summary
This research has the general objective of analyzing the communication dynamics present in the work of community agents, taking as a reference the case of San Mateo de Huanchor during the period 2019-2021. The development of the field of community health is vital to ensure the general welfare of the diverse populations in the country, since in an intercultural country like Peru, health processes must be understood from their own context and characteristics.
From a qualitative approach, emphasis was placed on the experiences and perceptions of community agents. We worked with a sample of two out of a total of twelve community agents active during the period 2019-2021 in San Mateo de Huanchor, and used the semi-structured interview guide as an instrument to collect information. Thus, this study concluded that the communication dynamics are characterized by the relationship based on trust and empathy generated between agents and neighbors, taking into account that the context in which they are inserted is marked by verticality and institutionality.
Key words: Public Health, Community Health, Community Health Agents, Community Participation, COVID-19.
Introduction
How to bring health services to all the different areas in a country so centralized and with such a saturated health sector? It is through the approaches of Health Promotion and Community Health that strategies and actions are deployed so that health care services reach the most remote communities. In this scenario, the work of Community Health Agents, in the rest of the text they will be referred to as CHWs, has meant a fundamental contribution to the promotion of preventive health practices in the communities where they are located.
CHWs are defined as the link between the community and health facilities. However, their work addresses many more aspects. They are representatives of their community, have an articulating role with diverse social actors and promote agency and participation within their community on health issues. Understanding how their work has developed from a communicational perspective is fundamental to gain a deeper understanding of the processes and actors involved in the field of community health.
Therefore, this research starts from the question: How are the communicational dynamics developed in the work of community agents: San Mateo de Huanchor case during the period 2019-2021, to explore the world of the agents from the communicational practices that are executed in the spaces they share and relationships they form with neighbors and institutional actors, understanding these as health personnel, municipal staff and representatives of the mining company. In this sense, first a description and justification of the topic will be provided, then the methodological design implemented will be presented, pointing out the key informants, techniques and tools for information analysis. Next, the theoretical framework of the research will be presented, together with the main concepts and authors taken into account. Next, the results obtained after the application of the tools will be shown and finally, the analysis and final conclusions will be presented.
1. Presentation and justification of the topic
Community health in Peru is fundamental to be able to reach and care for the population in the most remote areas. Most of its health services are still centralized. An example of this is that Lima concentrates the largest number of specialist physicians, in addition to having 25% of the second and third level hospitals at the national level (Altamirano, 2022). Although this concentration may be due to the number of people living in the capital, this distribution still ends up affecting the availability and quality of services in the other regions of the country, since Lima becomes the main scenario. Thus, strategies through community health become essential, and at the center of these dynamics is an articulating actor: the community agent.
The figure of the community agent has been present in the field of community health since before it was officialized and named as such, since it was not until 1995 that his work was made official (Diris Lima Norte, n.d.). An anonymous but hard-working actor, the community agent is motivated by the desire to help his community and his peers by providing them with information and seeking to empower them to prevent disease, promote healthy habits and care for their general wellbeing. In this way, the community agent becomes an active citizen within his or her social space and becomes a key player in the empowerment and participation of his or her community in health issues.
The interest in approaching this topic is, first of all, due to the lack of information in the Peruvian academy on ACS from a communicational perspective. Although several articles and reports can be found on the projects in which they participate as users or beneficiaries, there are few studies that delve into the universe of CHWs and try to understand it in its complexity and relationship with others. Secondly, because COVID-19 marked a before and after in the field of public health and society in general, so it is the duty of communications to analyze this phenomenon together with what it meant, impacted and transformed. Within this scenario, the work of the ACS was key to raising awareness on issues of care and disease prevention within their communities (Minsa, 2022).
Following this line, it is necessary to mention that the pandemic caused by COVID-19 has represented a historic moment at a global level, and has brought changes in the social, political, economic and cultural spheres. In Peru, the pandemic has had as a consequence several setbacks in key sectors for our development. For this reason, it is necessary to explore and understand how these processes have occurred and what impact they will have in a post-pandemic national scenario.
Public health is a vulnerable sector that was directly affected during the pandemic, exposing major structural problems in the institutions in charge. It is essential to study the communication dynamics of both government institutions and actors within the national health system in order to understand the successes, failures, challenges and opportunities that exist to date. In this sense, analyzing the work of key actors in health dynamics at the micro level, such as community agents, is an indispensable task, since they represent one of the main links between communities and public health systems. This becomes even more relevant if we take into account that one of the main reasons why the Peruvian State has not been able to implement policies tailored to the context of CHWs is because there is still a great lack of knowledge about their needs, environments and actions. The ACS continue to be anonymous actors within the dynamics of public health in the country and it is essential to give them a name and a history. Therefore, the need to produce research on these actors from various disciplines, not only medical, is an urgent task within the academic field.
From the perspective of Communication for Development, studying the field of public health will always be important because it is directly linked to the welfare and development of people. In addition, the topic becomes more important when we deal with populations in conditions of vulnerability and limited access to quality health systems, such as those located in semi-rural districts such as San Mateo de Huanchor.
Finally, taking into account that communication in the field of health has predominantly had an instrumentalist and diffusionist perception, studies from relational and participatory approaches are now essential to enrich the research between these two fields. Thus, the aim is to overcome the communication approach that works with products, by a communication that develops processes and relationships (Roeder, 2005), and with this objective in mind, it is possible to position the HCWs as protagonists in the community health dynamics, since they are the link between their community and the health facilities, in addition to interacting with other external actors in their daily work.
The institutionalization of the community health worker
Community health workers are characterized mainly by their work with communities in an articulated manner. Thus, according to David Sanders, community agents are agents of change, since they have a social participation in their communities, by mobilizing community resources, attending social events, consulting religious leaders, acting as advocates on various issues in their community and building intersectoral and collaborative action teams (Sanders, et al., 2012). Thus, the relational component present in their work is also fundamental to understanding their actions.
Likewise, in order to understand the agents’ ways of working, the theory proposed from the field of medicine by Jonathan Mann, which refers to the Vulnerability Model, is used. This proposes that community agents can be understood from three axes: firstly, the programmatic or institutional axis, which understands those political issues that affect the work of the agents, secondly, the social axis, which involves the issues of their daily work, and finally the individual axis, which are the situations that produce suffering in these actors (Mann in Schubert & Neves, 2011). In this way, emphasis is placed on their networks, experiences of participation in groups, associations, and in their community life.
In the Peruvian context, Community Health Agents (CHAs) are defined by the Ministry of Health (MINSA) as:
Leaders chosen and/or recognized by their community who carry out voluntary actions for health promotion and disease prevention, in coordination with health personnel and other local institutions, exercising the representativeness of their community through citizen participation, thus fulfilling the articulating role between the community and authorities (MINSA, 2014, p.6).
Thus, the ACSs represent a fundamental part of the public health strategy by being a transforming actor that brings health issues closer to the community of which they are a part.
Although the figure of the Community Health Agent has been present in the country for several decades, it was not until 1995 that their work was made official, and in 1999, June 4 was declared the National Day of the Community Health Agent (Diris Lima Norte, n.d.) in order to give more importance to their work. It was during these years that the institutionalization of CHWs began to take place gradually, intensifying during the last decade.
In 2018, Law No. 30825 was enacted under the title “Law that strengthens the work of community health agents” (Defensoría del Pueblo, 2018). This meant a breakthrough to indicate the functions to be fulfilled by MINSA to support the agents. However, to date, the regulations of this law have not been published, in addition to not including the intercultural approach, which is extremely relevant when dealing with public health issues in rural or semi-rural communities.
The Ministry of Health and its affiliated bodies have created various consultation and orientation materials over the last few years aimed at the agents themselves with the objective of strengthening their work and knowledge on how to deal with various situations and diseases. Although the focus has always been on the most common diseases in rural and vulnerable areas such as tuberculosis, anemia, malnutrition, etc. (which occur mainly due to the lack of basic services and sanitation problems in housing), initiatives such as those proposed by the National Institute of Neoplastic Diseases and its “Manual: health promotion and cancer prevention aimed at community agents” (2019) account for the need to continue producing material linked to other types of diseases and health scenarios.
Health Communication as a field of study
In its beginnings, Health Communication studies were predominantly of a diffusionist and informative nature. The emphasis was placed on the conditions and strategies that maximize the impact of the transmission of information and promote new knowledge, attitudes and practices. Thus, for several years it was reduced to the instrumental field, being identified as a basically technical, normative task, distant from reflection and analysis (Alfaro in Roeder, 2005). This limited the exploration of processes, relationships and actors in different areas involving health issues.
However, this reality was changing as a result of the questioning of authors such as Thomas Tufte (2007), who argued the need to investigate how the actors interact and give meaning to problems related to health, disease and wellbeing. Thus, the importance of including community and cultural contexts as part of the analysis and not as separate determinants began to be promoted. In addition, a new emphasis on the participatory and self-determining capacity of communities to serve as active agents in their health decisions became necessary. In this sense, studies on actors such as community agents bring up new and necessary debates within the dynamics of community health.
Today, it is understood that Health Communication aims to involve different population groups with whom to exchange information related to their health. It is also a field in which ideas and methods can be identified to influence, engage, empower and support individuals, communities, health professionals, patients, political decision makers, organizations and the general public to introduce or adopt practices, behaviors or policies that improve health outcomes at the individual, community and public levels (Schiavo in Navarro, 2019). The look on the field of Health Communication has been transformed to include in a more comprehensive way various aspects that seek to improve behaviors and collective action around health.
In Peru, Health Communication has been an actor in the social development agenda for approximately thirty years. It was born after the cholera epidemic, during the summer of 1991, and completely changed the perspective on public health. As a result of this event, the importance of social communication to preserve people’s lives began to be recognized, in addition to highlighting that the possibilities of facing a health emergency are greater when people are already informed, that it is possible to achieve spaces for participation and that it is necessary to promote transparency in political decisions when situations arise that compromise the lives of millions of people (Roeder, 2005). COVID-19 poses new challenges for the field of Health Communication, so it is essential to continue studying the new scenarios, actors and dynamics that have arisen in this historical context.
Communication skills in health professionals
According to the Scale on Communication Skills in Health Professionals (EHC-PS), postulated in a study by Leal-Costa et al (2016), communication skills in health professionals can be defined as:
The set of verbal and nonverbal techniques and behaviors […. ] that make up the relational competence of health professionals through which they 79 express, in an interpersonal context (patient-centered) and in a specific situation, their needs, feelings, preferences, opinions, wishes and rights, providing a series of consequences in the relationship that affect the patient himself (improvement or healing of the clinical process, satisfaction with care, behavioral and emotional changes), the professionals (satisfaction or well-being in their work), the relationship between the two (reinforcement, trust, support, complaints or claims), and even the healthcare system (use of resources, effectiveness and quality of care) (Leal-Costa et al, 2016, p. 51 ).
This definition can be adapted to the work performed by ACSs, since although these “are not health professionals in an official manner, they fulfill similar functions and carry out tasks in the same way as technical/specialized personnel. Thus, six specific skills are proposed in the study” (Leal-Costa et al, 2016, p.51), which are outlined below (See Table 1):
Table 1 – Communication skills in health professionals.
| Informative communication | The ability to provide information while ensuring that patients understand it, as well as to obtain comprehensive information from patients. |
| Active listening | The physical and mental willingness of the health care professional to listen carefully to the totality of the patient’s message, through verbal or nonverbal communication. An attempt should be made to understand the correct meaning of the patient’s message, and to indicate what the professional believes he or she is understanding of the patient’s content. |
| Empathy | Disposition of the professional that allows him to immerse himself and observe the patient’s experiences from his internal frame of reference, that is, from his subjective world. This is achieved by capturing through the way in which the patient signifies his environment and how he communicates his feelings, ideas, etc. An empathic attitude is the person’s willingness to understand the other’s inner frame of reference. The behavioral way in which this component is shown is through active listening, 80 mentioned above, and in the empathic response. This is described as the ability to “communicate verbally and nonverbally what is understood through different ways of responding” (Leal-Costa, 2016, p.51). |
| Respect | Reception, acceptance and understanding of what the patient conveys in the interaction, without judgment. |
| Authenticity or congruence | Attitude that allows the health professional to show him/herself as him/herself in the relationship with the patient. It is the coherence between what the professional thinks internally and the way he/she communicates it through verbal and non-verbal language. |
| Assertiveness or socially skilled behavior | Set of behaviors of the professional in an interpersonal context that allow him/her to express his/her emotions, rights, opinions, attitudes, etc., in an appropriate manner, respecting others, and that allow him/her to solve immediate problems and minimize the probability of the appearance of others. |
Participatory Communication
According to Thomas Tufte and Paolo Mefalopulos, this approach is based on dialogue and allows the exchange of information, perceptions and opinions among the various actors. In addition, it includes the exploration and generation of new knowledge aimed at addressing situations that need to be improved. From the perspective of these authors, participatory communication is composed of the following principles: a free and open dialogue, awareness of power relations to give voice to those who do not have it, liberating pedagogy that seeks action-oriented awareness, and action-reflection-action that seeks an articulation between awareness and commitment to action (Tufte & Mefalopulos, 2009). These elements are present in the actions of community agents in general, which is why they are positioned as subjects inserted in the dynamics of participatory communication, while at the same time promoting them.
It is in this same line that Alfonso Gumucio defines the main components that characterize participatory communication, which are related to ¨the capacity to involve the human subjects of social change in the process of communicating¨ (Gumucio, 2001, p. 38). That is, actors belonging to a community, such as community agents, must be part of the process to promote well-being in an integral manner.
Similarly, the author mentions that ¨participatory approaches contribute to placing decision making in the hands of the community and consolidate their capacity to confront their ideas about development with technical staff and planners. It also contributes to instilling self-esteem and pride in the culture, reinforces the social fabric by strengthening the community’s own organizations and protects tradition and cultural values, while facilitating the integration of new elements” (Gumucio, 2001, p. 37). Thus, it can be understood that not only community agents are part of the dynamics of participatory communication, but that their work also promotes active participation in their own communities to finally turn neighbors into agents of their own change. To better understand the elements that characterize participatory communication processes, the following can be observed (see Table 2):
| Feature | Description |
| Horizontality | The community as a dynamic actor that actively participates in the process of social change, taking control of communication instruments and contents instead of being perceived as mere passive receivers of information and instructions. |
| Process | Process of dialogue and democratic participation in the planning of communication activities instead of vertical, expensive and unsustainable campaigns, which do not contribute to building a capacity to respond to social needs, from the community level. |
| Long term | Communication-and development in general-are conceived as long-term processes that require a certain amount of time for the community to take ownership of them. |
| Collective | Urban and rural communities act collectively in the interest of the majority, preventing power from being monopolized by a few. |
| Con | Research, design and disseminate messages with community participation rather than designing, testing, launching and evaluating messages that were conceived for the community but are alien to it. |
| Specific | The communication process tailored to each community in terms of content, language, culture and media. |
| People’s needs | Community dialogue and communication tools to help identify, define and discriminate felt and real needs. |
| Ownership | Communication processes “owned” by the people, to provide equal opportunities for the community. |
| Awareness | A process of awareness and deep understanding of the social reality, its problems and solutions rather than persuasion mechanisms that induce short-term behavioral changes. |
2. Methodological design
The general objective of this research is to analyze the communicational dynamics that construct the work of the ACS, while the first specific objective is to know the communicational strategies used by the community agents for the relationship with the neighbors, and the second specific objective is to explore the communicational relationships deployed in the training and socialization spaces between the community agents and institutional actors. Based on the above, this research has a qualitative approach, as it privileges the voice of the ACS and related actors to give an account of their experiences and perceptions. Qualitative approaches allow us to know the subjects personally and to experience what they feel in their daily struggles in society (Taylor & Bodgan, 1987 in Espinoza, 2020). Therefore, this methodological approach is relevant for the purpose of the study, since it seeks to emphasize the experiences and experiences of the agents, while reconstructing and examining the communication processes used. We are particularly interested in what they as protagonists have to say about the work they do. Although all ACSs receive standardized training and guidance, each one has the autonomy to develop their own communication and relationship strategies, so each experience is different.
On the other hand, the scope of the study is descriptive, since it seeks to understand the elements that make up the work of the ACSs and their interrelationships from a communication perspective. It is also worth mentioning that, although studies on Health Communication have been developed for several years in Peru, the work of CHWs has been analyzed almost exclusively from an evaluation approach and/or from a medical perspective.
The ACS represent the main informants, since they are the ones who have the central experiences, opinions and feelings to be analyzed. If we take into account that the general objective is to analyze the communicational dynamics that construct the work of the ACS and the specific objectives revolve around the spaces and interactions that are formed with neighbors and other actors, it is logical that the main input should come from the perceptions that the agents themselves have about their work with others.
The first criterion for selecting the agents to work with was the feasibility of contacting them. In this sense, after a first contact attempt, the telephone number of three of the twelve currently active in the district was obtained, so priority was given to approaching these three, two of whom were finally interviewed. Another selection criterion was the length of time they had been working as ACSs, since the interviewees had been working for at least two years, so that they could provide more solid and extensive information. This period of time was selected, taking into account that from the first day the ACS is communicating with the neighbors, so two years was considered sufficient to have an established and identifiable dynamic for the researcher.
The semi-structured interview was chosen as the technique for collecting information, since through it it is possible to collect the experiences and opinions of the ACS in a spontaneous and natural way, but also in an orderly manner, since it allows the interviewer to have an established guide of questions that can be classified as he/she considers pertinent. In this sense, the semi-structured interview is capable of adapting to the diverse personalities of each subject, through which one works with the interviewee’s words and ways of feeling, and tries to make the subject speak, to understand him/her from the inside (Tonon, 2009). Therefore, it was considered the most appropriate technique to adjust to the responses of the agents interviewed at the time, while at the same time giving a general order to the questions.
In relation to the ethical criteria for the collection of information, a protocol was established for contacting the potential interviewees, who were called by telephone and informed about the research, its objective and the uses of the information they would provide. They were then asked if they wished to participate and if they answered affirmatively, they were recorded and gave their consent. Once this process was completed, the interview began and the call was recorded so that it could be saved as an input. It is important to note that the informants were also asked for their authorization for their answers to be recorded and were previously told that they could refuse to answer any question and/or could ask to stop the interview at any time if they did not feel comfortable.
3. Contextual framework
San Mateo de Huanchor
Huarochirí is divided into 32 districts (see Figure 1) and has 69 health facilities, grouped under the administration of the Huarochirí Health Network.
Picture 1- Map of Huarochirí
With the exception of the San Juan de Matucana Hospital, all facilities are categorized within the first level of care, which means that they are mainly dedicated to health promotion, risk prevention and disease damage control activities (MINSA, 2015). These are materialized in health posts and health centers, which have a basic technical staff.
According to the former head of the Health Promotion area of the Huarochirí Health Network, ¨in San Mateo de Huanchor there are 4 health posts and 12 community agents are active, all of them women¨ (Informant A, 2022). It is also one of the few districts in the province that has a functional Community Policing Promotion Center (CPVC), where workshops, training and events on health issues and other topics of interest to the population are held.
The community agents of San Mateo receive support through training, incentives, benefits, etc. from different entities such as the San Mateo Health Center, the Huarochirí Health Network, the Municipality of the same district and the Los Quenuales mining company, which has played a fundamental role in encouraging the work of the agents in the area during the last decade.
In the context of the pandemic, ensuring that community health workers could carry out face-to-face activities was a challenge. On the one hand, the Health Network had difficulties in coordinating with the Regional Health Directorate of Lima Provinces (DIRESA) and ensuring the delivery of protective equipment so that agents could carry out their home visits. This was one of the main reasons why their work was limited to the virtual environment during 2020, as they could not expose the agents to contagion. Nevertheless, the agents did not stop their work during that year, and in districts such as San Mateo de Huanchor, which has one of the highest rates of active community agents, they continued to carry out promotion and prevention activities on COVID-19 and other diseases that attack the population in the area.
4. Findings
In order to present the findings, the information will be organized according to the research objectives. In that sense, in relation to the first specific objective, which is to know the communicational strategies used by community agents for the relationship with neighbors, this is defined as “the set of techniques and verbal and nonverbal behaviors […] that make up the relational competence of health professionals” (Leal-Costa et al, 2016, p.51). For this objective, we sought to understand the interactions and strategies that the community agent deploys to relate to neighbors. In this sense, three key moments were identified in the process of relating with them, which will be discussed below.
The first is the structure of visits, in which the agents remind people that they will be making home visits that day so that they are attentive and available to receive them. New people are given an initial introductory speech, with the objective of making them aware of the role of the community agent and the importance of constant participation with the agent. At the end of the visits (whether to new neighbors or not), they are made to sign the visit log to confirm that they have indeed received the training as required.
When I have to go out, I schedule myself and tell the people I am going to visit. I cook early, grab my folder and go from house to house, I look for those who have appointments to visit, sometimes people hide, there are some who do not receive you. I stop all day until 2 o’clock and tell my son to eat, then I go out again, sometimes I stay until night, until I finish, because I have to deliver the report, notebook, folder and material that we use. Each agent has to invite at least 8 people, and they have to sign that you have gone to visit them (Informant A, 2022).
The second moment is the ways of working, which vary depending on the type of population with which we are interacting. For example, according to informant A: “with the elderly you have to be more patient and kind than usual”. Similarly, the interviewees pointed out that the goal is to have an impact on the user, as one describes: “About the anemia disease, we tell the mothers that it is not so important the quantity but the quality of the food, and they are surprised”.
The third moment is the resources and materials that the agents use during their training sessions. Among the most common are the posters provided by the Health Center itself. However, there are also drawings or slips of paper that the agents themselves prepare in advance to share. One of the most efficient resources and one that has the greatest impact on the neighbors are the live food preparation demonstrations, especially for mothers. This method captures the attention of the neighbors and even strengthens their participation, since they have to do the demonstrations themselves to confirm what they have learned.
I use flip charts, posters, drawings, I put up the food circle and we explain it to the people The Health Center gives us material, and the mining company also supports us, sometimes hiring a nutritionist to give us talks. We also meet at the Community Surveillance Center, where we summon the mothers and the agents prepare the food in front of them, so the pregnant women can watch (Informant A, 2022).
For the elderly, they give us posters of the Health Center and we show them, mostly with dialogue, treating them well, we have to be skillful to be able to talk and be understood, respect and solidarity have an influence. In my area they are calm (Informant B, 2022).
In relation to the second specific objective, which is to explore the communicational relationships deployed in the training and socialization spaces between community agents and institutional actors, it must be taken into account that it is based on the definition of community participation. This is understood as the “decision making that is placed in the hands of the community, which reinforces the social fabric through the strengthening of the community’s own organizations” (Gumucio, 2001, p. 37). In this sense, we sought to know the dynamics of communication present in the spaces of interaction with institutional actors and if indeed this interaction represented a dynamic of community participation. The following are the most relevant findings according to the type of actor with whom the community agents interact (see Table 3):
Table 3 – ACS interaction with other institutional actors.
| With the health center | Trainings are given on an ongoing basis, depending on the topics that need to be reinforced. This year there will be trainings on first aid and vaccination. They last between 3 – 4 hours and do not usually start on time. |
| With Los Quenuales mining company | They organize campaigns, donate medicines and offer training, they give bigger incentives, they have been working for years in San Mateo. |
| With the Municipality of San Mateo de Huanchor | It has minimal and inconsistent participation with community agents, articulates with these mainly for special dates. Supports with materials for demonstrationsGives training for the entire community in general, and asks for support from the ACS when there are festivities. |
5. Analysis
The analysis of the results has also been divided according to the research objectives. In that sense, in relation to the first objective, it is important to rescue the concept of Leal-Costa (2016) who understands communicational strategies as techniques and behaviors that make up the competencies of health professionals. Within the subcategory that the author presents as informative communication, he points out that this shows the capacity that the actor has to provide information, ensuring its understanding.
In the case of the interviewees, they mentioned that the information they provide to the neighbors in their talks is not chosen by them, since the topics are decided by the health center. However, once they know what they have to communicate, they try to connect the need with the topic so that the neighbors can better remember the information. For this reason, if they seek to raise awareness among mothers about feeding their children, they emphasize aspects such as the quality of the products they consume and the consequences of not feeding them well.
Another type of strategies used by the agents are visual support materials, which become indispensable to ensure the understanding of the topics. As mentioned by the interviewees, they often use flip charts, posters and live demonstrations to show how to prepare foods high in iron when they have to deal with anemia and malnutrition. The distrust and/or embarrassment of neighbors to talk to the agents is more common than it seems, so in order to motivate them to attend the talks given at the health center, the agents also give incentives such as food.
As we have seen, the interactions between neighbors and agents follow a marked institutional line, since the agents are inserted within the limits allowed by the health center for their actions. However, they also have the autonomy to develop and share their own support material for the talks, in addition to being able to choose how they wish to manifest the information to the neighbors. For this reason, it can be said that the communication spaces that are configured between community agents and neighbors are framed within the formality of the institutional role of the agents, but may present different levels of disruption depending on the agent and his or her way of communicating with the community.
Finally, we also found a regular participation of the agents in other community spaces. Taking into account that one of the characteristics of community participation is the construction of the social fabric through the active roles that an actor may have (Gumucio, 2001), the agents interviewed use their presence in other spaces as a means to have more visibility among the neighbors and get them to recognize them.
Both interviewees reported being part of different spaces and roles (from being leaders in their neighborhood to being candidates for councilors). Among the motivations for this action, it was found that they recognize that their participation in other spaces is an advantage for their work as agents, since it makes them better known among the neighbors and is a means to get closer to them. Once again, the strengthening of the social fabric is a fundamental aspect for them.
6. Conclusions
It can be seen that the communication dynamics deployed by community agents in San Mateo de Huanchor are characterized by the closeness that the agent is able to generate through their own resources and strategies, with their neighbors, such as the use of their own and visual material (slips of paper, drawings) to present health prevention issues. Especially because the spaces for socialization and training that they share with other actors are marked by verticality and formality.
As for the communicational practices they establish with neighbors, they are characterized by relationships of trust and empathy. The population understands the agent as an actor who is recognized as friendly, close and patient, and on these elements builds various relationships with the neighbors with whom he/she must interact. The objective is always to attract them, captivate their attention and question them in order to promote healthy prevention and care practices, so they use simple but impactful language that causes a questioning in the interlocutor.
In addition, the materials they choose and/or develop to complement their presentations and lectures are also fundamental tools. Most of these are basic materials, have a predominantly technical content and are in text format, since they do not have instruction or guides on any other type of resources, such as virtual ones. The consequence of this lack of knowledge is that in contexts such as those caused by Covid-19, in which face-to-face activities were halted, the adaptation of the agents has been very limited and their work has been halted.
Regarding the communicational relations deployed in the training and socialization spaces with other institutional actors, it is concluded that these are framed within institutionalized and supervised spaces. In this sense, the relationship between community agents and actors such as the health center staff becomes vertical and subordinate, limiting the participation of the agents themselves to make suggestions, ask questions and even make comments. This situation influences the agents’ performance, making it difficult for them to carry out their activities, since the support provided by other actors is weak.
Connecting with others is not an easy task. Getting the attention of another person to question and generate a change in attitudes and practices is a process that must be accompanied by the necessary tools, and it is only the beginning of a relationship that must be maintained and strengthened. Communication strategies can also be learned by people, and community agents, as community communicators, need to have the appropriate training and support to continue doing work that is sustainable and generates a real impact.
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