Date of Award

Spring 3-18-2020

Degree Type


Degree Name

Doctor of Nursing Science (DNS)



Committee Chair/First Advisor

Dr. Judith Hold

Committee Chair

Dr. Barbara J. Blake

Second Committee Member

Dr. Iván M. Jorrín Abellán

Third Committee Member

Dr. Nicole Mareno


In order to mitigate the growing health worker shortage, many low-middle income countries (LMICs) use community health workers (CHWs) to extend health services to underserved communities. Community health workers are laypersons with minimal training who provide basic health services for they communities in which they live. Although past research has demonstrated that CHWs can provide appropriate care that contributes to positive health outcomes, many CHW programs fail to achieve long-term sustainability. As the largest group of health professionals, nurses often work closely with CHWs, and are therefore well-positioned to support sustainability of CHW programs.

The purpose of this participatory action research (PAR) study was to explore the experiences and perspectives of CHWs living and working in a northern region of the Dominican Republic (D.R.). Using the PAR method known as photovoice, 13 CHWs were recruited to take photographs that represented their perceptions of the CHW role and the factors that supported and impeded their work. After generating photographs, participants took part in individual interviews and a focus group, during which the photographs were used to enhance understanding of participants’ experiences as CHWs.

Findings from the study demonstrated that participants viewed themselves as leaders and change agents for their communities, and that they perceived their work as having positive consequences for their communities and themselves. Furthermore, important intrinsic and external support systems were described, and several significant barriers were identified. Findings can be used to develop strategies to build upon existing strengths and design interventions to mitigate challenges encountered by CHWs.