From Community Bonds to Digital Mediation: Transforming Community Health Workers’ Practices in Primary Health Care
1
Departamento de Saúde Coletiva, Universidade de Brasília, Brasília, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A896
ABSTRACT
BACKGROUND:
Community Health Workers (CHWs) play a central role in Primary Health Care (PHC) within Brazil’s Unified Health System (SUS), conducting health promotion and disease prevention actions and mediating relations between services and communities. Historically grounded in Information, Education, and Communication in Health (IEC), their work has increasingly incorporated Digital Information and Communication Technologies (DICT) as part of broader digital health transformations, particularly during the COVID-19 pandemic, thereby reshaping practices, routines, and health information flows.
METHODS:
This mixed-methods study is part of a national multicenter research project conducted between 2021 and 2023. The quantitative component included 11,697 CHWs who completed a structured electronic questionnaire, with analysis focused on digitally mediated IEC practices. The qualitative component comprised 25 semi-structured interviews with CHWs from all regions of Brazil, exploring experiences with digital tools, health information management, and community communication.
RESULTS:
Findings indicate underutilization of CHWs' communicative and educational potential, alongside significant resilience in contexts characterized by structural precariousness, the absence of institutional digital health protocols, and increasing bureaucratization. Digital technologies expanded the scope of IEC activities but also intensified work demands and exposed gaps in training and digital literacy. Participants reported challenges in community mediation and in addressing health misinformation, revealing tensions between technical and popular knowledge within digitally mediated care.
CONCLUSIONS:
DICT is reshaping CHW practices and health information ecosystems in PHC, generating both opportunities and constraints. This study situates these transformations within historical disputes over the consolidation of the CHW role within the Family Health Strategy and the institutionalization of communication models within the SUS. The findings support public policies in PHC and Digital Health that promote critical digital appropriation, strengthen SUS principles, and enhance preparedness for public health emergencies.
Community Health Workers (CHWs) play a central role in Primary Health Care (PHC) within Brazil’s Unified Health System (SUS), conducting health promotion and disease prevention actions and mediating relations between services and communities. Historically grounded in Information, Education, and Communication in Health (IEC), their work has increasingly incorporated Digital Information and Communication Technologies (DICT) as part of broader digital health transformations, particularly during the COVID-19 pandemic, thereby reshaping practices, routines, and health information flows.
METHODS:
This mixed-methods study is part of a national multicenter research project conducted between 2021 and 2023. The quantitative component included 11,697 CHWs who completed a structured electronic questionnaire, with analysis focused on digitally mediated IEC practices. The qualitative component comprised 25 semi-structured interviews with CHWs from all regions of Brazil, exploring experiences with digital tools, health information management, and community communication.
RESULTS:
Findings indicate underutilization of CHWs' communicative and educational potential, alongside significant resilience in contexts characterized by structural precariousness, the absence of institutional digital health protocols, and increasing bureaucratization. Digital technologies expanded the scope of IEC activities but also intensified work demands and exposed gaps in training and digital literacy. Participants reported challenges in community mediation and in addressing health misinformation, revealing tensions between technical and popular knowledge within digitally mediated care.
CONCLUSIONS:
DICT is reshaping CHW practices and health information ecosystems in PHC, generating both opportunities and constraints. This study situates these transformations within historical disputes over the consolidation of the CHW role within the Family Health Strategy and the institutionalization of communication models within the SUS. The findings support public policies in PHC and Digital Health that promote critical digital appropriation, strengthen SUS principles, and enhance preparedness for public health emergencies.
| eISSN: | 2654-1459 |
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