3 Powerful Communication Skills That Build Rapport

Building strong communication skills is one of the core skills of a career as a health promoter, such as a community health worker (CHW) or promotora. Learn about these powerful communication skills and how to improve them and add them into your CHW program.

One of the most important skills that health promoters, such CHWs, need to have is the ability to form a healthy rapport with clients and patients.

[Learn the Most Important CHW Core Competencies – Read Now]

Rapport is the strong connection that helps relationships to build and strengthen. But it doesn’t come automatically, at least not all the time. Some people simply click and don’t have to work at developing it. The good news is that establishing rapport is a skill that any CHW can build and use with any client.

Why Does Rapport Matter?

The benefits of this communication skill to a CHW program are significant. Building rapport requires a minor time investment but pays off majorly with patient compliance, understanding the disease process, and even the eventual health outcomes.

There are three skills that you should follow in order to establish a good rapport with clients and patients:

1.    Listen

A large part of successfully supporting clients and patients is giving information and effectively getting your point across. But listening to what your clients have to say is equally important.

Melissa Daimler of Twitter wrote an article for the Harvard Business Review that explains different levels of listening:

Level 1: internal listening – is when you focus on your own thoughts, worries, and priorities, while you look like you’re focusing on the other person.

Level 2: focused listening – this next level means you’re focusing on the other person, but you’re not really connecting all the way.

Level 3: 360 listening – here’s the goal. This is when you’re listening to what someone is saying and how, plus interpreting what they’re not saying with words.

Building listening skills is tough. But you here are some ways to improve:

  1. Make eye contact.
  2. Give the client enough time to talk—don’t cut them off mid-sentence.
  3. Show respect by never making clients feel rushed when they are with you.
  4. Maintain professionalism while being approachable at the same time.
  5. Ask open-ended questions designed to gather information.


2.    Understand

CHWs find solutions to clients’ health problems by understanding their situation. You may not agree with all your clients or even like all of them, but making a genuine effort to understand where they are coming from is a large part of building trust and loyalty.

Cultural sensitivity is important because some issues, such as family planning, are still taboo and need to be approached with a certain restraint to avoid causing uneasiness.

The goal here is not to turn your clients into friends but to know them more than just what is on the case history sheet.

Ways to improve understanding skills:

  1. Repeat what your client says back to them. And ask them to repeat back any instructions you give to them.
  2. Practice empathy by putting yourself in the shoes of your clients. And cultivate a shame-free environment for sharing.
  3. Know your community through a community assessment. This will help you know what kinds of challenges your clients face before even talking with an individual. This should be part of community engagement and outreach training.
  4. Do what you can to boost your clients’ health literacy skills. This will help them read, understand, and act upon information you share.
  5. Encourage clients to share their views with you and ask them what they think to gauge at what level of understanding they have.

3.    Be Clear

One of the common mistakes that all healthcare providers make is assuming their clients know more than they do. Use your listening and understanding skills to tailor the information being shared. It is important that the client and healthcare provider be on the same plane of communication so they can work towards the same goals.

  1. Use the right language. This might be avoiding medical jargon or using multilingual resources.
  2. Include visual aids. They will help bring your words to life and encourage the clients to be more participative in the process.
  3. Say the same thing in different ways. Repeating yourself is OK, especially in slightly different ways that makes it easier for someone to get what they might have missed the first time.
  4. Slow down. It might take longer, but good communication means you have to speak slowly. Plus, it will save on clarifying phone calls later.
  5. Explain why. Sometimes people don’t make lifestyle changes because they don’t know why. Explain the reason for doing something to really drive the point home.

Getting clients to trust a CHW and other healthcare providers is as important as any treatment they receive. Every client walks in with similar expectations of wanting to be heard, demanding your complete attention and to be kept in the loop as to the decisions being taken. A couple of minutes of undivided attention on every visit is all that is required to achieve all of this.

Photo by Christina Morillo from Pexels

Top 5 Ways To Assess CHW Skills and Core Competencies

Read how you, as a program manager, director or HR manager, can use to learn more about abilities of your new or existing community health worker and increase your impact.

Your health agency has to adapt fast to improve the health outcomes of your community members, and keep people out of the ER. But in order to do that, your community health workers (CHWs), promotores, or other health advocates need to be ready to act.

Make a smooth liftoff of your CHW initiative by knowing just what kinds of skills your agency’s CHWs and related staff already have. And then you can note what core competencies they’re missing so you can build a comprehensive training plan.

[FREE RESOURCE: CHW Core Competency Requirements for Your State]

Once you have that information, you can organize training to fill in the gaps in their knowledge and skills.

Here are some effective methods you can use to assess your CHW team’s skills and competencies. Note that your state may have different competencies for CHW certification, so you should research local requirements.

Top 5 Ways To Assess CHW Skills and Competencies

  1. Test Your CHWs
  2. Request a Self-Assessment
  3. Collect Team Feedback
  4. Test CHWs in the Field
  5. Ask for Clients’ or Patients’ Feedback

1. Test Your CHWs

Probably the easiest and most straightforward way to find out what kinds of stills your CHW team already has is to test them. You can find a test online or create one of your own to assess their technical knowledge. These kinds of tests give very clear pass/fail results. However, they can be fuzzy on whether someone knows how to apply that knowledge with clients and patients.

2. Request a Self-Assessment

Asking your CHWs to prepare a self-assessment of their skills can give you a more nuanced idea of how well they can do the tasks on their job description. This method is helpful because it shows their abilities and also how they perceive their abilities.

You can structure these assessments by asking CHWs to tell you how familiar they are with key CHW skills, such as:

Rate how comfortable you feel preparing a client intake form:

  • Very comfortable
  • Comfortable
  • Slightly unsure
  • Not at all sure

These kinds of assessments are most helpful when combined with a more objective test. Sometimes CHWs can over- or underestimate their abilities.

3. Collect Team Feedback

Team-members, especially members of a multidisciplinary healthcare team, can have a much clearer idea of the competencies of the CHW working with them. So ask for their feedback. They can anonymously present an assessment of the CHW and where they might need extra skills. Just make sure to keep it at a high level.

4. Test CHWs in the Field

The best way to train and assess core competency skills is to see how a CHW uses them in practice. You or a mentor can watch the CHW in a variety of real or role-play scenarios to see how they fare.

The benefit here is that your assessor can ask the CHW unexpected questions or try out unusual circumstances. This will let you explore situations that are much more complex than a standard test.

5. Ask for Clients’ or Patients’ Feedback

Another kind of in-the-field testing is to actually find out how the CHW is doing with clients. You can survey their clients directly and find out if there are areas for improvement. This can be a great way to learn about your CHW team, but also find out about the unique needs of your clients and how you can support them better.

Best of all, you might like to choose all of the methods above or at least a combination of them. This mixed approach can give you the truest sense of how your CHWs are performing in their jobs.

Photo by Retha Ferguson from Pexels

Your Agency Needs Training for Food Insecurity

By Gabrielle Carrero

The coronavirus is emptying America’s cupboards. Growing food insecurity is making more people wonder where their next meal will come from.

Income disruption and limited access or availability of food at grocery stores are only a few reasons why families and individuals are experiencing it for the first time. Meanwhile, many that were already living with food insecurity are feeling added pressure.

Access Now: CHW Core Competencies Resource Guide [FREE GUIDE]

Agencies can help by understanding vulnerabilities in local communities, including where food deserts are.

It is also helpful to employ sensitive screening questionnaires to detect who might be food insecure and connect people experiencing food insecurity with sources of nutritious food.

Training your team to increase outreach efforts to connect those in need to food will ease the burden individuals and families are going through.

Using community outreach and engagement strategies for food insecurity might include talking to local groups, using local media and social media to promote food resources, or appearing at community events to do demonstrations and build linkages.

What Food Insecurity Is

Reviewing the background of food insecurity, causes, consequences, and responses prior to COVID-19 offers some insight into the complex environments people need to navigate to keep nutritious food on the table.

The United States Department of Agriculture (USDA) defines food insecurity as “a household-level economic and social condition of limited or uncertain access to adequate food.”

“Adequate food” here means safe and healthy food—not something like a candy bar for dinner.

Fewer than 1 in 10 US adults and adolescents eat enough fruits and vegetables. – CDC

The USDA reported that 37.2 million people were in food-insecure households in 2018. They also found that food insecurity happens in episodes averaging seven months to a year. That number is expected to rise hugely this year.

Source: Global Food Security Program, Center for Strategic & International Studies

People in food insecure households are more likely to suffer from hunger and the health issues associated with poor nutrition and diet like diabetes, cardiovascular disease, and obesity.

Children with a lack of food or poor nutrition harms their healthy growth, cognitive and social development, educational achievements, and mental health. Similarly, the health of the elderly can decline from little or unhealthy food.

“These groups are more at risk primarily because of a lack of money to buy food,” says Elizabeth Kimball, who manages the Healthy Eating, Active Living Program at Public Health – Seattle & King County. “It’s not because a person is disabled but because most likely they cannot work, have high medical bills, or live on a fixed income.”

Kimball is leading the King County Healthcare and Food Insecurity Learning Network, a Community of Practice whose goal is to eliminate food insecurity and improve health. The group is developing an online training to facilitate screening for food insecurity in communities.

“We don’t want to perpetuate stereotypes or prejudice by saying that people of color are more likely to be poor without saying how society contributed – otherwise people may assume that it is the fault of people of color for being poor,” she says.

Root Causes of Food Insecurity: Disparities and Discrimination

According to a 2014 Hunger Report by Research Triangle Institute (RIT), food insecurity doesn’t hit all sectors of society the same. People from low-socioeconomic status, racial or ethnic minority groups, single-parent households, and households that include persons with disabilities are more likely to be at risk.

The reason is pretty simple: lack of money. For example, if someone is disabled, it’s harder for them to find work or they might have high medical bills. Living on a fixed income means less money for everything, including food.

“You cannot take on poverty and hunger without taking on historical and contemporary discrimination,” Dr. Mariana Chilton, a professor of public health at Drexel University’s Center for Hunger-Free Communities, said in an article for The Nation.

This comes from a study that says it’s impossible to deal with food insecurity–like all health disparities–without taking on structural racism.

“How are racism and hunger related? Being mistreated at school, on the job, in health care and beyond, translates to lower wages and exclusion from society,” Sherita Mouzon, a community engagement specialist also at Drexel, said in an op-ed for the Philadelphia Inquirer.

“When employers discriminate, people of color make lower wages than white people. When health-care providers discriminate, people cannot get the health care they need, and when the courts and the police are biased, they are more likely to put our family members behind bars, which damages their prospects for economic security.”

Eating well is imperative to health, and COVID-19 has forced households to make hard decisions when it comes to food.

COVID-19 and Food Insecurity

The coronavirus has created many substantial barriers for people to access food, for example:

  • Food supply system disruptions have limited the availability of food in grocery stores
  • Food pantries and food banks have high demand and long wait lines
  • Some individuals are not healthy enough to leave home to get food
  • Some people are especially cautious leaving home because they have immunocompromised family members at home

And, of course, many more people can’t afford food.

The Department of Labor reports that millions of Americans are filing for unemployment benefits. Record unemployment rates have destabilized food budgets and left many uninsured without an employee-sponsored health plan.

With drastic changes in economic and physical circumstances since the virus, it is no wonder that so many are experiencing food insecurity for the first time.

A recent survey shares the impact COVID-19 has on children and the elderly, two of the same groups at risk or enduring food insecurity before the virus.

According to The Survey of Mothers with Young Children, “40.9 percent of mothers with children ages 12 and under reported household food insecurity since the onset of the COVID-19 pandemic.”

Comparatively, 15.1 percent of mothers with children of the same age reported food insecurity in the Food Security Supplement (FSS) 2018 survey.

A survey from December 2019 by the University of Michigan National Poll on Healthy Aging found that 1 in 7 older adults experienced food hunger in that past year. Because the elderly have been advised to isolate to safeguard health, food assistance programs like Meals on Wheels are seeing an increased demand of aid.

Meals on Wheels America

The pandemic is exacerbating the pre-existing issue of food insecurity. Without dedicated education and intervention for healthcare staff and non-clinical workers such as community health workers, the potential for long-lasting impacts on community members increases. Until now, food insecurity is a real and lived experience for many, and since COVID-19, it is also new and unfamiliar.

5 Ways Your Team Can Address Food Insecurity

Here are some ideas of how healthcare teams can help with food insecurity:

  1. Training individuals and teams on what food insecurity is and how to navigate food assistance since COVID-19 is imperative to reaching impacted communities.
  2. Make sure your team understands the basics of healthy eating and active living so they can promote healthy lifestyles to clients.
  3. Educate your agency team about where food insecurity happens. It cannot be stressed enough that households that are already vulnerable to food insecurity pre-pandemic are mainly found in communities of color, inner city and rural areas, and low-income homes. These communities always face battles in health equity and deserve visibility when it relates to their health, especially now.
  4. Train your team in food insecurity screening. Some programs, such as the King County Healthcare and Food Insecurity Learning Network, offer in-depth training that show participants how to sensitively screen.
  5. Use screening tool kits. Feeding America has a useful Food Insecurity Screening Toolkit for how healthcare and non-health care professionals might treat food insecurity in individuals.

A regular source of nutritious food can make a tremendous difference in the lives of Americans, and it’s more important now than ever for agencies to build the infrastructure to help them.

Gabrielle Carrero is a Latina educator and writer from Brooklyn, NY that now lives in Durham, NC. She teaches First Year Writing at NC State University.