Work process of community health workers: analysis of the influence of urban violence and COVID-19.

In this multicenter, cross-sectional and quantitative study we evaluated the influence of urban violence and COVID-19 on the work process and team rapport of community health workers (CHWs) in eight municipalities of Northeastern Brazil. The collected information covered sociodemographics, work routines, exposure to violence, self-efficacy and coronavirus anxiety. A logistic regression was performed using as outcome variable the answer to the question: "Do you think your team work process changed during the pandemic?" The sample included 1,944 CHWs, of whom 56.60% stated that violence interfered in their work, and almost 75% reported adaptations in their work process to cope with COVID-19. During the sanitary emergency, team rapport was positively associated with the absence of such adaptations (OR = 1.60; 95%CI = 1.22-2.10) and with occupational exposure to violence (OR = 2.73; 95%CI = 1.72-4.34). Our results confirmed that urban violence and COVID-19 affected the work process of the CHWs. A better understanding of this dynamic can help design interventions to make primary health care more resilient and better prepared for future stressors.