Group boundary salience and nonaccommodation between healthcare workers and community members in Ghana

Over the past decades, public health policy and initiatives have shifted away from individual interventions to focus more broadly on community-based and social determinants of health. Community-based health initiatives are health programs developed to be implemented at the community level, especially amongst poor rural populations and urban slums that may be excluded from traditional healthcare models. However, evidence regarding the success of community-based health initiatives remains mixed, perhaps due to lack of research focused on the social identity and communication experiences of community members and healthcare workers. Mobilizing communication accommodation theory, the current study analyzes healthcare discourses in the context of Ghana's Community-Based Health Planning and Service initiative. Critical discourse analysis of forty-four focus group interviews revealed significant tensions regarding patient-practitioner roles and expectations, organizational role constraints experienced by healthcare workers, and ethnolinguistic group boundaries. As a result, community members frequently express feelings of nonaccommodation from healthcare workers, leading to poor evaluations of healthcare workers' communication accommodation competence. Theoretical and practical implications of the findings are discussed.