Leveraging Community Health Worker's Deep Community Knowledge to Address Food and Nutrition Security in Appalachia.

Introduction: Community health workers (CHWs) are trusted professionals in communities because of the deep understanding and cultural insights learned from their lived experiences. In Appalachia, CHWs are embedded in the community, giving them a unique understanding of how social determinants, like food and nutrition security, impact health outcomes. Purpose: This study aimed to examine the professional characteristics and knowledge of CHWs while identifying culturally sensitive practices around food insecurity. Methods: This cross-sectional, mixed-methods study used an online survey and in-depth phone interviews with CHWs in the Appalachian Region to examine their professional characteristics and knowledge on food security in their community. Quantitative surveys included a Cultural Competence Assessment (CCA) with two subscales: Cultural Awareness and Sensitivity (CAS) and Cultural Competence Behaviors (CCB). Surveys were analyzed descriptively to examine professional characteristics, while interviews underwent thematic analysis to identify community-based food and nutrition solutions. Results: Fourteen CHWs completed the online survey, and over 75% reported being able to provide guidance to families on food assistance programs. Findings from in-depth interviews highlight the challenges that families face in accessing these programs, including generational differences that affect access to home-cooked v packaged foods, as well as access to entitlement programs due to non-custodial caretaker status. Implications: The deep cultural competence among CHWs makes their partnerships a valuable community asset. Their unique position and knowledge of the community enable them to identify opportunities for community-based solutions to improve food and nutrition security in rural Appalachia.