The exchange and use of cultural and social capital among community health workers in the United States.

Community health care workers (CHWs), lay community members with basic health care training, have been charged with providing appropriate care for vulnerable populations, addressing social determinants and improving population health. Frequently, CHWs lack the economic or cultural capital to accomplish these goals. Through analysis of 17 semi-structured interviews with CHWs and supervisors at a CHW programme in the United States, we draw on Bourdieu's theory of practice to examine how the exchange of cultural and social capital impact CHW effectiveness. We found that CHWs' reliance on bonding capital was perceived to effectively build social networks and mutual trust among marginalised communities. But, over-reliance on embodied cultural capital and bonding capital reduced integration into the health care field; limited access to bridging capital; and limited social standing. We highlight how the exchange of cultural to bonding and bridging capital presented structural limitations. Overall, the demonstrated tension demarcates and reinforces longstanding divisions between social issues and health care issues. Future efforts should focus on promoting the unique skills of CHWs within health care settings to avoid compromising CHWs' ability to advance population health.