No action, behavior, or outcome exists in a vacuum. There are always other factors that lead to health behaviors or outcomes. This concept is known as a root cause. Root causes “are the underlying reasons that create the differences seen in health outcomes.”
Root causes can be visualized as a tree. Leaves are specific outcomes, like COPD, diabetes, or high blood pressure. Branches are the specific health behaviors that lead to those outcomes. The trunk is life factors that inhibit or permit those health behaviors, like work schedules, living situations, and family status. And finally, the root causes are the additional, deeper factors that support the trunk, branches, and leaves. This visualization practice comes from Health Resources in Action.
Consider a young man experiencing homelessness. Homelessness is the outcome – the leaf. A community health worker (CHW) interviews the young man and discovers that he often missed work, leading to unemployment. Missing work is the behavior – the branch. Upon further conversation, the CHW learns that the young man missed work frequently because he would oversleep after long nights caring for his sick mother. Providing family care is a life situation – the trunk. Finally, the CHW learns that the young man’s family is impoverished and lacks health insurance, which is the root cause of the man’s homelessness.
CHWs address root causes by connecting individuals to appropriate resources and providing peer support. For example, a CHW can help someone with substance use disorder locate harm reduction materials and treatment centers while providing weekly check-ins. Additionally, a CHW can help community members apply for affordable housing and jobs, practice interviewing, and complete paperwork. CHWs are skilled in advocacy, education, system navigation, and more, which are all necessary for addressing root causes. But before CHWs can address root causes, they must identify them.
Root causes for a person’s behavior, health, or life situation differ for everyone. For example, some individuals may experience the same trauma and react differently. Other people may be more resilient or resistant to the harmful effects of adverse experiences. Without identifying root causes, modifications to behavior are not as likely to stick, and negative health outcomes will likely continue. Fortunately, CHWs are skilled in the identification of root causes.
Using Root Causes as a Proven Roadmap for Health
There are countless strategies that CHWs use to identify and address root causes for clients, patients, and community members. Below are simple steps for CHWs to use to identify root causes.
- Identify the health outcome. As a CHW, you might be referred to a client because they are dealing with a specific problem, such as diabetes or food insecurity. However, you might work with a client and realize they’re also struggling with other issues, or the referral form may not be clear about what a client is experiencing. Determining the problematic outcome is the first step to identifying and addressing root causes.
- Help the client identify the health outcome. As a CHW, you may know what health outcomes a client is experiencing. But the client may not realize that their experiences are problematic or hurting their quality of life. For example, if a client loves a certain type of food and doesn’t mind that their blood pressure is high, they won’t be aligned with you as you address the barriers they face. Ensure you and the client are on the same page about the specific conditions you’re working to address.
- Ask questions. Ask the client about their background, home life, work status, family status, and lifestyle. You may also ask about the client’s values and beliefs.
- Use conversations to learn more. Root causes of health outcomes aren’t always clear, so have conversations with the client to understand what underlying factors impact their health. This process often requires multiple discussions over multiple meetings and consistent rapport-building.
- Define the underlying factor. When you believe you’ve identified the root cause, present it to your client. Help them understand the processes that may have led to their adverse health outcomes, and ensure you’re both on the same page.
- Develop a clear goal. Now that you and the client know the root causes of their health outcomes, help them develop a SMART goal. SMART goals are specific, measurable, achievable, relevant, and time-bound. A clear, SMART goal will help motivate the client and stay on track. A clear goal will also help you and the client develop a plan.
- Create a plan to achieve the goal. With the SMART goal or goals in mind, help your client develop a clear plan. Use multiple, simple steps with timelines and resources to make the plan realistic and achievable.
- Offer support and routine check-ins. As your client works through their plan, provide additional support and resources to help at each step. For example, suppose your client experiences homelessness and aims to find affordable housing by the end of the year. In that case, you should help them find transportation for jobs, access free shower and laundry services, and find and apply for housing.
Addressing health inequities and negative health outcomes starts with understanding the root causes. Identifying root causes is a skill, and CHWs enhance their identification skills with each client they serve. Fortunately, Everyday Life Consulting provides advanced CHW training that includes root cause identification exercises.