ainorb.com/p/D-C/WONCA-1604-C.htm>) is a consensus report from WONCA and the international council for primary care \[[@CR6]\]. It lists 22 recommendations and describes the domains of primary care practice that must be addressed to deliver a high quality primary care service in the contemporary context. Some recommendations include domains that are considered difficult to address by individual primary care providers and require some form of collaborative action. For example, communication between primary care provider and community must be promoted and supported. A key driver for collaboration is shared understanding of roles, responsibilities, and expectations of both provider and community \[[@CR7]\]. Recent research by the authors found that although healthcare professionals agreed that primary care professionals should have enhanced skills in communication with the community, they perceived that these skills were difficult to implement in practice due to the time constraints that exist in contemporary primary care practice, coupled with difficulty in defining what constitutes communication with the community \[[@CR8]\]. To enhance communication between community and primary care, healthcare professionals recommended that communication could be facilitated through increased community engagement. There is an increasing literature documenting the importance of engaging communities, especially indigenous populations, in healthcare to enhance healthcare service provision and health outcomes \[[@CR9]--[@CR13]\]. A systematic review by Zwarenstein et al. (2006) found that for interventions involving culturally and linguistically diverse people, community involvement enhances healthcare service provision and health outcomes in a number of areas, including service utilization, use of preventive health services, and psychological health outcomes \[[@CR12]\]. This was particularly so when there was a sustained effect. To date there is no evidence to suggest that interventions involving the community have been widely implemented in practice to enhance communication between primary care and the community. However, there are examples from New Zealand, Australia, and the United States that have used a community based approach to enhance communication between primary care and the community \[[@CR14]--[@CR16]\]. In New Zealand, the Riwaka Primary Care Partnership Project aimed to build trust between primary care and the community, thereby enhancing communication and facilitating the delivery of primary care in an environment where primary care professionals and community were considered separate and distant entities \[[@CR15], [@CR17]\]. In Australia, the Aboriginal Community Controlled Health Service developed the Community Partnership Framework to enhance communication and collaboration between primary care and the community, thereby facilitating the delivery of primary care to indigenous people \[[@CR14]\]. In the United States, Community Health Workers provided services to clients in primary care and enhanced communication between primary care and community by providing care tailored to the needs of the clients. Healthcare professionals and researchers who advocate for enhanced communication between community and primary care must consider how these interventions can be implemented in current healthcare practice. This research report describes one approach to the implementation of communication between primary care and the community in New Zealand \[[@CR17]\]. The aims of the research were to: (1) understand how communication between primary care and community is currently conceptualised and understood and (2) investigate the acceptability of community based health promotion worker (CBHW) and other methods to enhance communication between primary care and community in the context of the practice setting. Methods {#Sec2} ======= This project involved three main components. Firstly, as part of a larger project investigating access to primary care by Māori and Pacific Island people in Tairāwhiti \[[@CR18], [@CR19]\] information was collected about the perspectives of healthcare professionals on communication between community and primary care, as well as the communication models in place within their practice setting. The healthcare professionals worked in primary health organisations that provided primary health care to an urban population of approximately 80,000. To increase the feasibility of the study and to gain access to a wide variety of healthcare professionals, it was agreed that a one-day workshop would be conducted in which clinicians working in primary care would learn about communication between primary care and community. The aim was to provide a forum for clinicians to consider how communication could be enhanced in their setting. Secondly, a literature review was conducted to identify existing approaches to enhance communication between community and primary care. A framework for how a CBHW could be implemented was also developed. Thirdly, a workshop was conducted with 30 healthcare professionals working in primary care to test and refine the framework for implementing the CBHW. Literature review {#Sec3} ----------------- A literature search was conducted to identify existing models of communication and to describe communication between primary care and community from a healthcare professionals' perspective. The search included the following databases: CINAHL, PubMed, and Google Scholar. Search terms used included primary care, primary care physician, primary healthcare, community, community nurse, carer, community health nurse, community health worker, indigenous people, Māori, indigenous people, Pacific Islander, Pasifika, and New Zealand. Workshop {#Sec4} -------- The workshop was held at an urban primary health organisation. Approximately 30 healthcare professionals attended. To reduce the impact of participant fatigue, a shorter version of the literature review was used to introduce the topic. The one-hour workshop was intended to provide participants with a learning environment, rather than an educational event. A framework was developed to provide a framework for developing a CBHW. This framework was developed by a group of healthcare professionals with expertise in public health, community engagement, primary care, and social services. The focus was on how communication between primary care and the community could be facilitated in practice. The framework consisted of four domains: (1) establishing trust between the community and primary care organisations; (2) setting a vision for a CBHW, thereby understanding how the CBHW role could fit within the current setting; (3) developing and maintaining communication between primary care and community; and (4) providing support for CBHW. These four domains were discussed by the group of healthcare professionals and organised into a visual framework for how communication between primary care and community could be implemented in practice (Fig. [1](#Fig1){ref-type="fig"}). The healthcare professionals in the audience were then invited to propose methods to enhance communication between primary care and the community.Fig. 1The framework for establishing a communication between primary care and the community in practice Participants were then provided with written examples of methods that had been implemented to enhance communication between primary care and community that had been used in a variety of settings including home and school visiting by Community Health Workers, visiting nurses in rural areas, and the provision of healthcare information and social services within a primary care setting \[[@CR17], [@CR20]\]. The participants then worked in small groups to discuss how these communication strategies could be implemented in their setting. Findings {#Sec5} ======== The health professionals included a range of staff from a variety of professions, including general practice nurses, doctors, clinical nurse specialists, community nurses, and managers, along with other professionals such as community health workers and social workers. The workshop was facilitated by a community nurse and the workshop was audio recorded. A summary of the workshop findings are included in Table [1](#Tab1){ref-type="table"}. The audio recording was transcribed verbatim and analysed by hand using a thematic approach. The themes identified were: (1) building trust and (2) identifying the setting.Table 1Summary of the workshop findingsSummary of the workshop findings *Key themes identified*  Build trust between community and health care professionals  Set vision and expectations  Provide feedback to the community  Provide support for community  Community engagement  Provide information and support to healthcare professionals  Provide healthcare information, support and referralFindings from a literature review Communication between community and primary care is essential to ensure equitable access to care, enhance the health status of the community, and support primary care organisations. Many approaches to enhance communication between community and primary care have been developed with the aim of improving health outcomes. Healthcare professionals have identified barriers to promoting communication between community and primary care, including the difficulty to provide a culturally safe service and a lack of resources. The literature suggests that the use of community based workers (CBHW) within the setting facilitates a number of the interventions identified in the literature to enhance communication between community and primary care. The literature suggests that CBHW are a form of community health workers The literature suggests that although an informal role, CBHW are undervalued and their contribution is often unrecognised by healthcare professionals. The literature suggests that CBHW are a culturally appropriate and effective way of enhancing communication between community and primary care. The literature suggests that CBHW have a range of roles that enhance communication between community and primary care, including working alongside and supporting primary care staff, providing healthcare information to members of the community, identifying health needs within a community, providing support to people in need and promoting health, prevention, and health promotion programs. The literature suggests that CBHW improve trust between community and primary care by building rapport and facilitating communication and mutual understanding between community and primary care. The literature suggests that CBHW can have significant impact on enhancing communication between community and primary care The literature suggests that CBHW may have particular roles and responsibilities that must be defined by the healthcare organisation in order to develop communication between community and primary care.Conclusions The literature suggests that primary care organisations can use a number of approaches to establish communication between community and primary care. These approaches may vary depending on the community and the setting, but some commonalities were identified. The literature suggests that the CBHW model is an appropriate approach to enhance communication between community and primary care in a variety of settings, including primary healthcare settings The literature suggests that effective and sustainable CBHW roles and responsibilities need to be identified and agreed upon within primary care organisations and those roles must be defined by the healthcare