Perspectives on Workforce Development Needs for Community Health Workers (CHWs): Results from a Statewide Survey of CHW Employers

Abstract

We conducted a survey of community health worker (CHW) employers in Texas to understand the employment context and workforce development needs of Texas CHWs. An electronic, mixed-methods survey was emailed to 841 CHW employers across Texas in Spring 2020. The survey consisted of 51 questions. The response rate was 22% (n = 182). Responses were analyzed using SPSS, Microsoft Excel, and N.Vivo. We found that most CHW employers directly employ their CHWs, and CHWs are typically part of a multidisciplinary healthcare team. Most respondents required their CHWs be certified by the state’s health department and have at least a high school diploma or GED. The most common services that CHWs provide are health education/promotion and information referral. The main health issues that CHWs address are diabetes, hypertension, and mental/behavioral health. Current CHW workforce development needs include continued training on topics including chronic disease self-management and health promotion. CHW employers differ in their capacity to implement workforce development activities. There is significant variety in the employment context and workforce development needs of CHWs across Texas. Results reinforce previous findings on the need for specialized, continuing training for CHWs and the development of pathways, resources, and opportunities that could advance the CHW profession even more. These results can inform those interested in employing CHWs in their CHW program development. Findings from this study can be used to guide development of tailored curriculum for continuing education units, specialized certifications, or other professional development resources for CHWs.

A Review of Community Health Worker Integration in Health Departments

“…Several statewide CHW census surveys have examined state-level CHW demographics and workforce development needs. The proportion of CHWs working under local health departments in each state varies widely, ranging from 9% in Texas to 22% in Florida to 32% in Nebraska [ 12 – 14 ].…”

“…Most surveys identified certification as a primary workforce development issue [ 12 , 13 , 15 , 16 ]. In Louisiana, CHWs and CHW employers agreed that certification would support CHWs in learning new skills, improving job prospects, and expanding the CHW workforce [ 15 ].…”

Understanding the Public Health Role, Motivations, and Perceptions of Community Health Workers Deployed to Low-Income Housing in Richmond, Virginia

“…Dunn et al (2021) 25 surveyed employers of CHWs in Texas and indicated that there was a need to survey CHWs, and Maes et al (2014) 16 called for application of ethnographic research to inform setting up CHW programs and for better administration of such programs to serve communities effectively. Swartz (2013) 26 called for closer attention to the experiences of CHWs when designing public health policies for communities as critical information for improving, evaluating and designing new CHW interventions could be garnered from such interviews.…”

Community Health Workers as Puentes/Bridges to Increase COVID-19 Health Equity in Latinx Communities of the Southwest U.S.

“…Findings also illustrate the dual role of CHWs as community members and public health workers, identifying the limited support CHWs receive while serving their communities, including their own closer social structures such as family members [ 25 ]. This is vital, as lower resource allocation can lead to lower levels of trust and respect from the community [ 42 ].…”

“…Communites are asking for a better integration of CHWs into the larger primary healthcare system, as well as the allocation of sustainable economic and training resources for CHWs [ 20 – 24 ]. There is a lack of consensus about the CHWs role, some advocate for CHWs to be only enagged in upstream interventions addressing SDoH, such as food insecurity [ 22 ],others see CHWs playing more clinical roles [ 25 ]. Regardles of how narrow or broad their role is defined, CHWs tend to have stressful and poorly compensated jobs, experiencing “high levels of stress and anxiety due to limited resources while trying to balance the needs of clients with personal and family needs” [ 17 ], p. 8.…”