Table 5 Convergent themes/subcodes and divergent perceptions of CHWs and employers
Convergent Findings (CHW and Employers agree) | |||
Theme | Sub-code | Qualitative results | Quantitative results |
Roles/Responsibilities | Diverse roles | “The role of community health workers is as varied as the places that have them.” [E-CHW3] | CHWs identified a wide variety of unique job titles (n = 69) |
Training | Competencies | “…outside of her role here at (Organization name), she really is a female strong leader in that whole community.… And she just knows everybody, people trust her people believe in her.” [E-CHW1] “And another thing which is very important is to find a trusted person of the community. For example, the immigrants, wanting to do a team plan and make it successful. You need somebody who can really reach out to many people who is accepted among the people…” [CHW5] | When asked to list valued characteristics of a CHW, both CHWs and Employers emphasized (1) Communication and active listening (2) Client advocacy (3) Technical knowledge and (4) Cultural competency/Language |
Gaps | “I feel I do not get enough time to properly train our FSS before we throw a caseload on them to appease funders. I feel like training is one size fits all and that is not how we should approach it to ensure we do not have high turnover” [E-CHW3] “How to be a CHW, I understand how to interact with the people I am serving but there is not actual training to help us BE a CHW. Nothing telling us how our daily operation should flow or what resources are available and how to overcome barriers we encounter” [CHW, survey] | 48% of CHWs say they would benefit from additional training in order to carry out their job responsibilities | |
Communities Served | Communities Served | “We work with multiple different problems, concerns, all sorts of different types of people, low-income, high-income, aged. We do actually 19 and up. We’ll take referrals for anybody in 19 and up. So it’s a diverse population.” [E-CHW3] | CHWs all selected that they work with more than one health condition, and no one condition was disproportionately targeted or neglected (Fig. 1). They also reported working with a diverse client population (Table 4). |
Client Barriers | “And then her (client), she is from Guatemala. So her first language is not Spanish. It’s her own native language from her tribe. So that even makes it harder for her.” [CHW2] | Only 17.8% of employers indicated that all of their CHWs speak the same languages as the populations they serve. Supporting this, only 18% of CHWs reported speaking a second language | |
Funding | “We could have had like a great plan six months ago and had a good resource and everything was working, but then, funding stopped, or something decided to not continue and now we’re back to square one.” [CHW1] “Without payment for services we can only provide limited services that come up with patients. We aren’t able to do much more than basic screenings which are done during a different paid encounter with the patient” [E-CHW4] | 46% of employers disagreed that their funding sources are stable, and around 35% reported that they may not be able to fund CHWs in the future. | |
Perceptions of CHW Role | Satisfying | “The CHW is a valuable member of our team and is critical to our community outreach and work toward health equity and addressing SDoH” [E-CHW, survey] “This is a very rewarding and exciting position, one that did not exist a few years ago within the healthcare system. I look forward to continuing and growing in this position” [CHW, survey] | 90% of CHWs and 97% of employers agree or strongly agree that CHWs are valued members of the care team. |
Clarity of role | “Better defining CHWs would be key. There are so many entities with staff doing similar roles it becomes confusing for the community and those being served” [E-CHW, survey] “Coworkers understanding my purpose and usefulness would help them to buy into making referrals and understanding the process” [CHW, survey] | ||
Divergent Perceptions (CHWs and Employers Disagree) | |||
Workforce Characteristics | Payment deliverance | 70% of employers indicated that their employees are paid via a monthly salary, whereas only 19% of CHWs claimed the same | |
Pay scale | CHWs reported pay scales ranging from $20,000 a year to more than $45,000, Employers reported $27,000 a year to > 100,000` | ||
Training and Hiring | Hiring requirements | 66% of CHWs reported that their organization had a requirement for prior education, certification, or a specific desired skillset from their applicants, where only 42% of employers noted the same | |
Populations Served | The diversity of populations being served | 50% of employers indicated that their CHWs work with a specific immigrant or refugee population, only 28% of CHWs reported the same. 86% of employers reported that their CHWs served Hispanic clients, compared to only 20% of CHWs | |