Community health workers (CHWs) are the frontline members of our public health workforce and provide direct care to the communities they serve. They’re also among the most diverse part of that workforce. Today, about 40% of CHWs across the U.S. are non-white, and the number of CHWs as a proportion of the overall public health workforce is increasing.

CHWs are also among the lowest-paid members of the workforce. While previous studies have investigated the challenges facing the public health workforce generally, a new study from the University of Minnesota School of Public Health (SPH) is the first to explore the factors driving employment decisions among CHWs.

Specifically, the SPH study investigates the organizational factors contributing to the intent of CHWs to quit their jobs in local and state health departments in the US. Using data from the Public Health Interests and Needs Survey from 2017 and 2021, researchers examined how the makeup and characteristics of the CHW workforce in local health departments changed in those four years, and the key factors associated with CHWs intent to leave their positions.

The study, published in the American Journal of Public Health, found:

• The estimated number of CHWs within health departments increased from 3,359 in 2017 to 4,649 in 2021. In that time, the CHW workforce also became younger and more diverse.
• The number of CHWs intending to leave their jobs increased from 25% to 28%.
• CHWs dissatisfied with organizational support, job security, or pay had higher probabilities of reporting an intent to leave their jobs, as compared to satisfied or neutral workers. For CHWs concerned with a lack of organizational support, 50% intended to leave, while 42% of CHWs concerned about job security and 39% who were unhappy with their pay cited an intention to leave.

“Community health workers (CHWs) are essential to the functioning of our nation’s public health workforce,” says Chelsey Kirkland, SPH researcher and lead author. “However, because the CHW position is a newer role within many public health agencies, little research has been conducted on CHW recruitment and retention strategies. Improving organizational support, satisfaction with pay, and job security can significantly improve CHW retention, which may lower overall organizational costs from hiring and training, enhance organizational morale, and promote community health through continued trust and relationships between CHWs and community members.”

The paper includes action items that public health agencies could adopt to improve the retention of CHWs, including sufficient training on workplace technology, more opportunities for career and professional development, prioritizing diversity, equity and inclusion in hiring, and targeting healthy equity programs toward historically marginalized communities.