Billimek John, Michelen Melina, Cantero Patricia J, Chirinos Noraima, Salazar Rocio, Foo Mary Anne, Peralta Samantha, Morey Brittany N, Chow Jacqueline J, Kauffman Vanessa, Donaldson Lindsay, Montiel Gloria I, Zarate Salvador, Tanjasiri Sora Park, Lebrón Alana M W
School of Medicine, University of California, Irvine.
Joe C. Wen School of Population & Public Health, University of California, Irvine.
Milbank Q. 2025 Jul 26. doi: 10.1111/1468-0009.70038.
Policy Points Community health workers (CHWs) recognize that health care and public health institutions and representatives value their roles, but these institutions are often unaware of the labor required to obtain the expertise that CHWs leverage. Despite a recognition of the value of the CHW role, CHWs feel their roles are not properly compensated or acknowledged, and they face other structural barriers that perpetuate the precarity of the role. As the CHW landscape for compensation and certification changes, these conditions need to be considered to better support and sustain this workforce.
Community health workers (CHWs) are frontline public health workers who support the well-being and capacity building of residents disproportionately affected by health inequities. The purpose of this study is to examine diverse perspectives on the conditions for CHW success as CHWs were engaged in rapidly implemented, highly responsive education, vaccination, and recovery efforts during the COVID-19 pandemic in a large county in Southern California.
The Community Activation to Transform Local Systems (CATALYST) study leveraged a community-based participatory research approach to conduct a case study of CHW COVID-19 responses in Orange County, California. From 2023 to 2024, we conducted 16 semistructured, in-depth interviews and eight focus group discussions with CHWs (n = 60). Interviews and focus group discussions were recorded, transcribed, and analyzed following an adapted flexible coding approach, including inductive and deductive codes.
Findings highlight three key themes: 1) CHWs recognize that institutions value their expertise and capacity to build connections with community members, 2) CHWs' labor to build their expertise often goes unacknowledged, and 3) CHWs face financial and structural constraints that undermine the value ascribed to their contributions. Despite this, CHWs stress the importance of proper recognition and fair compensation to reflect the critical role CHWs serve in advancing community health.
Institutions recognize CHWs' impact; however, CHWs feel that the aspects of their work that build their expertise often go unnoticed and undervalued. To sustain CHWs as integral members of the public health workforce, especially during crises and recovery, institutions need to recognize the full extent of CHW roles and provide adequate financial and structural support essential to preserve the model's viability and impact. Findings from this case study may inform policies and practices for governmental and health care systems that rely upon and contract with CHWs to mitigate health inequities. Such practices include evolving CHW accreditation and reimbursement policies and initiatives.
社区卫生工作者（CHWs）认识到医疗保健和公共卫生机构及其代表重视他们的作用，但这些机构往往没有意识到获得社区卫生工作者所利用的专业知识所需的劳动。尽管认识到社区卫生工作者角色的价值，但社区卫生工作者觉得他们的角色没有得到适当的补偿或认可，并且他们面临其他结构性障碍，这些障碍使该角色的不稳定状况长期存在。随着社区卫生工作者薪酬和认证情况的变化，需要考虑这些情况以更好地支持和维持这支劳动力队伍。
社区卫生工作者是一线公共卫生工作者，他们支持受健康不平等影响尤为严重的居民的福祉和能力建设。本研究的目的是考察在加利福尼亚州南部一个大县的新冠疫情期间，社区卫生工作者迅速开展、高度响应的教育、疫苗接种和恢复工作中，关于社区卫生工作者取得成功的条件的不同观点。
社区激活以转变地方系统（CATALYST）研究采用基于社区的参与性研究方法，对加利福尼亚州奥兰治县社区卫生工作者对新冠疫情的应对措施进行案例研究。在2023年至2024年期间，我们对社区卫生工作者（n = 60）进行了16次半结构化的深入访谈和8次焦点小组讨论。访谈和焦点小组讨论进行了录音、转录，并采用一种经过调整的灵活编码方法进行分析，包括归纳和演绎编码。
结果突出了三个关键主题：1）社区卫生工作者认识到机构重视他们与社区成员建立联系的专业知识和能力；2）社区卫生工作者为积累专业知识所付出的劳动往往未得到认可；3）社区卫生工作者面临财务和结构方面的限制，这削弱了对他们贡献的重视程度。尽管如此，社区卫生工作者强调适当认可和公平补偿的重要性，以体现社区卫生工作者在促进社区健康方面所发挥的关键作用。
机构认识到社区卫生工作者的影响；然而，社区卫生工作者觉得他们积累专业知识的工作方面往往被忽视和低估。为了将社区卫生工作者维持为公共卫生劳动力队伍的重要成员，特别是在危机和恢复期间，机构需要充分认识社区卫生工作者的角色，并提供足够的财务和结构支持，这对于维持该模式的可行性和影响力至关重要。本案例研究的结果可能为依赖社区卫生工作者并与之签约以减轻健康不平等的政府和医疗保健系统的政策和实践提供参考。此类实践包括改进社区卫生工作者的认证和报销政策及举措。
