University of Minnesota: State and Local Public Health Departments Experience Departure of Community Health Workers

Community health workers are the frontline members of the U.S. public health workforce. They’re also among the most diverse part of that workforce — about 40% are non-white, and that number is increasing.

While previous studies 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 community health workers.

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

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

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

“Community health workers are essential to our nation’s public health workforce,” said Chelsey Kirkland, a researcher at SPH and lead author. “However, because this is a newer role within many public health agencies, little research has been conducted on recruitment and retention strategies that could lower overall organizational costs from hiring and training, enhance organizational morale and promote community health through continued trust and relationships between community health workers and community members.”

The researchers include action items that public health agencies could adopt to improve the retention of community health workers, 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.