"I feel like my job is to give patients hope" - perspectives of Community Health Workers and employers in Iowa: a mixed methods study

Amanda M Sursely; Debra Kazmerzak; William Appelgate; Laurie M Walkner; Samra Hiros; Roger Hileman; Heidi Haines; Rima A Afifi

doi:10.1186/s12913-025-12536-9

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"I feel like my job is to give patients hope" - perspectives of Community Health Workers and employers in Iowa: a mixed methods study

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"I feel like my job is to give patients hope" - perspectives of Community Health Workers and employers in Iowa: a mixed methods study

Amanda M Sursely, Debra Kazmerzak, William Appelgate, Laurie M Walkner, Samra Hiros, Roger Hileman, Heidi Haines and Rima A Afifi

BMC health services research, Vol.25(1), 386

03/15/2025

DOI: 10.1186/s12913-025-12536-9

PMCID: PMC11910000

PMID: 40089724

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Abstract

Community Health Workers (CHWs) play a crucial role in extending health services, particularly for people who are medically underserved. Despite efforts to expand CHW programs nationally and in Iowa, challenges persist in defining their roles and responsibilities. Few studies have considered the perspectives of both CHWs and CHW employers simultaneously.INTRODUCTIONCommunity Health Workers (CHWs) play a crucial role in extending health services, particularly for people who are medically underserved. Despite efforts to expand CHW programs nationally and in Iowa, challenges persist in defining their roles and responsibilities. Few studies have considered the perspectives of both CHWs and CHW employers simultaneously.We conducted an exploratory sequential mixed-methods study, first involving key informant interviews with CHWs and employers, which then informed the development of surveys distributed to both populations. We performed thematic analysis of qualitative data and calculated descriptive statistics of quantitative data.METHODSWe conducted an exploratory sequential mixed-methods study, first involving key informant interviews with CHWs and employers, which then informed the development of surveys distributed to both populations. We performed thematic analysis of qualitative data and calculated descriptive statistics of quantitative data.Key informant interviews were conducted with five CHWs and five employers. An additional 123 CHWs and 81 employers responded to the survey. From the interviews, we report six themes, including roles and responsibilities, interaction with the broader health care team, and support needed. Survey respondents reported 69 unique job titles, a wide range of populations served, and diverse training needs. Despite 93.6% (n = 102) of CHWs receiving on-the-job training, 48% (n = 52) indicated they would still benefit from more training to be effective in their roles. 46% (n = 21) of employers reported unstable funding as a major barrier to program implementation.RESULTSKey informant interviews were conducted with five CHWs and five employers. An additional 123 CHWs and 81 employers responded to the survey. From the interviews, we report six themes, including roles and responsibilities, interaction with the broader health care team, and support needed. Survey respondents reported 69 unique job titles, a wide range of populations served, and diverse training needs. Despite 93.6% (n = 102) of CHWs receiving on-the-job training, 48% (n = 52) indicated they would still benefit from more training to be effective in their roles. 46% (n = 21) of employers reported unstable funding as a major barrier to program implementation.CHWs in Iowa felt supported and valued as members of the care team, yet challenges to growing the CHW workforce remain. Our findings highlight the need for continued role definition of the CHW workforce, as well as the need to establish more sustainable sources of funding to ensure the continuity and expansion of this health equity-enhancing workforce.DISCUSSIONCHWs in Iowa felt supported and valued as members of the care team, yet challenges to growing the CHW workforce remain. Our findings highlight the need for continued role definition of the CHW workforce, as well as the need to establish more sustainable sources of funding to ensure the continuity and expansion of this health equity-enhancing workforce.

Community health workers

Mixed methods

Iowa

Scope of practice

Healthcare team

Details

Title: Subtitle: "I feel like my job is to give patients hope" - perspectives of Community Health Workers and employers in Iowa: a mixed methods study
Creators: Amanda M Sursely - University of Iowa
Debra Kazmerzak
William Appelgate
Laurie M Walkner - University of Iowa
Samra Hiros - Iowa Department of Public Health
Roger Hileman - University of Iowa
Heidi Haines - University of Iowa
Rima A Afifi - University of Iowa
Resource Type: Journal article
Publication Details: BMC health services research, Vol.25(1), 386
DOI: 10.1186/s12913-025-12536-9
PMID: 40089724
PMCID: PMC11910000
NLM abbreviation: BMC Health Serv Res
ISSN: 1472-6963
eISSN: 1472-6963
Publisher: BMC
Grant note: Health Resources and Services AdministrationIowa CHW Alliance
The authors would like to acknowledge the guidance and support provided to this project from the Iowa CHW Alliance. We also would like to extend our gratitude to the CHWs and CHW employers who took time to be interviewed and to complete the survey. We appreciate the work that you all do in support of community health.The authors also extend their thanks to anonymous peer reviewers for comments that strengthened the manuscript.
Language: English
Date published: 03/15/2025
Academic Unit: Institute for Public Health Practice, Research and Policy; Injury Prevention Research Center; Community and Behavioral Health
Record Identifier: 9984799678702771

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