Community Health Workers' Involvement In Policy and Decision Making

Background and Purpose:

Community Health Workers (CHWs) are frontline public health professionals, who serve as a trusted bridge between community members and healthcare-, social-, and behavioral health-services, while also advocating for community health needs. Although advocacy is at the heart of a CHWs’ job, CHWs face numerous barriers (e.g., limited funding, minimal institutional support, workplace discrimination) that can hinder their ability to effectively engage in advocacy. There is a lack of research on the factors that enhance CHWs’ engagement in advocacy. The current paper fills this gap by examining how demographic factors (e.g., gender, race), organizational characteristics (e.g., type of organization, salary), workplace experiences (e.g., supervision, discrimination), and involvement with CHW networks impact CHW participation in policy and decision-making.

Methods:

Between 2021 and 2024 the Community Health Workers for COVID Response and Resilient Communities (CCR) program provided more than funding to 67 recipients across the U.S. to mobilize CHWs in COVID-19 public health response efforts and to build community resilience (DeJesus et al., 2024). Data for the current study came from a survey of CCR CHWs collected as part of the national evaluation of the CCR program. The CHW survey was a digital, web-based survey completed by 689 CCR-funded CHWs.

The following measures were included in the current study: CHW demographics, CHW employer organization type, hourly wage, supervisor attitudes and characteristics (modified version of CHW Common Indicator #12), influence of racism and discrimination (modified version of CHW Common Indicator #5), involvement with CHW Networks, and CHW involvement in decision- and policy-making (CHW Common Indicator #4).

The data were analyzed using hierarchical multiple regression, with a total of four blocks of independent variables (i.e., CHW Demographics, Organization Characteristics, Experiences with Supervisors and Colleagues, and Involvement with CHW Associations) regressed onto the dependent variable CHW Involvement in Decision- and Policy-Making.

Results

Results of the hierarchical multiple regression indicated that CHW-reported involvement with CHW associations or networks was the strongest predictor of CHW involvement in decision- and policy-making. In addition, CHWs who identified as being economically disadvantaged were significantly less likely to report involvement in decision- and policy-making, whereas CHWs who reported experiencing incarceration were significantly more likely to report involvement in decision- and policy-making. As reported wages increased, CHWs reported greater involvement in decision- and policy-making. Positive supervisor attitudes and characteristics was significantly and positively associated with CHW involvement in decision- and policy-making.

Conclusions and Implications

Involvement with CHW associations/networks was the strongest predictor of CHW involvement in decision and policy-making. It is possible that participation in CHW networks enhances CHWs’ professional identity and provides opportunities to engage in policy and decision-making. In terms of workplace conditions, higher wages and supportive supervision experiences may be indicative of organizations that highly value CHWs, which may also mean that these employers build decision/policy making into CHW job duties. A key takeaway from this study is the importance of increasing CHWs’ participation in associations and networks to increase engagement in advocacy. Implications for advocacy partnerships between CHWs and social workers are discussed.