Predictors to Burnout Faced By Community Health Workers in New York State

Background: Provider burnout prevention is widely accepted as the fourth of the ‘quadruple aim’ of health care reform, however burnout among Community Health Workers (CHWs) has yet to be studied. CHWs have a personal and emotional contact with clients and often share similar live experiences. Moreover, physical demands of going door-to-door to households further place them at risk for burnout. During COVID-19, CHWs ensured that clients’ basic needs were met, and witnessed deaths of family members and clients. Turnover rates are disproportionately high among CHWs, reaching as high as 50% within the first year of employment (Health Leads, 2021). With the expansion of the CHW workforce through funding from the Coronavirus Aid, Relief, and Economic Security (CARES) Act, it becomes imperative to examine predictors to burnout to determine workplace interventions for the retention and well-being of this workforce.

Methods: We conducted an online survey of 75 CHWs employed across 17 community-based agencies in New York State. CHWs who participated in this study were funded by the Maternal Infant Community Health Collaborative (MICHC) program, which is focused on improving maternal and infant health outcomes as well as reducing the racial, ethnic, and economic inequities. Our exploratory study sought to investigate predictors (race, ethnicity, age, job retention, caseload, hours worked, job satisfaction, role clarity, self-efficacy, physical health, Generalized anxiety disorder, and adverse childhood experience) to burnout, secondary stress trauma, and compassion satisfaction. Descriptive statistics were performed. Linear regression was used to investigate the correlates of burnout, secondary stress trauma, and compassion satisfaction. Correlates of burnout included: race, ethnicity, age, job retention, caseload, hours worked, job satisfaction, role clarity, self-efficacy, physical health, GAD, and adverse childhood experiences. Analyses were conducted using SAS 9.4.

Results: The majority of our sample identified as non-Hispanic (80%), White (66.67%), and females (97.33%) with an average age of 40.13 years old; 73.33% made a gross annual income between $25,000-49,999. Participants in our study mostly worked in agencies located in the West, Central, or Capital Region of New York state (65.33%). The average age was about 40.13 (SD=11.54) years old. After controlling for covariates, CHWs with more GAD (β=1.44, p=0.01) and lower job satisfaction (β = -0.10, p<0.001) were more likely to have a higher burnout score. Higher GAD category (β=2.44, p=0.005) and lower job satisfaction (β= -0.1, p=0.02) were also associated with higher secondary stress trauma. CHWS that tend to be work more than 35 hours were less likely to have higher compassion satisfaction (β= -3.34, p=0.02).

Implications: Licensed social workers and Registered nurses serve as CHWs supervisors and hold management positions for CHW programs. Our study proposes the need for greater organizational supports, such as lower caseloads, frequent supervision check-ins, well-being programs, and employee appreciation events. Our study also proposes for greater advocacy to enhance funding for CHW programs so CHW salaries are increased and health care benefits are offered so they could access mental health services. Further qualitative interviews are needed to understand the association between higher levels of GAD, and burnout and secondary stress trauma.