Sustaining Community Health Workers through State Policies

Background/Purpose: Sustaining community health worker (CHW) programs is essential for reducing health disparities, particularly in underserved populations. There are various state-level policies that play a pivotal role in shaping the CHW workforce, including statewide definitions, credentialing frameworks, and financial support mechanisms. Evidence suggests these policies can facilitate the integration of CHWs into public health systems. This study seeks to address the following research questions: (1) Do CHW core role performance levels differ based on policy type (CHW association, certification, advisory board)? (2) Do CHW core role performance levels differ depending on whether CHWs complete administrative duties remotely or in person (work mode)? (3) Does the effect of state policies on CHW core role performance vary by CHWs’ work mode?

Methods: This cross-sectional study combines two data sources: (1) individual-level CHW survey data collected across multiple sites funded by the CDC Community Health Workers for COVID Response and Resilience Communities (CCR) initiative and (2) state-level policy data retrieved from public records. The analysis focuses on CHW participants (n=314) from 16 project sites, spanning five states: Ohio, New Mexico, Illinois, California, and Arizona. Participants were grouped based on the presence of state-level CHW infrastructure:

• Control group (n = 51) CHW association
• Group 1 (n = 112) CHW association and a certification program
• Group 2 (n = 60) CHW association and an advisory board
• Group 3 (n = 91) with all three components

To examine group differences in CHW core role performance, a 4 X 2 factorial analysis of covariance (ANCOVA) was conducted. The outcome measure consisted of 10 items assessing the frequency with which CHWs engaged in each of 10 CHW core roles as part of their CCR project activities.

Results: The effect of policy infrastructure was significant, F (3, 226) = 4.13, p = .007 (η² ≈.05). The interaction between policy infrastructure and work mode was also significant, F (3, 226) = 2.70, p = .046, meaning that the state policy effects on performing the CHW core roles were moderated by work mode. Notably, this effect was most evident in that Group 3 CHWs outperformed the Control Group while working from home (M = 5.06, SE = 1.29, p < .001).

Conclusions/Implications: This study underscores the importance of policy infrastructure in supporting CHW core role performance, particularly among those who complete administrative duties remotely. CHWs working in states with state-level policies for a certification program and advisory board had significantly higher performance scores than those CHWs who conduct administrative tasks remotely in states with only a CHW association. This suggests formal structures offer critical training, guidance, and accountability without direct workplace engagement. CHW associations alone, while valuable for networking and advocacy, may not provide sufficient support for remote CHWs who lack access to informal peer learning. Public health agencies should prioritize the development of comprehensive CHW infrastructure—such as certification programs and advisory boards—in states where administrative CHW work is remote. Additionally, CHW associations may benefit from integrating structured training, supervision, or digital platforms to better support remote workers.