A cross-sectional survey of community health workers and their roles in Indiana

Abstract

Background: In the US, there is a lack of information about the community health worker (CHW) workforce, which is critical to inform workforce policy, development, and training initiatives. In this manuscript, we report the results of a cross-sectional workforce survey of CHWs in Indiana. Methods: We conducted a statewide electronic survey of CHWs in Indiana. Eligible participants were self-reported CHWs and over the age of 18. The survey was adapted from an existing tool and included questions about CHWs' demographics, employer, compensation, and roles and responsibilities. The survey was pilot-tested and distributed in partnership with the state's CHW professional association. Data were collected anonymously using REDCap. Bivariate correlations were examined between salary and demographics, employer type, training, and length of employment. Analyses were conducted using SAS version 9.4. Results: Among 282 participants that met eligibility, a majority were female (92%) with 39% identifying as Black/African American, 38% as White, and 13% as Hispanic/Latino. Over 40% held at least a Bachelor's degree, and 20% were multilingual. CHWs worked under various job titles - only half reported that their official job title was as a CHW - and for a variety of organizations with about half working for either a health system or academic employer. Respondents had a median of 2 years of experience as a CHW. The majority of CHWs were employed full-time (85%) and had completed a training program (83%). Their scopes of practice varied but CHWs were most engaged in activities related to culturally relevant communication, care coordination, coaching, and social support. Lower salary was significantly associated with less education and working as a CHW for less than one year, but not with other demographic characteristics, employer type, or having completed a training program. Conclusion: This study offers a snapshot of Indiana's CHW workforce, highlighting that it is predominantly female but diverse demographically, in employment setting, job title, and roles played. The findings provide insights to guide workforce development and planning efforts by employers, professional associations, health departments, and policymakers to strengthen and expand this essential workforce in Indiana and beyond.