Abstract
Policy Points Community health workers (CHWs) recognize that health care and public health institutions and representatives value their roles, but these institutions are often unaware of the labor required to obtain the expertise that CHWs leverage. Despite a recognition of the value of the CHW role, CHWs feel their roles are not properly compensated or acknowledged, and they face other structural barriers that perpetuate the precarity of the role. As the CHW landscape for compensation and certification changes, these conditions need to be considered to better support and sustain this workforce. CONTEXT: Community health workers (CHWs) are frontline public health workers who support the well-being and capacity building of residents disproportionately affected by health inequities. The purpose of this study is to examine diverse perspectives on the conditions for CHW success as CHWs were engaged in rapidly implemented, highly responsive education, vaccination, and recovery efforts during the COVID-19 pandemic in a large county in Southern California. METHODS: The Community Activation to Transform Local Systems (CATALYST) study leveraged a community-based participatory research approach to conduct a case study of CHW COVID-19 responses in Orange County, California. From 2023 to 2024, we conducted 16 semistructured, in-depth interviews and eight focus group discussions with CHWs (n = 60). Interviews and focus group discussions were recorded, transcribed, and analyzed following an adapted flexible coding approach, including inductive and deductive codes. FINDINGS: Findings highlight three key themes: 1) CHWs recognize that institutions value their expertise and capacity to build connections with community members, 2) CHWs' labor to build their expertise often goes unacknowledged, and 3) CHWs face financial and structural constraints that undermine the value ascribed to their contributions. Despite this, CHWs stress the importance of proper recognition and fair compensation to reflect the critical role CHWs serve in advancing community health. CONCLUSIONS: Institutions recognize CHWs' impact; however, CHWs feel that the aspects of their work that build their expertise often go unnoticed and undervalued. To sustain CHWs as integral members of the public health workforce, especially during crises and recovery, institutions need to recognize the full extent of CHW roles and provide adequate financial and structural support essential to preserve the model's viability and impact. Findings from this case study may inform policies and practices for governmental and health care systems that rely upon and contract with CHWs to mitigate health inequities. Such practices include evolving CHW accreditation and reimbursement policies and initiatives.