Abstract
INTRODUCTION: Health systems depend on care workers to provide "hands-on" direct care with eating, dressing, and other needs, as well as indirect care with household tasks, meals, and transport. Care workers are in high demand to support growing populations who need help in daily life, yet they often fall outside of health human resource planning. Recruiting, supporting, and retaining the care workforce are urgent priorities for health workforce planners. METHODS: This realist synthesis review asks: Which interventions strengthen the care workforce? We systematically identified 7396 peer-reviewed sources and 481 gray literature sources, with 151 included in the review. RESULTS: The sources document a variety of interventions that strengthen the care workforce, with an emphasis on pre-service and ongoing training for care workers. There were ambitious interventions that aimed to support the care workforce on multiple fronts. CONCLUSION: Policy makers and researchers are encouraged to implement complex interventions that cover multiple factors simultaneously. We recommend focusing on legislative structures, educational oversight, and material working conditions, such as scheduling and pay, as highly promising avenues for strengthening the care workforce across multiple contexts.