"I feel like my job is to give patients hope" - perspectives of Community Health Workers and employers in Iowa: a mixed methods study.

Introduction: Community Health Workers (CHWs) play a crucial role in extending health services, particularly for people who are medically underserved. Despite efforts to expand CHW programs nationally and in Iowa, challenges persist in defining their roles and responsibilities. Few studies have considered the perspectives of both CHWs and CHW employers simultaneously.

Methods: We conducted an exploratory sequential mixed-methods study, first involving key informant interviews with CHWs and employers, which then informed the development of surveys distributed to both populations. We performed thematic analysis of qualitative data and calculated descriptive statistics of quantitative data.

Results: Key informant interviews were conducted with five CHWs and five employers. An additional 123 CHWs and 81 employers responded to the survey. From the interviews, we report six themes, including roles and responsibilities, interaction with the broader health care team, and support needed. Survey respondents reported 69 unique job titles, a wide range of populations served, and diverse training needs. Despite 93.6% (n = 102) of CHWs receiving on-the-job training, 48% (n = 52) indicated they would still benefit from more training to be effective in their roles. 46% (n = 21) of employers reported unstable funding as a major barrier to program implementation.

Discussion: CHWs in Iowa felt supported and valued as members of the care team, yet challenges to growing the CHW workforce remain. Our findings highlight the need for continued role definition of the CHW workforce, as well as the need to establish more sustainable sources of funding to ensure the continuity and expansion of this health equity-enhancing workforce.