Community Health Worker Roles, Regulation and Growth in Rural America

Research center:
Lead researcher:
Project funded:
September 2018
Project completed:
November 2019

Growing bodies of research in public health point to Community Health Workers (CHWs) as vital figures in ensuring access to care in a cost-effective manner. By engaging with patients to bridge the gap between the public and needed services, CHWs are positioned to help enhance patient knowledge and improve individual responsibility for care.

Critically, the number of CHWs working throughout the U.S. has increased dramatically in recent years. Understanding this growth and its impact on our health system is an important area of inquiry. Our research worked to work to understand the impact that the growing number of CHWs nationwide has had on healthcare in the U.S. Through a series of focus groups in rural and urban environments nationwide, we better understand the variety of roles that CHWs play, the ways in which they help individuals access care, and their recommendations for improving patient engagement and responsibility. We were particularly interested in how these factors varied across rural and urban environments. In addition, we took what we learned from these focus groups and developed a survey on health access to be administered to CHWs nationwide.

Through this survey and the focus groups, we gained important insight into the varied roles of CHWs in health access in rural and urban environments across the U.S. Furthermore, we used a legal analysis to study the growing regulatory frameworks states are developing that relate to CHWs and the relationship between these regulations and the increasing numbers of CHWs in states across the country. Some states have established regulations related to CHW infrastructure, professional identity, workforce development, and financing. We investigated how states have differentially treated each of these regulatory components and how this relates to trends in CHW employment. In particular, we analyzed this relationship across metropolitan and non- metropolitan areas.


  • Community Health Worker Roles and Responsibilities in Rural and Urban America
    Policy Brief
    Southwest Rural Health Research Center
    Date: 11/2019
    The primary aim of this study was to understand the evolving profession of community health workers (CHWs) in the U.S. Through focus groups in rural and urban regions of four states, we explored CHW roles and responsibilities, the growing professionalization of the field, and evolving interactions between CHWs and other care providers.
  • Community Health Worker Roles and Their Evolving Interprofessional Relationships in the United States
    Journal Article
    Southwest Rural Health Research Center
    Date: 10/2021
    This project analyzes the evolving integration of Community Health Workers (CHWs) into the United States healthcare system. CHWs can aid patients in navigating the complex nature of medical services. Through focus groups with CHWs, three stages in the interprofessional relationships between CHWs and other care providers were identified.
  • Community Health Worker Sustainability: Funding, Payment, and Reimbursement Laws in the United States
    Journal Article
    Southwest Rural Health Research Center
    Date: 04/2021
    Recent changes have been made to community health worker (CHW) funding at the federal level, but payment structures vary from state to state. This paper aims to identify funding mechanisms that would enable CHW programs to sustain a robust workforce.