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Table 2 Qualitative findings about CHW certification from CHW, program manager, and system-level participants

From: Don’t change who we are but give us a chance: confronting the potential of community health worker certification for workforce recognition and exclusion

Common themes Illustrative quote
1) Certification may enhance recognition of CHWs from health care providers and the community
Certification could validate CHW work and provide recognition from health care providers “[Health care providers] have better education, have better licensing, and better certifications. They don't see us like we belong. They make us feel like we're not important, we're not capable of doing what we do.”
Certification could help CHWs more effectively deliver information within their community by strengthening their credibility “Creating a certification gives the person who is receiving the information the assurance that you are saying things correctly.”
2) Certification may offer more upward mobility and professional growth for CHWs
Unified training and consensus about core CHW skills and knowledge could create the foundation for the professionalization of the CHW workforce in the state “[CHWs are] not all the same depending on who trained them and what they’ve got. This uneven training could open the workforce to outside criticism, as employers may speculate: “‘You’re missing some basic skills, but yet you’ve been a CHW for 10 years.’”
Certification may result in career mobility “CHWs will get hired and trained for one specific job, and then that job ends. Then they have to start from scratch and they just have whatever job they can find.”
Certification could lead to higher compensation and an established pay rate “It’s not that money is important, I have 15 years of being a promotora and, believe me that all promotoras, yes, it is the love for the work, but we would be at a more recognized level [if we earned money.]”
3) Certification may threaten CHW identity
Certification may dissolve the identity of CHWs and promotores de salud and push them into a more clinical role “Institutions were under some pressure to get people into their program, and they were recruiting some people who might have been inappropriate for the work. They were certified, but they weren’t really CHWs. They were not from the community. They didn’t have anything in common with the community, but they had the training, and so they were entitled to call themselves certified CHWs, even though the community would probably look at them and say, ‘You’re not a CHW. You got a piece of paper, but you’re not a CHW. You’re not from here.’”
Tension between clinically focused and community-based roles could exacerbate identity differences between CHWs and promotores de salud in a state with no universal definition of CHWs “We have never thought of a certification because we never thought of receiving money for our service. It’s always volunteer, we always do everything from the heart.”
Certification may create a hierarchy between certified and non-certified CHWs “We have the entitlement piece where it’s like, ‘I’m certified and you’re not so I’m better at my job.’ That’s going to be a barrier, unfortunately.”
4) Certification may exclude some current or potential CHWs due to entry requirements
Certification could exclude CHWs from working in their communities “When you’re certifying people,” one CHW shared, “you’re limiting other groups of people getting the job done. You think it’s best for them, but when you get the certification you have to be literate, able to learn, be multi-tasking. It requires a little bit more steps that other people are not willing to do.”
Certification could exclude CHWs without legal residence “They’re already facing racism, xenophobia, ICE [Immigration and Customs Enforcement] raids, and they don’t want to see this profession move along without remembering the unique contributions that they make in our state, and they’re worried particularly that certification will leave them behind.”
Certification could exclude CHWs with a history of incarceration “Society [holds] stigma against people who are incarcerated,” noted one system-level participant, “There’s some really great people there, who have had this experience, who can turn it around and really help others and, that’s what makes them so successful.”
Certification could place more emphasis on state requirements than the vital social skills of connecting with communities “[Training requirements] would actually knock a lot of people out of the workforce who actually demonstrated that they were great at connecting with [high-risk and high-needs patients].”