Perceived barriers, facilitators, and workforce recommendations from community health workers in Nebraska

Introduction: Community Health Workers (CHWs) play a critical role in addressing health inequities and improving access to essential health services. However, their perspectives are often underrepresented in research examining their roles, challenges, and experiences within healthcare systems and communities. Objective: This study explored CHWs’ perspectives on perceived barriers and facilitators influencing healthcare service delivery and identified recommendations to strengthen workplace supports and broader CHW workforce development. Methods: A qualitative phenomenological approach was used. A purposive sample of 65 CHWs participated in nine focus groups conducted across five health agencies in Nebraska. Data were transcribed verbatim and analyzed using thematic analysis. Results: Three major themes emerged: barriers to CHW healthcare service delivery, facilitators of health promotion, and recommendations for strengthening the CHW workforce. Community-level barriers included undocumented immigration status, cultural and gender norms, language barriers, transportation challenges, financial constraints, and limited access to affordable insurance. Structural and workplace barriers included limited awareness of community resources, healthcare provider shortages, excessive documentation requirements, restrictive eligibility criteria, unclear role definitions, low pay, heavy workload, and emotional stress. Facilitators included parental education, technology use, financial incentives, job flexibility, empowerment, communication, collaboration, trust-building, and recognition. Participants recommended strengthening funding stability, prevention-focused reimbursement policies, staffing support, workload management, collaboration, and cultural competence training. Conclusion: This study highlights structural, workplace, and community-level factors significantly shape CHWs’ capacity to deliver effective services. Strengthening policy support, ensuring stable funding, improving working conditions, and integrating CHWs clearly within healthcare systems may enhance workforce sustainability and improve community-based efforts to reduce health inequities.