Date of Completion


Embargo Period



Stress, health knowledge, health behavior, community health workers

Major Advisor

Nicholas Warren, ScD

Associate Advisor

Thomas Babor, PhD

Associate Advisor

Vicki J. Magley, PhD

Associate Advisor

Timothy Morse, PhD

Associate Advisor

Richard Stevens, PhD

Field of Study

Public Health


Doctor of Philosophy

Open Access

Campus Access


Community health workers act as intermediaries between health care providers and patients. CHWs often reside in the same community as their patients and have an intimate knowledge of the social and economic factors driving their health beliefs and health behaviors. CHWs employ their knowledge to help patients overcome barriers to accessing health care. To date, existing research on CHWs in the United States has focused on their inclusion in health care teams as a cost-saving strategy, preventing hospital readmissions and emergency room visits. There has been extensive research on the use of CHWs in health interventions. The research on CHW work experiences is much more limited. There is still a need for research on work stress experienced by CHWs, as well as the effect of work stress on both the health outcomes, and job performance of CHWs. It is not clear the impact of work stress on the health behaviors of CHWs and their ability to model good health to their clients. Work stress that negatively affects the health behavior of CHWs in turn negatively affects CHW job performance. This study used a cross-sectional design to investigate the effect of work stress on the health behaviors of CHWs in 49 U.S. states. The CHWs (n = 438) completed a survey that assessed their organizational and job level stressors, stress experiences and stress outcomes. The study also investigated the health beliefs, the health behaviors and role efficacy (job performance) of CHWs. Confirmatory Factor analysis, Structural Equation Modeling and Path Analysis were used to analyze the data. Work stress was positively associated with negative health behaviors, negatively associated with the use of formal health systems, positively associated with the use of informal health services and Systems, and positively associated with poor overall health in CHWs. In addition, work stress was negatively associated with role efficacy in CHWs. Work stress therefore appears to have a negative impact on both the health outcomes and job performance of CHWs. This research lays the foundation for future research on interventions to support CHWs.