Measuring Clients' Satisfaction and Trust in Community Health Workers: Results From a Cross-Sectional Survey

Community health workers (CHWs) are widely deployed in the United States to support the health of underserved communities, yet little is known about the extent to which clients of CHWs are satisfied with the services they receive and their level of trust with their CHWs. We assessed levels of trust, satisfaction, and feelings of empowerment of clients served by CHWs.

We conducted a cross-sectional survey among clients of CHWs employed at health care and community-based organizations throughout New Jersey between June and July 2024. Client trust was measured using the Trust in CHWs Scale, assessing subscales of health care competence and respectful communication. Satisfaction was measured using a 4-point Likert scale. Empowerment was measured using the Influence of CHWs on Empowerment Scale. We used multiple linear regression models to examine predictors of client trust in CHWs.

Seventy-five participants completed the survey (89% women; 37% Latino; 40% Black; 17% White). Among participants, 100% reported that they trusted the information their CHW provides, 97.4% were very or somewhat satisfied with the services they received, and 89% reported that they can make better decisions about their health because of their interactions with their CHWs. While overall levels of health care competence (mean 3.3 out of 4) and respectful communication (mean 3.4 out of 4) were high, housing insecurity, being uninsured, and being disabled were associated with significantly lower scores on subscales. Clients who had more frequent interactions with their CHWs had greater levels of trust in their CHWs.

In the current era of medical mistrust, our findings support CHWs as essential public health workers who promote trusted health information to underserved communities. Unmet social needs, such as housing insecurity, may lower clients' assessment of satisfaction and trust in CHWs. Findings underscore the importance of alignment and integration of CHW programs with health and social care systems to address the social determinants of health.