Community Health Workers' Roles and Challenges in Wisconsin: A Mixed-Methods Study.

Community health workers (CHWs) play a critical role in addressing social determinants of health and bridging gaps between communities and healthcare systems, yet limited research has examined how CHWs perceive their roles, integration within healthcare systems, and implementation challenges within specific state-level contexts. We conducted a sequential mixed-methods study consisting of an anonymous statewide online survey of CHWs in Wisconsin followed by two virtual focus group discussions. Survey data were analyzed descriptively. Focus group transcripts were analyzed using team-based inductive thematic analysis. Forty CHWs completed the survey, most of whom were female (98%) and worked in community-based or nonprofit settings. Participants commonly provided advocacy, health education, referrals to services, and navigation of social needs, with focus on chronic disease, mental and behavioral health. Although 84% rated their impact on patient outcomes as high to very high, 74% reported low to neutral levels of professional recognition. Major challenges included lack of funding, limited professional recognition, and inadequate resources. Five qualitative themes emerged: multifaceted CHW roles, bridging healthcare systems and communities, persistent structural barriers, navigating professional identity and recognition, and sustaining commitment amid limited institutional support. Despite high perceived impact, CHWs in Wisconsin experience limited recognition, funding instability, and inconsistent integration into healthcare systems. Addressing these barriers through professional pathways and sustainable financing mechanisms is essential to strengthening CHW workforce integration and long-term system impact.