Factors influencing the retention and attrition of community health aides/practitioners in Alaska

J Rural Health. 2004 Summer;20(3):221-30. doi: 10.1111/j.1748-0361.2004.tb00032.x.


Context: The Community Health Aide Program (CHAP) is a unique program employing local, indigenous peoples as primary care nonphysician providers in extremely remote frontier, tribal Alaskan communities. With attrition rates up to 20%, recommendations for improving retention are necessary to maintain access to health services for Alaska Natives in these communities.

Purpose: The purpose of this study was to identify factors contributing to retention in Alaska's CHAP program.

Methods: Key informant interviews were conducted with 41 community health aides/practitioners (CHA/Ps) in 15 villages statewide. Efforts were made to ensure the sample included a mix of villages with high retention of health aides and villages with lower retention. Geographic and ethnic diversity were also considered. Transcripts were coded using NUD*IST software, and data were analyzed for differences between high retention and low retention villages and between more experienced and less experienced CHA/Ps.

Findings: Five fundamental needs of health aides were identified as crucial for retention of personnel. These needs include strong co-worker support, access to basic training, a fully staffed clinic, good community support, and supportive families.

Conclusions: For 35 years, the CHAP program has worked to diminish health disparities for Alaska Natives. Though unique challenges associated with the job have factored into low retention of CHA/Ps, improved retention is possible with easier access to basic training, increased support from colleagues and community, enhanced team-building skills, and better on-call schedules.

MeSH terms

  • Adult
  • Alaska
  • Community Health Services*
  • Community Health Workers / education
  • Community Health Workers / supply & distribution*
  • Community Networks / statistics & numerical data
  • Female
  • Health Services, Indigenous*
  • Humans
  • Indians, North American / statistics & numerical data*
  • Interprofessional Relations
  • Male
  • Middle Aged
  • Personnel Turnover / statistics & numerical data*
  • Professional Role
  • Qualitative Research
  • Social Support
  • Workforce