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


OBJECTIVE
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.


RESULTS
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.
Alaska Center for Rural Health, University of Alaska Anchorage, Alaska 99508, USA. anbml@uaa.alaska.edu
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D000328:Adult; D000413:Alaska; D003153:Community Health Services; D003150:Community Health Workers / Q000193:education / Q000600:supply & distribution*; D019058:Community Networks / Q000706:statistics & numerical data; D005260:Female; D006303:Health Services, Indigenous; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D024382:Professional Role; D036301:Qualitative Research; D012944:Social Support; D000078329:Workforce