Having a Say Matters: The Association Between Home Health Aides’ Voice and Job Satisfaction

Mara Bensson-Ravunniarath, Joanna Bryan Ringel, Ariel Avgar, Faith Wiggins, Ann Lee, Margaret V. McDonald, Lourdes R. Guerrero, John Kallas, Geoffrey Gusoff, Megan Shen, Emily Tseng, Nicola Dell, Sara Czaja, Lee A. Lindquist, Madeline R. Sterling

Research output: Contribution to journalArticlepeer-review


Purpose: Despite a rapidly growing need for home health aides (HHAs), turnover rates are high. While this is driven in large part by the demanding nature of their work and low wages, another factor may be that HHAs are often not considered part of the medical team which can leave them feeling unheard by other healthcare professionals. We sought to determine whether this concept, or HHAs’ perceived voice, was associated with job satisfaction. Methods and Design: This cross-sectional survey of English-and Spanish-speaking HHAs caring for adults with heart failure (HF) was conducted from June 2020 to July 2021 in New York, NY in partnership with a labor management fund of a large healthcare union that provides benefits and training to HHAs. Voice was assessed with a validated 5-item scale (total score range 5 to 25). Job Satisfaction was assessed with the 5-item Work Domain Satisfaction Scale (total score range 5 to 35). Multivariable linear regression analysis was used to examine the association between voice and job satisfaction. Results: A total of 413 HHAs employed by 56 unique home care agencies completed the survey; they had a mean age of 48 years, 97.6% were female, 60.2% were Hispanic, and they worked as HHAs for a median of 10 years (IQR, 5, 17). They had a median Voice score of 18 (IQR 15–20) and mean job satisfaction score of 26.4 (SD 5.6). Higher levels of voice (1.75 [0.46–3.04]) were associated with greater job satisfaction (p=0.008). When adjusting for Race/Ethnicity, HF training, and HF knowledge, the association between Voice and job satisfaction remained significant ((1.77 [0.40–3.13]) Conclusion: HHAs with a voice in the care of their patients experienced greater job satisfaction. Voice may be an important target for interventions aiming to improve HHAs’ retention in the field.

Original languageEnglish (US)
Pages (from-to)1791-1800
Number of pages10
JournalRisk Management and Healthcare Policy
StatePublished - 2023
Externally publishedYes


  • communication
  • healthcare team
  • home health aide
  • long-term care

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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