Author ORCID Identifier
https://orcid.org/0000-0003-2173-8437
Defense Date
2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Social Work
First Advisor
Denise Burnette, PhD
Second Advisor
Dina Garcia, PhD
Third Advisor
Kyeongmo Kim, PhD
Fourth Advisor
Yifan Lou, PhD
Abstract
Community health workers (CHWs) are trusted, community-embedded members of the public health workforce, yet little is known about their knowledge, attitudes, and practices (KAP) regarding end-of-life (EOL) care. This explanatory sequential mixed-methods study examined the EOL knowledge, attitudes, and practices of CHWs in Virginia and the cultural, structural, and professional factors that shape them. In the first phase, 137 CHWs were surveyed, with a complete-case sample of 60 for the multivariate models, on palliative care knowledge, hospice knowledge, hospice attitudes, EOL practices and confidence, and sociodemographic and professional characteristics. Forward stepwise regression served as the primary analysis, complemented by elastic net and non-parametric robustness checks, small-sample-corrected effect sizes, and a minimum detectable effect size analysis appropriate to the sample. In the second phase, two focus groups and one individual interview (N = 9) were analyzed using reflexive thematic analysis, interpreted through the socioecological model and critical race theory, and integrated with the survey findings through joint displays.
Participants held moderately high knowledge (palliative care knowledge M = 9.65 of 13; hospice knowledge M = 16.41 of 23) and favorable attitudes (M = 35.79 of 40) yet reported low confidence in performing specific EOL tasks. Objective knowledge was the most consistent and modifiable predictor and was strongly associated with attitudes, whereas practice frequency was not predicted by knowledge, attitudes, or any other individual-level characteristic measured here, and practice confidence rested primarily on the capacity to cope with death. Language group produced the largest differences, identifying culturally and linguistically grounded outreach as a priority. Six qualitative themes elaborated these patterns: cultural and spiritual frameworks shape who can be told they are dying, with CHWs mediating across them; emotional labor is constitutive of the work; CHWs enact a relational bridge that is itself a form of access; training must scaffold rather than replace relational expertise; silence around death is structural, and language is a strategic workaround; and equitable care entails ongoing moral work. Much hospice avoidance stemmed from gaps in information that better access and communication could address, rather than from incompatible values.
As a preliminary study, the work is positioned to generate hypotheses and effect-size estimates to inform future intervention research rather than to support broad prediction. The findings indicate that hands-on, role-specific EOL training, combined with employer support and culturally and linguistically tailored design, is a promising way to prepare CHWs to expand equitable access to end-of-life care. The study contributes one of the first applications of the full KAP model to CHWs in EOL care and offers a multilevel, equity-focused foundation for workforce development.
Rights
© Matthew R. Morgan
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
8-7-2026
Included in
Community Health and Preventive Medicine Commons, Gerontology Commons, Health Policy Commons, Health Services Research Commons, Palliative Care Commons, Race and Ethnicity Commons, Social Work Commons