“This is what community care looks like:” emotional labor and relational care among U.S. community health workers

Community Health Workers (CHWs) play a critical role in advancing health equity by bridging the gap between health systems and the communities they serve. Although research on CHWs in the US has focused primarily on health outcomes and return on investment, less is known about CHWs' engagement in emotional labor and how they may be impacted by the emotional demands of their work. This ethnographic study examined how CHWs employed in one metropolitan area in the Mountain West experienced and made sense of their daily roles. We used a multimethod research design that included field observations, respondent diaries, semi-structured interviews, and participatory data analysis workshops to explore CHWs' relationship-building practices, emotional experiences, and strategies for sustaining themselves in their work. Findings highlight that emotional labor and relational caregiving were central components of CHW practice, including expressing empathy, validating clients' experiences, and persisting through systemic barriers while managing their own emotional responses. CHWs described both fulfillment and strain in navigating clients' needs within fragmented healthcare and social systems and often felt responsible for addressing structural inequities beyond their control. They managed these emotional demands through self-sustaining activities and peer connection and problem-solving. Drawing on social reproduction theory, we argue that CHWs’ emotional and relational labor constitutes a form of essential yet undervalued care work that sustains community well-being and public health systems. Recognizing and resourcing this labor is critical to workforce retention, program sustainability, and equitable health system transformation.