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. Author manuscript; available in PMC: 2026 Apr 18.
Published before final editing as: Transl Issues Psychol Sci. 2026 Apr 16:10.1037/tps0000503. doi: 10.1037/tps0000503

Psychological Agency Attenuates the Link Between Discrimination and COVID-19 Burnout in Latine-Serving Community Health Workers

Daniela Arcos 1, Olivia Jensen 1, Christina Rowley 1, Elayne Zhou 2, Graciela Espejo 1, Dariela Espinoza Lopez 1, Veronica Naranjo 1, Lyric N Russo 1, Kelly Kazmierski 1, Jessica L Borelli 1
PMCID: PMC13089964  NIHMSID: NIHMS2146659  PMID: 42004215

Abstract

Community health workers that serve low income Latine families (Latine-serving CHWs) play a crucial role in reducing health disparities, yet frequently encounter discrimination, which may elevate their risk for burnout. Burnout not only harms these CHWs’ wellbeing but also deprives communities of the full benefit of CHWs’ service. Identifying factors that buffer against these effects, such as psychological agency, can offer valuable insights for supporting CHWs. This study examines (1) the association between discrimination and burnout among Latine-serving CHWs and (2) the role of agency as a potential buffer in the link between discrimination and burnout. Data were collected in a context of pronounced stress for CHWs: the aftermath of the acute phase of the COVID-19 pandemic. Participants (N = 81 Latine-serving CHWs) completed standardized measures of discrimination and burnout. Participants also provided discrimination narratives which were coded for psychological agency. Higher frequency of self-reported discrimination significantly predicted higher work- and COVID-related burnout. Additionally, agency moderated the association between discrimination and COVID-related burnout, such that at high levels of agency, discrimination no longer predicted COVID-related burnout. However, agency did not significantly moderate the link between discrimination and work-related burnout. Findings suggest that strengthening agency may protect Latine-serving CHWs from the adverse effects of discrimination during periods of acute external stress. Programs building on this buffer may be particularly crucial in the current period of sociopolitical hostility toward immigrant Latine communities and may have implications for workers serving other vulnerable communities.

Keywords: Psychological agency, discrimination, burnout, COVID-19, Latine, community health worker

Community Health Workers (CHWs) —frontline health workers who operate outside traditional healthcare infrastructures— possess unique insight and access into the communities they serve, often because they belong to these communities (Ingram et al., 2012). CHWs reduce health inequities by narrowing the systemic divide between historically underserved populations and health institutions (Ayala et al., 2010). Among immigrant communities, the function of CHWs may be particularly relevant, as they help individuals navigate complex healthcare systems and access essential resources through their role as advocates and cultural liaisons (Ayala et al., 2010). The COVID-19 pandemic inflicted an unprecedented strain on CHWs, and despite emerging awareness of CHWs’ crucial role in linking vulnerable communities to resources, exploring CHWs’ own experiences and well-being remains scarce.

Challenges Faced by Latine Communities

Latine1-serving CHWs, most of whom are Latine, encounter multilayered sociodemographic stressors. In the U.S., people who identify as Latine are disproportionately represented among those living in poverty and face higher rates of housing insecurity, unemployment, and healthcare inaccessibility (Brener et al., 2024; Guzman & Kollar, 2024). These challenges are often compounded for immigrants, who face added burdens such as acculturative stress, fear of deportation, and language barriers (Bekteshi & Kang, 2020; Roche et al., 2018). Importantly, racial-ethnic discrimination has been identified as a significant stressor among Latine groups, though its prevalence and impact varies depending on factors that intersect with their Latine identity, such as gender, region of origin, and acculturation level (Arellano-Morales et al., 2015).

Discrimination, the unjust or prejudicial treatment of individuals or groups based on specific characteristics (e.g., race-ethnicity), can occur at multiple levels (e.g., interpersonal, systemic) (APA, 2019). Interpersonal discrimination refers to biased treatment occurring in interactions between individuals, and it is considered a psychosocial stressor that poses a direct threat to wellbeing (Pascoe & Smart Richman, 2009). Among Latine populations, racial-ethnic interpersonal discrimination is linked to poorer physical (e.g., chronic illnesses) and psychological (e.g., depression, anxiety) health, and worse health behaviors (e.g., substance use) (Andrade et al., 2021). Often members of the Latine community themselves, Latine-serving CHWs may be exposed to discrimination and related stressors, which, alongside the unique demands of their role, can further compromise their well-being.

In addition to facing high rates of discrimination during the COVID-19 period (Lopez, 2021), Latines were exposed to multiple risk factors that increased their vulnerability to a range of stressors, including a disproportionate burden of COVID-19 morbidity and mortality (Salgado de Snyder et al., 2021). Notably, the sociopolitical climate of the past 10 years (i.e., anti-immigrant rhetoric, deportations) may have similar effects—both contexts can intensify experiences of discrimination (López-Hinojosa et al., 2024; Offidani-Bertrand, 2023) and introduce significant barriers (e.g., funding cuts, fear of immigration enforcement that hinders health-seeking behaviors; Rodriguez et al., 2019; Calhoon, 2023) that increase the demands placed on Latine-serving CHWs. For Latine-serving CHWs —many of whom are immigrants or closely connected to immigrants— such policies increase stress and fear within the families they serve, making it harder to build trust and provide effective support, while directly impacting their own sense of safety. These layered stressors have implications for CHWs’ well-being.

CHWs’ Experiences of Burnout

Burnout—a state of emotional, mental, and physical exhaustion from prolonged stress (Maslach et al., 2016)—is common among healthcare workers and linked to serious health risks (Salvagioni et al., 2017; Sipos et al., 2024). The pandemic exacerbated existing stressors, such as demanding conditions and limited resources, while also blurring personal-professional boundaries, leading to increased burnout rates (Lluch et al., 2022; Rapp et al., 2021). Burnout can be conceptualized in two ways: as tied to broader contextual stressors, such as the pandemic (COVID-related burnout; Moroń et al., 2021) or as stemming from occupational strain (work-related burnout; Maslach et al., 2016). COVID-related burnout reflects psychological strain linked to the wider societal and public health context, whereas work-related burnout centers on exhaustion, depersonalization, and reduced personal accomplishment within one’s professional role. Because these forms of burnout capture distinct experiences, the predictors and protective factors for each may differ — an important consideration for supporting CHWs.

Characteristics of CHWs’ roles, including blurred personal-professional boundaries (e.g., responding to needs outside work hours or with personal resources) and limited resources (Alvarez-Hernandez et al., 2021; Marquez et al., 2023; Zhou et al., under review), may heighten their vulnerability to burnout. These challenges intensified during the pandemic. For example, Garcini and colleagues (2022) found that CHWs working near the U.S.-Mexico border faced amplified distress due to personal losses, economic hardship, and overwhelming occupational demands as community mental needs surged. Similarly, studies with CHWs serving Latine communities reported elevated risks for compassion fatigue, traumatic stress, and burnout (Hernandez-Salinas et al., 2023; Sainz et al., 2024). A review by Ndulue and colleagues (2023) further documented widespread distress and burnout among CHWs in low- and middle-income countries. Collectively, this body of work underscores the heightened vulnerability of CHWs to burnout in times of crisis.

Latine-serving CHWs face an additional risk factor for burnout: discrimination. Indeed, Latine-serving CHWs who are Latine themselves report discrimination, alongside the emotional toll of hearing others’ struggles and ethnocentric attitudes, as challenges (Orpinas et al., 2021; Sainz et al., 2024). Research shows a strong link between burnout and discrimination based on age, gender, sexual orientation, or race-ethnicity among healthcare workers (Dyrbye et al., 2022; Johnson et al., 2019; Teshome et al., 2022), suggesting that CHWs—especially those from immigrant communities—may be particularly vulnerable.

Psychological Agency as a Protective Factor Against Discrimination

In the face of adversities such as discrimination, people react in various ways. Some take a more active approach, viewing themselves as the initiators of their actions, while others adopt a more passive stance, perceiving themselves as constrained by external forces (Little et al., 2002, 2006). Psychological agency refers to one’s belief in the ability to influence one’s personal circumstances (Bandura, 1989, 2006) and is consistent with an internal locus of control—the belief that outcomes are determined by one’s personal effort and ability, rather than by external factors (Lefcourt, 1984). Agency can be understood as a multidimensional construct, encompassing both cognitive (i.e., beliefs about one’s capacities) and behavioral components (i.e., actions reflecting one’s capacities). Agentic stances enable people to approach challenging situations with hope (Snyder et al., 1991), openness to envision creative ways of handling difficulties, and conviction in their capabilities (Firat, 2017).

Theoretical Frameworks of Agency

Several theoretical perspectives frame psychological agency as central to resilience in the face of stressors. Social cognitive theory (Bandura, 1989, 2006) emphasizes agency as a core mechanism through which individuals regulate their functioning and adapt to challenges. In this view, beliefs about personal efficacy shape whether people view stressors as manageable, shaping their coping response. As described above, Rotter’s locus of control framework (Lefcourt, 1984; Rotter, 1966) distinguishes between internal (e.g., perceiving outcomes to be determined by own actions) and external orientations (e.g., perceiving outcomes to be determined by external forces), suggesting that the former leads to greater coping capacity. Similarly, developmental models of action and control (Little et al., 2002, 2006) conceptualize agency as a stance that shapes motivational pathways, leading to perseverance in the face of adversity. These theoretical perspectives converge on the idea that psychological agency provides a lens through which individuals interpret and respond to adversity, influencing whether discrimination is experienced as debilitating or as a challenge that can be navigated. From this standpoint, agency may moderate the association between discrimination and burnout: those with stronger beliefs in their capacity to shape outcomes may experience less emotional exhaustion and disengagement in the face of discrimination than those with a weaker agentic stance.

Empirical Support

Existing work on psychological agency and related concepts provide empirical support for the protective role of agency in the context of discrimination. Firat (2017) demonstrated that agentic value orientations (e.g., openness) moderated the link between discrimination and health. Similarly, studies with racial-ethnic minority samples have found that perceived control mediates the association between discrimination and psychological health (Jang et al., 2010; Vargas et al., 2021), and that self-efficacy moderates the association between discrimination and health behaviors (Barreras et al., 2023). Similarly, a meta-analysis suggested that personal strengths—such as self-esteem and self-efficacy—were most protective against the effects of discrimination among Latine people in the U.S., even more so than social support or cultural identity (Lee & Ahn, 2012). Related to agency, these constructs also pertain to a person’s sense of capability and belief that their actions can influence outcomes. The current study expands upon prior work by examining psychological agency as a protective factor against burnout among Latine-serving CHWs, highlighting potential resilience pathways through which immigrant communities respond to and resist stressors.

Current Investigation

In the current study, we examine the association between discrimination frequency and burnout, as well as whether psychological agency moderates the association between discrimination and two measures of burnout (work- and COVID-related) among Latine-serving CHWs. To our knowledge, this is the first study to investigate these links in this population. First, we hypothesized that greater discrimination frequency would predict more symptoms of work- and COVID-related burnout (H1). Second, we predicted that the positive association between discrimination frequency and burnout would be moderated by agency, such that higher levels of agency would attenuate the association between discrimination and burnout (H2).

Method

Participants

The current sample (N = 81 CHWs) was drawn from a larger study (ClinicalTrials.gov NCT05560893; Arcos et al., 2023) that examined the effect of a relationship-based intervention on Latine-serving CHWs’ wellbeing. Participants were recruited from Latine-serving community service agencies via phone calls, presentations, flyers, and emails. Participants were eligible if they worked or volunteered as CHWs serving Latine families and were at least 18 years old. Most participants identified as female (91.3%) and Latine (95%) (see Table 1). While information about immigration status was not obtained, most participants were born outside of the U.S. (81%) and lived in Southern California for at least 20 years (81.3%). Of those born outside of the U.S., 89.2% reported Mexico as their country of origin. Relatedly, the majority (76.5%) chose Spanish as their preferred language. The average annual household income for this sample fell between $35,000 and $45,000, slightly above the state poverty line of $32,000 for a family of four.

Table 1.

Participant Demographics

Demographic Variable Value Demographic Variable Value
Gender N (%) Children N (%)
 Cisgender woman 73 (91.3)  Yes 68 (85)
 Cisgender man 6 (7.5)  No 12 (15)
 Other 1 (1.3) Food Insecurity
Race or Ethnicity  Yes 37 (46.3)
 Latine or Hispanic 76 (95)  No 43 (53.8)
 Black/African-American 2 (2.5) Language of Choice
 Other 2 (2.5)  Spanish 62 (76.5)
Marital Status  English 19 (23.5)
 Married 41 (51.2)
 Single 15 (18.8) Continuous Variables M (SD)
 Separated 8 (10)  Age (years) 47.9 (11.1)
 Living with Partner 8 (10)  Years as CHW 7.2 (7.3)
 Divorced 6 (7.5)  Years of education 11.3 (2.6)
 Widowed 2 (2.5)
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Procedure

All study procedures for the parent study were developed in collaboration with a partner community health agency, Latino Health Agency, following a community-based participatory research (CBPR) framework. CBPR is a collaborative approach that emphasizes equitable partnerships between researchers and community stakeholders, shared decision-making, and co-creation of research processes to ensure both scientific rigor and responsiveness to community priorities (Wallerstein & Duran, 2006). Prior to data collection, the study was approved by University of California Irvine Institutional Review Board (#1596). Data collection began in October 2022 and ended in September 2024. Data included here were part of a longitudinal study lasting 5 months, which included one or two baseline assessments (depending on randomization to the experimental or waitlist control group), a 4-week intervention, a post-intervention assessment, and a 3-month follow-up. Complete study procedures can be found in Arcos et al., 2023. The current study draws from data collected in the baseline assessment only. During a screening phone call, participants’ eligibility was confirmed and verbal consent was obtained. Subsequently, participants completed a baseline assessment battery (in English or Spanish) via Qualtrics while connected to a Zoom session, during which a research assistant was available to answer questions. Next, participants were instructed to sit still with no stimuli for a two-minute period. Then, participants engaged in a four-minute stream-of-consciousness task (Borelli et al., 2013) in their preferred language (English or Spanish), during which they were asked to speak about a discrimination experience.

Measures

Demographic Variables

Participants completed a demographic survey, reporting on factors such as age, gender, marital status, parental status, education, employment, nativity, annual household income, and food insecurity.

Burnout

Work-Related Burnout.

The Maslach Burnout Inventory (MBI; Maslach et al., 2016), a 22-item survey that assesses work-related burnout, includes three subscales: emotional exhaustion (EE; e.g., “I feel emotionally drained from my work”), depersonalization (DP; e.g., “I doubt the significance of my work”), and personal accomplishment (PA; e.g., “In my opinion, I am good at my job”). Participants rated how often they experienced each symptom on a scale from 0 (Never) to 6 (Every day). Higher scores on EE and DP, and lower scores on PA, typically indicate more burnout. The internal consistency in this study was good for EE (α = 0.86) and PA (α = 0.74), though lower for DP (α = 0.64).

COVID-19 Burnout.

The COVID-19-BS (Morón et al., 2021) is a 10-item measure that assesses frequency of burnout symptoms related to COVID-19 (e.g., “When you think about COVID-19 in general, how often do you feel hopeless?”) on a 7-point Likert scale from 0 (Never) to 6 (All the time), with higher scores reflecting more discrimination. However, due to a survey programming error, in the current study only 8 items were administered (see supplemental material), but internal consistency was good (α = 0.86).

Discrimination

Participants completed the 9-item Everyday Discrimination Scale (EDS; Williams et al., 2003), which assesses frequency and perceived reasons for discriminatory experiences. In the current study, only the frequency portion of the EDS was utilized (e.g., “In your day-to-day life, how often are you treated with less respect than other people are?”). Responses are rated on a scale from 0 (Never) to 5 (Almost every day), with higher scores reflecting more frequent discrimination (α = .90). The EDS items do not restrict discrimination to a specific basis, allowing respondents to report perceived experiences of discrimination on any grounds, not solely race-ethnicity.

Agency

The Discrimination stream-of-consciousness task was modeled after a task developed and utilized in prior studies (Borelli et al., 2013). In the current study, participants were first asked to think about an experience of discrimination to focus on during the task. To support recall, participants were shown a blank EDS questionnaire. Once the experience was selected, participants were asked to speak for 4 minutes in a stream-of-consciousness manner, focusing on their thoughts and feelings pertaining to this experience. The prompt was provided in English or Spanish based on the participant’s preferred language (see supplementary material).

Audio-recorded stream-of-consciousness tasks were transcribed verbatim, de-identified, and deductively coded using a pre-established codebook created for the purposes of this study and based on prior research (Borelli et al., 2020). The codebook included items pertaining to characteristics of the event (e.g., ‘When did the discrimination event occur?’) as well as scales pertaining to how participants talked about the event (e.g., Attribution of self-blame: ‘Extent to which participant talks about the event by attributing blame to themselves or talks about their responsibility for the discrimination event’). The scales were coded using a 4-point Likert scale ranging from 0 (Not at all) to 3 (A lot) by a team of three bilingual coders.

Before beginning the coding process, the team met to review the codebook and ensure all members had clarity on the items and coding process. The team collaboratively reviewed and coded a first transcript, discussing the rationale for selecting specific responses and working together to reach consensus. Subsequently, the team proceeded to independently read and code the same four transcripts. These initial codebooks were reviewed jointly to discuss answers and reach a consensus in cases of disagreements. Once all coders felt confident with the coding process, the team proceeded to code transcripts independently. Weekly meetings were held throughout the coding process to review progress, engage in reflective practices, and facilitate peer debriefing. To establish interrater reliability, a subset (24.7%) of transcripts were double-coded. This yielded good to excellent intraclass correlation coefficients for agency (ICC = .85), confrontation/assertiveness (ICC = .90), resistance/resilience (ICC = .76), and across the three scales (ICC = .84).

A composite measure, comprising three coded constructs from the discrimination SOC, was utilized as a measure of agency. This composite approach was chosen in order to capture a broader range of agentic expressions, representing the multifaceted ways agency may be expressed during the narration. These included ‘general agency’ (extent to which participant talks about the discrimination event with a sense of agency, expressing a proactive stance and emphasizing their own ability to take action or make choices in response to the current and/or future discrimination events), ‘behavioral confrontation/assertiveness’ (extent to which the participant openly discusses responding to the event by directly confronting the perpetrator or assertively addressing the discrimination, voicing their concerns, or advocating for themselves or others), and ‘behavioral resistance/resilience’ (extent to which participant openly discusses responding to the event by demonstrating resistance or resilience in the face of discrimination, refusing to be defined or defeated by the event and actively working to overcome its negative effects).

Data Analytic Plan

First, we computed descriptive statistics and bivariate correlations to summarize the data and examine associations among the key variables. Next, Hypotheses 1 and 2 were tested using a series of hierarchical linear regressions. All analyses were conducted in IBM SPSS Statistics (Version 29). Aligned with the conceptual framework of the MBI and the distinct focus of the COVID-19-BS, we conducted separate hierarchical regressions for each burnout dimension separately (four models in total) to examine potentially unique associations with discrimination and agency. In the first step, covariates (food insecurity, age, and gender) were entered based on a priori decisions informed by previous research (Borelli et al., under review) as well as discrimination (EDS) frequency. In the second step of the regression, the composite agency variable was entered. Finally, in the third step of the regression, the interaction term between agency and discrimination was entered. The standardized beta value for the association between discrimination and burnout in step 1 was used to test Hypothesis 1. The standardized beta value for the interaction term in step 3 was used to test Hypothesis 2. Significant interaction terms from step 3 were probed using simple slopes analyses at one standard deviation above and below the mean of the moderator

Eight participants were missing responses on the EDS. To affirm that missing data did not alter the magnitude or direction of observed effects, we repeated the models using multiple imputation to account for missing data. We conducted five rounds of multiple imputation using the fully conditional specification (chained equations) method, generating imputed values for all EDS items for those with missing data, which were used to calculate multiple imputed total scores. The imputation model included EDS, COVID-19-BS, age, years as CHW, race-ethnicity, years living in Southern California, employment, marital status, and nativity, under the assumption that data were missing at random. Results across imputations were pooled using Rubin’s rule. As no significant differences were observed between the original and multiple imputation datasets, the results presented are based on the original data. Separately, to further explore the subcomponents of the agency variable, we conducted supplemental analyses in which we disaggregated the agency variable into its constituent parts and reran the moderation analyses. These exploratory analyses are presented in the supplemental materials.

Results

Descriptives and Correlations

Demographic characteristics and bivariate correlations are described in Tables 1 and 2, respectively. Greater frequency of discrimination was significantly associated with higher work- and COVID-19-related burnout. Agency was not significantly correlated to discrimination or burnout variables. The most common reasons for discrimination in the stream-of-consciousness narration (not the EDS) included race-ethnicity (21.6%) and spoken language (20.6%) (see supplementary material).

Table 2.

Descriptive Statistics and Correlations for Study Variables

Variable M SD 1 2 3 4 5 6
1. EDS 16.23 7.66 —
2. Agency 0.00a 0.83 .13 —
3. MBI EE 15.19 10.73 .51** .13 —
4. MBI DP 4.40 5.02 .47** .02 .54** —
5. MBI PA 34.14 8.62 −.30** .10 −.26* −.34** —
6. COVID-19-BS 17.62 8.78 .42** 0 .57** .28* −.23* —
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Note. EDS = Everyday Discrimination Scale; MBI EE = Maslach Burnout Inventory Emotional Exhaustion; MBI DP = Maslach Burnout Inventory Depersonalization; MBI PA = Maslach Burnout Inventory Personal Accomplishment; COVID-19-BS = COVID-19 Burnout Scale.

a.

The agency composite score was created by averaging standardized (z-scored) ratings of agency, confrontation, and resilience (see Method section). As expected, its mean was approximately zero.

*

p < .05

**

p < .01

Hypothesis 1: Greater Discrimination Frequency Will Predict Higher Burnout

Consistent with our hypothesis, frequency of discrimination significantly COVID-related burnout (see Table 3) and work-related burnout (see Table 4).

Table 3.

Hierarchical Linear Regression Examining the Association Between Discrimination, Agency, and Their Interaction with COVID-Related Burnout

COVID-Related Burnout
Unstand C Stand C 95% CI for b
b/ΔR2 SE β t lower upper
Step 1 ΔR2 0.19 **
(Constant) 3.13 8.35 0.38 −13.53 19.80
 Food Insecurity 1.72 2.04 0.10 0.85 −2.34 5.79
 Age 0.05 0.09 0.06 0.49 −0.14 0.23
 Gender 1.79 3.52 0.06 0.51 −5.23 8.82
 Discrimination 0.48 ** 0.13 0.41 3.58 0.21 0.74
Step 2 ΔR2 0.00
(Constant) 2.88 8.67 0.33 −14.43 20.18
 Food Insecurity 1.71 2.06 0.10 0.83 −2.40 5.81
 Age 0.05 0.10 0.06 0.50 −0.14 0.24
 Gender 1.85 3.58 0.06 0.52 −5.29 8.98
 Discrimination 0.48 ** 0.14 0.42 3.50 0.21 0.75
 Agency −0.15 1.22 −0.01 −0.12 −2.59 2.29
Step 3 ΔR2 0.15 **
(Constant) 1.22 7.93 0.15 −14.62 17.05
 Food Insecurity −0.19 1.95 −0.01 −0.10 −4.07 3.70
 Age 0.14 0.09 0.17 1.56 −0.04 0.32
 Gender −0.59 3.33 −0.02 −0.18 −7.23 6.06
 Discrimination 0.69 ** 0.14 0.60 5.04 0.42 0.97
 Agency −0.70 1.12 −0.07 −0.62 −2.94 1.55
 Disc*Agency −5.17 ** 1.36 −0.43 −3.79 −7.89 −2.45
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Note. Unstand C = unstandardized coefficient; Stand C = standardized coefficient; CI = confidence interval; Disc = discrimination. Bolded values are significant at *p< .05 or less. The standardized beta for discrimination in Step 1 was used to evaluate Hypothesis 1, whereas the standardized beta for the interaction term in Step 3 was used to evaluate Hypothesis 2.

*

p< .05

**

p< .01

Table 4.

Hierarchical Linear Regressions Examining the Association Between Discrimination, Agency, and Their Interaction on Work-Related Burnout

MBI EE MBI DP MBI PA
Unstand C Stand C 95% CI for b Unstand C Stand C 95% CI for b Unstand C Stand C 95% CI for b
b/ΔR2 SE β t lower upper b/ΔR2 SE β t lower upper b/ΔR2 SE β t lower upper
Step 1 ΔR2 0.29 ** 0.25 ** 0.14*
(Constant) 2.31 9.46 0.25 −16.56 21.18 2.60 4.72 0.55 −6.82 12.03 26.78 ** 7.84 3.42 11.15 42.42
 Food Insecurity −1.24 2.31 −0.06 −0.54 −5.85 3.36 −0.19 1.15 −0.02 −0.16 −2.49 2.11 −1.17 1.91 −0.07 −0.61 −4.99 2.64
 Age 0.04 0.11 0.04 0.33 −0.18 0.24 −0.04 0.05 −0.08 −0.74 −0.14 0.07 0.13 0.09 0.17 1.43 −0.05 0.30
 Gender −0.55 3.99 −0.02 −0.14 −8.51 7.41 −0.76 1.99 −0.04 −0.38 −4.74 3.21 3.26 3.30 0.12 0.99 −3.33 9.86
 Discrimination 0.77 ** 0.15 0.55 5.13 0.47 1.07 0.32 ** 0.08 0.47 4.26 0.17 0.47 −0.26* 0.13 −0.24 −2.06 −0.51 −0.01
Step 2 ΔR2 0.01 0.00 0.00
(Constant) 4.52 9.76 0.46 −14.96 23.99 2.58 4.91 0.53 −7.21 12.37 27.84 ** 8.12 3.43 11.63 44.04
 Food Insecurity −1.08 2.32 −0.05 −0.46 −5.70 3.55 −0.19 1.17 −0.02 −0.16 −2.52 2.13 −1.09 1.93 −0.07 −0.57 −4.94 2.76
 Age 0.02 0.11 0.02 0.15 −0.20 0.23 −0.04 0.05 −0.08 −0.72 −0.15 0.07 0.12 0.09 0.16 1.30 −0.06 0.29
 Gender −1.01 4.02 −0.03 −0.25 −9.04 7.02 −0.76 2.02 −0.04 −0.38 −4.80 3.28 3.04 3.35 0.11 0.91 −3.64 9.72
 Discrimination 0.74 ** 0.15 0.53 4.79 0.43 1.05 0.32 ** 0.08 0.47 4.13 0.17 0.48 −0.27* 0.13 −0.26 −2.11 −0.53 −0.02
 Agency 1.28 1.37 0.10 0.93 −1.46 4.02 −0.01 0.69 0.00 −0.02 −1.39 1.37 0.61 1.14 0.06 0.53 −1.67 2.89
Step 3 ΔR2 0.03 0.03 0.01
(Constant) 3.67 9.66 0.38 −15.62 22.96 2.15 4.86 0.44 −7.55 11.85 28.23 ** 8.15 3.47 11.97 44.50
 Food Insecurity −2.04 2.37 −0.10 −0.86 −6.77 2.69 −0.68 1.19 −0.07 −0.57 −3.06 1.70 −0.64 2.00 −0.04 −0.32 −4.63 3.35
 Age 0.06 0.11 0.06 0.57 −0.16 0.28 −0.02 0.06 −0.03 −0.27 −0.13 0.10 0.09 0.09 0.13 1.01 −0.09 0.28
 Gender −2.25 4.05 −0.06 −0.56 −10.35 5.84 −1.38 2.04 −0.08 −0.68 −5.45 2.69 3.62 3.42 0.13 1.06 −3.20 10.44
 Discrimination 0.85 ** 0.17 0.61 5.07 0.51 1.18 0.38 ** 0.08 0.55 4.46 0.21 0.54 −0.32* 0.14 −0.31 −2.28 −0.60 −0.04
 Agency 1.00 1.37 0.08 0.73 −1.74 3.74 −0.16 0.69 −0.03 −0.23 −1.53 1.22 0.74 1.16 0.08 0.64 −1.56 3.05
 Disc*Agency −2.63 1.66 −0.18 −1.59 −5.95 0.68 −1.33 0.84 −0.19 −1.59 −3.00 0.34 1.23 1.40 0.11 0.88 −1.57 4.03
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Note: Unstand C = unstandardized coefficient; Stand C = standardized coefficient; CI = confidence interval; MBI EE = Maslach Burnout Inventory emotional exhaustion; occupational exhaustion; DP = depersonalization, PA = personal accomplishment; Disc = discrimination. Bolded values are significant at *p< .05 or less. The standardized beta for discrimination in Step 1 was used to evaluate Hypothesis 1, whereas the standardized beta for the interaction term in Step 3 was used to evaluate Hypothesis 2.

*

p< .05

**

p< .01

Hypothesis 2: Positive Association between Frequency of Discrimination and Burnout Will be Moderated by Agency

However, agency was a significant moderator of the association between discrimination frequency and COVID-19 burnout (see Table 3 and Figure 1). At low (−1 SD; b = −0.93, t(66) = 5.18, p < .001) and mean levels of agency (b = −0.01, t(66) = 5.07, p < .001), discrimination significantly predicted greater COVID-19 burnout. At high levels of agency (+1 SD), however, the association between discrimination frequency and burnout was not significant (b = 0.95, t(66) = 0.31, p = .754). However, agency did not significantly moderate the association between discrimination frequency and work-related burnout (see Table 4).

Figure 1.

Figure 1.

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Moderating Effect of Agency on the Link Between Discrimination and COVID-Related Burnout

Disaggregated Agency Results

Follow-up exploratory hierarchical regression models conducted with the disaggregated variables comprising agency replicated the overall pattern of findings from the original moderation analyses (Hypothesis 2). Moderation effects consistently emerged for COVID-related burnout, with higher agency levels (in all three disaggregated components) attenuating the association between discrimination and COVID-related burnout. In addition, behavioral confrontation/assertiveness moderated the association between discrimination and work-related burnout (emotional exhaustion and depersonalization), with higher confrontation/assertiveness attenuating the association between discrimination and burnout. No other moderation effects were found. These analyses are provided in the supplementary materials.

Discussion

Among a sample of Latine-serving CHWs, higher discrimination frequency predicted higher levels of work- and COVID-related burnout. Interestingly, psychological agency —coded from participants’ narratives describing discrimination experiences— moderated the association between discrimination and COVID-related burnout, but did not moderate the link between discrimination and work-related burnout. Offering partial support for our hypothesis, higher levels of agency weakened the link between discrimination and COVID-related burnout, such that discrimination no longer significantly predicted burnout when agency was high.

Link Between Discrimination and Burnout Among Latine-serving CHWs

While few studies have examined these associations among CHWs, our findings linking discrimination and burnout are consistent with existing research. The association between discrimination and work-related burnout has been repeatedly documented among other healthcare workers, including nurses, physicians, and medical students (Dyrbye et al., 2022; Gadjradj et al., 2021; Teshome et al., 2022). Relatedly, extensive literature points to the negative effects of discrimination in mental and physical health (Andrade et al., 2021; Pascoe & Smart Richman, 2009). By shedding light on the discrimination-burnout link among Latine-serving CHWs, our study extends this body of work to a crucial yet understudied population. Importantly, our findings highlight the distinction between the two types of burnout examined, which may reflect that different sources of stress respond differently to protective factors such as agency.

The Role of Agency Across Different Types of Burnout

Agency moderated the link between discrimination frequency and COVID-related, but not work-related, burnout. The moderating effect of agency in the link between discrimination and COVID-related burnout aligns with theoretical models of agency, which suggest that confidence in one’s ability to manage distressing experiences can protect against the psychological and physiological toll of stressors (Bandura, 1989). This also aligns with the theorization that an internal locus of control (i.e., belief that outcomes are shaped by personal actions) compared to an external locus of control (i.e., belief that outcomes are determined by outside forces) may help individuals better withstand the stress of discrimination, reducing vulnerability to burnout (Lefcourt, 1984). These frameworks help contextualize our findings and underscore the potential value of fostering psychological agency as means of supporting the well-being of Latine-serving CHWs facing chronic, systemic stressors.

The lack of a moderating effect of agency on the link between discrimination and work-related burnout may be explained by differences in how each measure captures burnout. COVID-related burnout showed a strong correlation with work-related emotional exhaustion, but only weak correlations with work-related depersonalization and personal accomplishment, further suggesting that while some overlap exists, the measures may be reflecting different aspects of burnout.

The MBI focuses specifically on occupational burnout, using work-related language (e.g., “I feel…from my work”), while the COVID-19-BS assesses emotional responses related to the pandemic more broadly (e.g., “When you think about COVID-19, how often do you feel…?”). Relatedly, it is possible that the MBI may not fully capture the distinct work experience of Latine-serving CHWs, often described as having blurred limits between CHWs’ personal and work life (e.g., assisting community members with personal resources or outside work hours; Marquez et al., 2023; Zhou et al., under review). That is, because so much of their work blends into their personal lives, CHWs may not identify certain emotional experiences as work-related, even if they stem from their professional role. In contrast, by capturing feelings of burnout during a contextual period (i.e., pandemic) rather than within a specific domain (i.e., work), the COVID-19-BS may pick up on the more integrated stressors Latine-serving CHWs face.

Moreover, when analyzing the difference between these two burnout measures, it is relevant to consider that a stronger sense of agency, reflecting greater perceived ability to impact one’s circumstances, may have been particularly relevant in the context of the pandemic’s profound loss of control. That is, while agency may help CHWs cope with uncontrollable sources of burnout, such as the pandemic or a hostile political climate, it may be less relevant for burnout stemming from more addressable work-related stressors. In these cases, structural solutions like sustainable funding, equitable wages, and increased recognition within healthcare systems should be prioritized.

On a different note, it is possible that by inquiring about the frequency of certain affective states more broadly, the COVID-19-BS may be tapping into depressive states (e.g., sadness or hopelessness). This, in turn, could be more directly impacted by agency. In support of this argument, results from a meta-analysis concluded that, across studies, higher levels of agentic thinking were associated with less depression and anxiety (Corrigan & Schutte, 2023).

Finally, when interpreting our findings, it is worth considering how agency was operationalized in the current study—as a composite of three coded constructs that pertained to a general proactive stance throughout the narrative, as well as behavioral displays of assertiveness and resilience. This operationalization allowed for a broader capturing of agentic stances, and as seen from our analyses with the disaggregated components, different approaches (e.g., displays of agentic behavior, such as confrontation) may yield different patterns in its association with the link between discrimination and burnout measures. Likewise, examining work-related burnout as a composite score instead of analyzing its three dimensions separately could have shed light on a different association with discrimination and agency. It would be valuable for future research to explore these questions, as the findings could have important implications for intervention—for example, whether psychological orientation, behavior, or a combination of both is necessary to buffer against stress.

Implications

Similar to healthcare workers more broadly, when Latine-serving CHWs experience discrimination they are at greater risk for burnout. Further, agency may be a potential pathway to promote resilience among Latine-serving CHWs—a population at increased risk of discrimination in the current anti-immigrant climate and vulnerable to the broader stressors Latine communities face. Effective interventions to support Latine-serving CHWs could involve components that promote agency (e.g., Shankar et al., 2019). These findings also highlight the need for systemic changes that will further support Latine-serving CHWs, who serve as a vital bridge to under-resourced, culturally diverse communities—and especially to immigrant communities. Improving CHWs retention can benefit both the workers and the health outcomes of those they serve.

Strengths and Limitations

The contributions of this study should be considered in light of its strengths and limitations. Among its strengths is the parent study’s use of a CBPR framework, which led to researchers and partner CHWs co-creating all study procedures, including the adaptation of the intervention being tested. This partnership also facilitated the recruitment of an understudied and hard-to-reach population whose experiences are essential to understand. Including both self-report and observational data reflects methodological triangulation, strengthening the validity of the findings. Further, the option to complete assessments in either English or Spanish enhanced accessibility and the cultural-linguistic relevance of the study.

Several limitations also warrant consideration. The cross-sectional design prevents conclusions about temporal precedence or causality. The relatively small sample size limits statistical power, especially for detecting smaller effects, and constrains our ability to conduct follow-up subgroup analyses. Running multiple models on the same sample increases the risk of Type I error. Given the small sample and pilot nature of this study, we prioritized detecting potential effects. An important next step is to replicate these analyses in a larger sample, where more rigorous safeguards against false positives can be applied. Moreover, because all participants worked in Latine-serving agencies located in Southern California, and most identified as Latine and cisgender women, findings may not generalize to CHWs serving other communities or representing other demographic backgrounds. Relatedly, emphasizing the diversity within the Latine population, these findings may not generalize to Latine-serving CHWs with different cultural or lived experiences. In addition, this study assessed agency as an individual-level construct; however, agency can also be conceptualized as a collective process better captured using measures that emphasize shared action and community empowerment. Future research should explore these dimensions to build a more comprehensive understanding of agency in marginalized populations. Further, the omission of two items of the COVID-19-BS, despite adequate internal consistency, may narrow the scope of burnout assessed and limit comparability with studies that used the full scale. The low reliability of the MBI DP subscale (α = 0.64) suggests that the results on this subscale should be interpreted with caution. Building on the current findings, future research may consider longitudinal and intervention-based designs to test whether enhancing agency could reduce burnout risk among CHWS. Likewise, future work should further examine how structural or organizational factors contribute to burnout in this population.

Conclusion

The first to examine the link between discrimination and burnout among Latine-serving CHWs, this study offers evidence that psychological agency may buffer against the association between discrimination and COVID-related burnout. Especially timely given the current anti-immigration policies and rising discrimination, these findings highlight the potential value of interventions that foster a sense of control and active coping in the face of such stressors and underscore the need for structural changes to address systemic conditions that may contribute to burnout among CHWs.

Supplementary Material

Supplemental Material

Public Significance Statement:

Strengthening agency may be an effective strategy to foster resilience among Latine-serving community health workers navigating discrimination and other systemic stressors. Our findings also point to the need to consider structural factors when seeking to reduce burnout in this population.

Footnotes

The authors have no known conflicts of interest to disclose.

1

We intentionally adopt the term Latine – a gender-neutral alternative to Latino/Latina that uses the Spanish-standard “-e” ending—to encompass diverse gender identities and offer a more linguistically inclusive form that remains pronounceable for Spanish speakers (Miranda et al., 2023).

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