Rural health care aide training experiences in a Canadian tuition assistance program: a qualitative study

Background: Healthcare aides (HCAs) are vital in supporting Canada’s growing aging population. Rural communities face unique but understudied challenges to HCA recruitment and retention, including limited training options and employment opportunities. To better understand and address these challenges, this qualitative study investigated HCAs’ experiences of training and working in a rural Canadian town. This training was subsidized by a municipal tuition assistance program, which provided up to $5,000 towards tuition fees. Methods: In 2023, through a community-engaged research partnership with the town, we conducted three focus group interviews with 11 women studying to become certified HCAs, supported by the municipal tuition assistance program. Focus group interviews explored topics such as educational and work experiences, impacts of these experiences on their day-to-day lives, and their perceptions of high-quality employment. Qualitative data, including transcripts, fieldnotes, and reflexive notes, were analyzed using reflexive thematic analysis. Results: Participants applied to the HCA program for various reasons, arriving with diverse personal and professional backgrounds. Most participants had no previous postsecondary education. We generated three themes: (1) fostering friendships and community; (2) inspiring confidence and pride in school, the workplace, and home; and (3) working to improve the profession. Participants considered their in-person (as opposed to online) education to be a key factor in increasing their confidence at work. Engaging in union activity and advocacy work represented a significant way participants exerted their confidence and skills. Participants’ engagement with their union and collective bargaining resulted in improved working conditions for local HCAs and other healthcare workers. Conclusions: This study is one of few to explore rural HCA training and working in Canada and is the only one (to our knowledge) focusing on HCAs’ experiences of accessing a tuition assistance program. This research also contributes to literature on improving HCA working conditions. Empowering HCAs to participate in decision-making about their work environments could lead to positive outcomes for workers and care recipients. Our findings underscore the importance of providing accessible, high-quality HCA programs in rural communities, particularly given the increasing demand for elder care in Canada.