Precarious work among personal support workers in the Greater Toronto Area: a respondent-driven sampling study

Background: The COVID-19 pandemic has highlighted the role of personal support workers (PSWs) in health care, as well as their work conditions. Our study aimed to understand the characteristics of the PSW workforce, their work conditions and their job security, as well as to explore the health of PSWs and the impact of precarious employment on their health. Methods: Our community-based participatory action research focused on PSWs in the Greater Toronto Area. We administered an online, cross-sectional survey between June and December 2020 using respondent-driven sampling. Data on sociodemographics, employment precarity, worker empowerment and health status were collected. We assessed the association between precarious employment and health using multivariable logistic regression models. Results: We contacted 739 PSWs, and 664 consented to participate. Overall, 658 (99.1%) completed at least part of the survey. Using data adjusted for our sampling approach, the participants were predominantly Black (76.5%, 95% confidence interval [CI] 68.2%–84.9%), women (90.1%, 95% CI 85.1%–95.1%) and born outside of Canada (97.4%, 95% CI 94.9%–99.9%). Most worked in home care (43.9%, 95% CI 35.2%–52.5%) or long-term care (34.5%, 95% CI 27.4%–42.0%). Although most participants had at least some postsecondary education (unadjusted proportion = 83.4%, n = 529), more than half were considered low income (55.1%, 95% CI 46.3%–63.9%). Most participants were precariously employed (86.5%, 95% CI 80.7%–92.4%) and lacked paid sick days (89.5%, 95% CI 85.8%–93.3%) or extended health benefits (74.1%, 95% CI 66.8%–81.4%). Nearly half of the participants described their health as less than very good (46.7%, 95% CI 37.9%–55.5%). Employment precarity was significantly associated with higher risk of depression (odds ratio 1.02, 95% CI 1.01–1.03). Interpretation: Despite being key members of health care teams, most PSWs were precariously employed with low wages that keep them in poverty; the poor work conditions they faced could be detrimental to their physical and mental health. Equitable strategies are needed to provide decent work conditions for PSWs and to improve their health.