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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Paul W. Colson, PhD, Charles P. Felton Nat. TB Ctr., Harlem Hospital Center, 2238 Fifth Ave., New York, NY 10037, 212-939-8241, pwc2@columbia.edu, Sally Findley, PhD, Joseph L. Mailman School of Public Health, Columbia University, 600 West 168th Street, Fourth floor, New York, NY 10032, and Julie Franks, PhD, Harlem Hospital Center, Columbia University, 506 Lenox Avenue rm 3101-A, New York, NY 10037.
Background: Peer workers (PWs) or community health workers often play an important role in improving health outcomes, particularly with disadvantaged populations. Recent programs have employed PWs to encourage adherence to treatment for Latent Tuberculosis Infection (LTBI).
Methods: A telephone survey was undertaken of five LTBI adherence programs using PWs. After describing program objectives and operations, respondents were asked questions on recruitment, training, supervision, retention, and operating policies.
Results: All programs surveyed used PWs as paraprofessionals promoting adherence to LTBI treatment. Recruited from the target communities, PWs were either former substance abusers, homeless, or themselves treated for TB. PW training included lectures on LTBI and related topics, and workshops on counseling techniques and strategies for connecting with clients. No difficulties were reported in establishing rapport with clients; however, problems arose because the PW role is not well understood by clients or professionals. PWs experience difficulties in maintaining distance from clients' problems. They are expected to relate to clients as friends to achieve medication adherence, and found it awkward to terminate relationships according to research or programmatic guidelines.
Conclusions: PWs can promote positive health outcomes because they have credibility with clients and can relate to difficulties clients face. Working independently in the field can pose dangers for PWs, especially those with substance abuse histories. Supervision is essential in programs utilizing PWs because they face role ambiguities while mostly working independently. PWs need more guidance about such issues as establishing boundaries, relationships with clients, and using their personal experience.
Learning Objectives:
Keywords: Community Health Advisor, Tuberculosis
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.