227056 Taking infant mortality prevetnion to the people: Successes and challenges in state initiated community based interventions

Wednesday, November 10, 2010

Lynda Sagrestano, PhD , Center for Research on Women, University of Memphis, Memphis, TN
Ruthbeth Finerman, PhD , Department of Anthropology, University of Memphis, Memphis, TN
Joy Clay, PhD , Division of Public and Non-Profit Administration, University of Memphis, Memphis, TN
Phyllis Betts, PhD , Center for Community Building and Neighborhood Action, University of Memphis, Memphis, TN
Naketa Edney, MA , Center for Research on Women, University of Memphis, Memphis, TN
Teresa Diener, MA , Center for Research on Women, University of Memphis, Memphis, TN
Carrie Brooks, MA , Center for Research on Women, University of Memphis, Memphis, TN
Low-income neighborhoods in Memphis experience infant mortality rates as high as 36 per 1000 live births, with large health disparities between African-Americans and European-Americans. As part of the Governor's Infant Mortality Initiative, the March of Dimes implemented the Community Voice Program, designed to reduce infant mortality among African-Americans by training Lay Health Advisors (LHA) to take accurate information about perinatal health and infant mortality to the local community. Two years into the project, our multi-method evaluation of process and outcomes has provided us with unique perspective on the program's successes and challenges. Results indicate that over 95% of participants pass the post-test with a score of 80% or better and become certified LHAs. LHAs are challenged to “Take it to the People” by delivering information in individual and small group settings, and documenting delivery through contact reporting forms. Although LHA's report anecdotally that they are talking in the community, in two years approximately 12% have returned contact forms. As evaluators, our team has discovered ironic tensions between the goal to empower and the inclination to commodify knowledge and micromanage grassroots action. For example, the curriculum and support materials remain expensive intellectual property restricting capacity to train new LHAs. Certified LHAs are cautioned not to deliver information to large audiences, but to instead refer requests back to agency supervisors. As the push-pull nature of the program conflates social justice and authoritative knowledge, the true impact of lay health advisors might be witnessed only after they achieve emancipation from the program.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs

Learning Objectives:
Describe the Community Voice Program, including success and challenges in implementation evidence of effectiveness. Discuss the role of state government in initiating community based programs in the area of infant mortality. Analyze the pros and cons of a top down versus bottom up approach to financing community based interventions, including impact on sustainability.

Keywords: Infant Mortality, Evaluation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present on this program as I am the Principal Investigator on this Evaluation Project. As a Health Psychologist, I have many years of research experience related to maternal and child health, as well as extensive evaluation experience.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.