236014 An exploration of determinants that impact the capacity of community health workers to integrate breast and cervical cancer control into practice

Monday, October 31, 2011

Kevin English, RPh, MPH , Sociomedical Sciences, Columbia University, New York, NY
Community health worker (CHW) interventions have demonstrated value in a variety of settings and health priority areas. There is limited research, however, that elucidates key determinants that impact the capacity of CHWs to serve as effective community change agents. This is especially true for more sensitive health issues such as cancer, which may be subject to pervasive stigma and taboos among both community members and CHWs themselves. This presentation will address this gap in knowledge by presenting findings from a qualitative study designed to explore factors that impact the capacity of American Indian CHWs to integrate breast and cervical health education, outreach and patient navigation services into practice. In-depth interviews were conducted with 43 CHWs, medical providers and health administrators from seven American Indian Tribes and analyzed utilizing grounded theory. Findings revealed a constellation of determinants that facilitate and/or constrain CHW capacity. Interestingly, these factors followed a socioecological pattern where individual, community and system level influences worked synergistically to impact CHW capacity. Three particular domains emerged as highly salient, which have broad implications for future CHW intervention research, including: 1) the unique dual-role of CHWs as community members and health providers, which confers both advantages and challenges to CHWs, 2) the need for continuous capacity development that integrates experiential learning approaches and extends beyond a unilateral, disease-specific emphasis, and 3) the importance of implementing concomitant system-level initiatives to improve access to health care services (e.g. breast and cervical cancer screening exams) and enhance collaboration between CHWs and medical providers.

Learning Areas:
Chronic disease management and prevention
Diversity and culture
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
1) Describe key individual, community and system-level factors that should be considered and integrated into the design and implementation of community health worker (CHW) interventions. 2) Discuss both the advantages and challenges experienced by CHWs as a consequence of their unique dual-role as health providers and members of the communities they serve, especially when addressing more sensitive and/or stigmatized health issues such as cancer. 3) Identify important leverage points for strengthening CHW capacity development as a central component of future CHW interventions, especially the value of a) experiential learning activities, b) training at multiple points in time, and c) joint emphasis on core competencies and disease-specific competencies.

Keywords: Community Health Advisor, American Indians

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I conceptualized and implemented all phases of the research which this presentation is based upon (data collection, analysis and findings write-up).
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.