An innovative capacity building approach to prepare tribal community health representatives (CHRs) to deliver colorectal health education, outreach and patient navigation services

Background: Colorectal cancer is the second leading cancer among Americans Indians, and survival rates are disproportionately poor. One promising approach towards addressing this disparity entails the use of community health representatives (CHRs) to raise colorectal cancer awareness and navigate patents to screening and appropriate follow-up.

Methods: To sufficiently prepare CHRs to intervene, a series of three colorectal health workshops was implemented for 25 CHRs from a consortium of seven Tribes. Teaching strategies included a dynamic mix of lecture and experiential learning activities. A 34-item pre-post test was administered at the third workshop to assess the impact of these trainings upon CHR capacity. Paired-sample t-tests were utilized to analyze mean differences in overall pre-post test scores and subscales measuring three key constructs – knowledge, intentions and self-efficacy.

Results: Participants demonstrated significant increases in overall pre-post test scores and scores on all three subscales. However, when data was analyzed according to training exposure, participants who attended all three workshops continued to display significant increases on all scores, while those who attended fewer trainings only experienced gains in knowledge. Pre-test scores were also significantly higher among CHRs who attended all three workshops, suggesting an association between training attendance and retention of training content and self-efficacy.

Conclusion: Considerable attention to capacity development is essential towards strengthening the ability of CHRs to integrate new health priority areas, such as colorectal cancer control, into practice. Moreover, the use of multiple training sessions over time, appears to confer advantages in engendering CHR confidence and motivation to intervene.