240310 An innovative capacity building approach to prepare tribal community health representatives (CHRs) to deliver colorectal health education, outreach and patient navigation services

Sunday, October 30, 2011

Kevin English, RPh, MPH , Albuquerque Area Indian Health Board, Inc., Albuquerque, NM
Donald Haverkamp, MPH , Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), Albuquerque, NM
David Espey, MD , CDC/Cchp/Nccdphp, IHS Division of Epidemiology, Albuquerque, NM
Melany Cueva, RN, EdD , Alaska Native Tribal Health, Anchorage, AK
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.

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

Learning Objectives:
1. Assess the value of incorporating constructs beyond knowledge into pre-post tests, such as intentions and self-efficacy (confidence), as a means of more comprehensively evaluating the impact of training sessions upon CHR capacity development. 2. Compare the benefits of conducting multiple training sessions in increments over time, versus consolidating CHR capacity development into a singular training session. 3. Describe key experiential learning approaches that can be integrated into CHR capacity development initiatives including role playing, interactive games, health education materials development, and site visits to facilities that perform health procedures associated with training content (e.g. colonoscopy). 4. Identify useful tools for providing colorectal health education and outreach in American Indian communities. A toolkit of materials that have been developed and pilot tested by CHRs will be disseminated to all participants who attend this session. Toolkit contents include customizable PowerPoint slides, American Indian specific videos, colorectal health resource guides and interactive educational games.

Keywords: Lay Health Workers, Native Americans

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have led the development of all facets of the intervention/evaluation research highlighted in this abstract
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.