Online Program

Community-based health promoters as change agents: Culturally-appropriate strategies for hygiene behavior modification in a rural salvadoran setting

Monday, November 4, 2013 : 10:50 a.m. - 11:10 a.m.

Elizabeth Andrade, DrPH, MPH, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
Mark Edberg, PhD, MA, Department of Epidemiology & Biostatistics, George Washington University School of Public Health & Health Services, Washington, DC
Tilly Gurman, DrPH, MPH, Department of Global Health, The George Washington University School of Public Health and Health Services, Washington, DC
Informed by Everett Rogers' Diffusion of Innovations (DOI) theory, this study examined the role of community-based health promoters as change agents for improved hygiene behavior adoption in a two-year hygiene promotion intervention that took place in a rural Salvadoran community setting. We conducted three focus groups and six semi-structured individual interviews to gain a fuller perspective of the health promoter's role in hygiene behavior modification. We used a grounded theory approach to examine the social processes behind hygiene behavior adoption to elaborate on the role of health promoters in these processes. More specifically, we explored household decision-making dynamics and perceived attributes of recommended hygiene practices. Free-listing was used to identify attributes about the health promoters with regards to how these attributes influenced reception of promotion messages. Findings suggest that program successes may be attributed to the community-based approach and intervention delivery by local, culturally appropriate health promoters, who played a vital role in community members' acceptance of hygiene messages. Health promoter characteristics identified as important to hygiene behavior change included: amabilidad (kindness), respeto (respect), confianza (trust), homophily, effort, and credibility. The ama de casa, or female homemaker, emerged as a key player in the hygiene behavior adoption process. Community social networks, desired obedience to authority, and dedication to community priorities emerged as key factors in hygiene behavior change. This study offers a deeper understanding of the way in which this theoretical approach and intervention strategy can be applied in a culturally and linguistically appropriate manner.

Learning Areas:

Diversity and culture
Implementation of health education strategies, interventions and programs
Public health or related education
Social and behavioral sciences

Learning Objectives:
Describe the methods used to examine the role of health promoters in hygiene behavior change. Discuss a new application of the Diffusion of Innovations theory, by Everett Rogers. Explain successes of the hygiene behavior change intervention. Identify health promoter attributes that emerged as being important to hygiene behavior change adoption. Discuss implications of the study's findings for the future implementation of culturally-tailored interventions for similar populations.

Keyword(s): Community-Based Health Promotion, Culture

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a public health researcher with over 10 years experience conducting research in the areas of Latino health and health disparities. I am the principal investigator for the study described 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.