A community health advisor program: Dissemination challenges and opportunities

Community health advisor (CHA) programs are recognized as important tools to promote health equity in medically underserved communities. Building on the extensive experience over more than two decades of a CHA program in the area of cancer screening and early detection, we tested the feasibility of the program dissemination under significant logistic constraints. More than 20 community agencies in California participated in the program. The agencies implementing the program were primarily community clinics that had worked with community health advisors in some capacity. Together across all sites and in the course of three months, CHAs completed 62 breast health and 15 colorectal cancer screening two-hour sessions following the corresponding standardized facilitator's guide. Thirteen participants attended the sessions on average (N=946). Paper and pencil questionnaires were administered before, immediately after, and 4-6 weeks after the session. Analyses were conducted separately for the breast health and colorectal cancer screening CHA program sessions. Pretest-posttest comparisons in both programs (i.e. breast health and colorectal cancer screening) indicated a statistically significant (McNemar tests, p<.01) increase in cancer screening knowledge. In addition, the percentage of program participants who reported having had a cancer screening test according to age and gender recommendations was also statistically significantly higher at follow-up compared to pretest. The results of the project demonstrated the feasibility of successfully implementing a standardized CHA program across a variety of sites and agencies despite tight time and budget constraints. The importance of community partnerships forged over time can't be overemphasized.