Trained community health workers can successfully implement a health literacy-focused intervention in a community-based randomized trial

Community health workers (CHWs) selected from ethnic churches were trained to deliver a health literacy-focused intervention to promote breast and cervical cancer screening among Korean American (KA) women who were past due for screening tests. The intervention consisted of 2-hour health literacy education, monthly telephone counseling, and navigation assistance. The purpose of this paper is to report on: 1) the intervention delivery; 2) participant satisfaction; and 3) CHW capacity building. We used multiple sources of information such as CHW activity logs, participant satisfaction surveys (20-item), and study team meeting logs, in addition to interview data from two focus groups with CHWs to learn about their intervention delivery and capacity building. Fifteen CHWs delivered the intervention to 278 KA women in 13 ethnic churches randomly assigned to the intervention group in a community-based trial. CHWs held 109 education sessions at varying locations (e.g., CHW home, church, Korean bakery) and offered telephone counseling 17,020 times over the 6-month intervention period. Examples of navigation assistance were: making appointments, translation, transportation, and billing clearance. Participant satisfaction ranged from 2.8 to 3.5 (mean=3.3±0.6) on a 1-4 point scale. Focus group data indicated that CHWs became more cognizant about community resources as they were trying to refer un- or under-insured women to local free clinics or health departments. As limited health literacy strongly predicts inadequate utilization of healthcare resources among recent immigrants such as KAs, well-trained CHWs can successfully implement a multi-faceted health literacy intervention to Korean women to promote their breast and cervical cancer screening.