Community Health Workers (CHWs) are essential in complex health systems. They eliminate cultural barriers, maximize adherence to clinical directives, and promote health. CHWs at Jordan & Harris Community Health Center (JHCHC) come from within the communities served. JHCHC is a nurse-managed center providing health resources to three public housing complexes in Newark, NJ. CHWs educate the community on the merits of medical remedies and help facilitate delivery and compliance with medical directives of the RN and Advanced Nurse Practitioner staff.

The top 3 diagnoses in this predominantly African Americans population are Hypertension, Diabetes and Asthma. In the 4 years that JHCHC has been operational, we have followed over 1,300 patients. Blood pressure trends in systolic and diastolic level were examined for 120 patients from August 2012 to May 2013. The improvements were highly significant, with decreases at 10 months in mean systolic pressure from 139 mmHg to 132 mmHg (a 7 mm Hg decrease), and in mean diastolic pressure from 84 mm Hg to 80 mm Hg (a 4mm Hg decrease). Similarly, blood sugar trends for 39 patients showed blood sugar level was significantly decreased after 10 months, from 175mg/dl to 115mg/dl, a drop of over 35%.

We believe such control is in direct correlation with a community based primary care model that is supported by CHW effort in education of the patients and supervision of directives at home.

As part of a four-abstract series, our CHWs will be presenting on innovative outreach methods that guide the activities of JHCHC.

Recently, breast health navigation has become mainstream in clinical settings. Although the roles of navigators remain loosely defined, the goals are to improve follow-up, decrease times between services and eliminate barriers to making appointments. Utilizing the expertise of lay community health workers, extensively trained in breast health to act as a bridge between patients and providers, navigation begins when an abnormal mammogram is identified and ends when a recommendation for annual screening or treatment starts. Navigators schedule appointments, obtain referrals and prior films, make reminder calls, and among many other activities provide social support during a time of uncertainty.  Patient encounter data are tracked in a database and patient interactions are qualitatively described for reporting purposes.  During our 10 years of operation at a safety-net hospital, we have encountered patients with many distinct barriers ranging from: fear of positive results, financial concerns, language barriers, or lack of information.  In addition, we have fully become integrated in a high-volume radiology department at a safety-net hospital.   With a discussion (oral or roundtable) led by our senior lay patient navigator we will describe patient encounters at various stages of the diagnostic process, discuss how we became fully integrated into the health system, and describe success and challenges of being a navigator in a clinical setting.

Background:  The purpose of this pilot study was to test the feasibility, acceptability, and preliminary effectiveness of a Promotora-Led Diabetes Prevention Program (PL-DPP) in Hispanic women (Latinas). This is an adaptation of the Diabetes Prevention Program lifestyle intervention delivered by lay health workers, or promotoras. And it is the first to enroll only Latinas, the demographic group with the highest lifetime diabetes risk.

Methods: Twenty Latina adults with prediabetes were enrolled in this single-arm trial of PL-DPP. Participants underwent a year-long lifestyle intervention consisting of 24 sessions divided into 14 weekly core sessions and 10 post-core sessions offered either biweekly or monthly. Each session was led by one promotora in Spanish. The primary outcome was weight change over the 12-month study period.

Results:  Eighteen participants (90%) completed at least 10 sessions and one was lost to follow-up. Overall, patients reported high levels of satisfaction with PL-DPP. At 12 months, the participants achieved a clinically meaningful and statistically significant mean change in body weight of 10.8lbs (4.9kg), which corresponded to 5.6% of initial body weight. Forty-two percent of participants achieved the 7% weight loss goal. Significant pre-post reductions in waist circumference, diastolic blood pressure, LDL cholesterol, and insulin levels were also observed. Modest reductions in A1C and fasting plasma glucose were not significant.

Conclusions:  The PL-DPP demonstrated feasibility, acceptability, and preliminary effectiveness in a high-risk population of Latinas. Future research examining this intervention in a randomized clinical trial should explore factors impacting its effects using both qualitative and quantitative methods.

In Wyandotte County (WyCo) Latinos, who represent 27% of the population, confront increasing poverty and language barriers. Moreover, female breast cancer (BCA) mortality in WyCo is higher than the US average, and the proportion of BCA distant stage diagnoses is higher than the surrounding counties’.

In this scenario, KU Medical Center through an American Cancer Society award developed the A.M.I.G.A. promotora program, an academic-community partnership addressing BCA-related disparities in Latinas. Five promotoras were trained on BCA and BCA screening, participated in weekly case discussions and supervision meetings, and completed monthly training sessions in health-related topics and communication skills. They provided culturally and linguistically relevant BCA education and linked women with screening resources. 

Over the year-program, promotoras maintained high levels of BCA knowledge, self-efficacy and motivation. They provided BCA education to 1,101 Latinas at community health events/settings (37%), the Mexican consulate (35%), and safety-net clinics (28%). The majority of women identified were uninsured (99%) and 347 (32%) were age-eligible, had a working telephone number, and were referred for BCA screening. Of them, 202 (58%) reported completing a mammography. Promotoras actively documented participant outcomes throughout the program and contributed to the development of reports to disseminate their results in multiple audiences including APHA.

The A.M.I.G.A. promotora model has the potential to function as a sustainable approach to address cancer-related disparities at large, especially with the Affordable Care Act provisions to incorporate CHW in the healthcare system. Furthermore, the program activities and results are currently informing the development of the Kansas CHW certification policy.

Hmong women in the United States experience significant disparities in cervical and breast cancer outcomes, a consequence of lower rates of cancer screening and resultant diagnosis at later disease stage.  In an effort to improve cancer health outcomes for Hmong women, the Milwaukee Consortium for Hmong Health – founded in 2008 to facilitate engagement with the Hmong community around women’s cancer health and wellness – developed a culturally-grounded lay community health worker (CHW) program to increase cancer literacy and rates of cancer screening.  This presentation will discuss the creation of the Consortium and the community-engaged processes that led to the emergence of lay cancer health education as a stated priority of the Milwaukee Hmong community.  We will provide an overview of the Healthy Hmong Women program, describing the development of this culturally-grounded lay CHW model, its approach, and the curriculum and training developed for use with lay Hmong community members.  In addition, we will evaluate the effectiveness of this lay CHW model in improving awareness of cancer as a health concern in the Hmong community, cancer literacy, and intent to screen.  Finally, we will discuss some of the challenges in implementing this program and detail our plans to expand the program to include Hmong men and other cancers of concern in the community.  The academic and community partners who collaboratively developed the program and curriculum will jointly participate in the presentation, each describing their unique contributions and collaborative approach. Our CHWs, however, will not be part of the presentation team.

Community Health Workers are at the heart of efforts to reduce health disparities. While the Bureau of Labor Statistics estimates that there are over 45,000 CHWs employed in the US at present, many more have been recruited and trained over the past four decades. Despite this, in many parts of the country, projects seeking to hire CHWs must often develop their own curricula and determine standards for training and selection process.

The Multiclinic Action Trial to Control Hyperglycemia and Hypertension (MATCH2) is a behavioral clinical CBPR trial of a home based CHW intervention to reduce diabetes disparities. The recruitment and training protocol for the study was based on several prior studies of the Rush Center for Urban Health Equity.  64 candidates applied for training; six candidates had prior experience as CHWs.  From this group, investigators and community partners selected twenty candidates for training.   All twenty completed the 40-hour study training over a three week period.  The training used adult learning methods, with an emphasis on shared experience and role playing.  In addition to basic education about diabetes, hypertension, physical activity, and diet, modules emphasized training in social determinants of health and behavioral interventions.  The MATCH2 CHW toolkit includes stress management, problem solving, motivational interviewing, and chronic disease self-management.

In this presentation, including CHW presenters from the project, we will share the approaches used to train the CHWs in a complex behavioral intervention, and the evaluation tools for both formative feedback and final CHW selection.

PURPOSE: African Americans suffer disproportionately from heart disease mortality and morbidity.  Trained community health workers (CHWs) can help to close this disparity gap. There is a dearth of research delineating the implementation and evaluation of peer-to-peer training of CHWs as heart health educators.  We evaluated a highly replicable CHW training program designed to reduce heart disease risk among high-risk African American populations. METHODS: We used a Learning Circle approach to train CHWs. The curriculum blended web-based training, self-directed learning and in-person peer coaching.  CHWs learned through: 1) peer-to-peer sharing; 2) problem-solving and brain-storming; 3) leadership and experiential activities. Training evaluation measures were CHW: 1) self-confidence; 2) heart health knowledge; 3) satisfaction with training; 4) training retention; and 5) replication of training within 90 days after training.  FINDINGS: This training resulted in appreciable effects on four of five outcome measures.  Heart health knowledge increased significantly among experienced CHWs (p=0.011). CHWs were highly satisfied with training.  Retention over the 4-day training period was 100%. CHWs initiated and subsequently delivered 122 person hours of community-based heart health education and CHW training sessions in their communities. DISCUSSION/CONCLUSION: The Learning Circle approach is easily tailored and closely simulates CHWs’ typical teaching/coaching style. The preliminary evaluation of this training model suggests that the methodology may work best for increasing heart health knowledge among experienced CHWs and CHWs who have some prior familiarity with heart health education content. Using the Learning Circle method to train CHWs is a practical and replicable method of training CHWs, and holds significant potential for building organization training capacity in resource-poor, community-based organizations.

Background: In 2012, The University of Rochester Medical Center developed a Blood Pressure Advocate Program to assist neighborhood clinics in Rochester, NY address hypertension. Community Health Advocates help patients improve their blood pressure through counseling on risk factors for hypertension, teaching them self-management techniques, helping them set goals to improve nutrition, and medication adherence. Yet, before they can address these aspects of blood pressure health, the CHAs may need to address underlying factors that prevent patients from focusing on their health.  In our program, these factors have included accessing affordable health foods, accessing health insurance, and dealing with bed bugs.  One of the authors and potential presenters of this abstract is a CHA.

Methods: Four Community Health Advocates (CHAs) employed in three local health care clinics receive physician referrals of hypertensive patients. During the first patient visit with the CHA, patients are asked their biggest barrier to controlling their blood pressure. CHAs work with patients to address barriers using innovative strategies that include contact with other agencies (such as the county health department) and other community resources.  

Results: In a subset of 357 patients, 20% (71) stated they had too many other pressing priorities that prevented them from focusing on controlling blood pressure.  After joining and participating in the intervention, 85% of patients report positive changes, including reductions in weight, increased physical activity and better nutrition.

Conclusion: As health care evolves to become more patient centered, Community Health Workers can assist clinicians in addressing the social determinants that impact health.

Mount Sinai Hospital is located on the Westside of Chicago where there is a disproportionate prevalence of asthma among adults. In 2012, Mount Sinai Hospital’s 30-day readmission rate for asthma was 8.1%, a figure that is 3.2 times higher than the national rate.

This presentation will be given by a CHW and describes the CHW-based approach to reduce ED visits and improve asthma outcomes among adults enrolled in the Helping Chicago’s Westside Adults Breathe and Thrive program.  CHW interventions are proven to be effective at addressing pediatric asthma; however, this program is among the first ever CHW-led asthma interventions to focus on adults.

CHWs make 5-6 home visits over the course of the year-long intervention, providing comprehensive and individualized asthma education to adults with poorly controlled asthma. They work closely with participants to conduct home environmental assessments to identify possible asthma triggers and how to avoid them, promote smoking cessation, and address patient comorbidities.

Preliminary results are based on 40 adults who have completed six months of the year-long intervention.  There is significant reduction from baseline to the six month follow-up in daytime symptoms (59.7%), nighttime symptoms (44.8%), and days needed rescue medication (35.6%). ED visits were reduced by 56.4%. CHWs are an effective means of improving asthma symptoms and reducing urgent health care visits among adults with severe asthma. These findings from this innovative CHW-led asthma intervention have the potential to influence policy by demonstrating that CHWs significantly improve health disparities and decrease healthcare costs, in Chicago and beyond.