Abstract
Reaching the hard-to-reach pastoralist and border communities using community volunteers: Lesson from Ethiopia based on three years of experience
Filimona Bisrat, MD, MPH1, Tenager Jemberi2 and Legesse Bezabih3
(1)CORE Group Polio Project in Ethiopia, Addis Ababa, Ethiopia, (2)CORE Group Polio Project Ethiopia, Addis Ababa, Addis Ababa, Ethiopia, (3)CORE Group Polio Project, Addis Ababa, Ethiopia
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
There are various methods and models of community volunteer systems. Generally, it is thought to be a community effort to increase awareness, detection, identification, and reporting of illnesses/diseases. So it is very important to recognize the contribution of community volunteers and share their experiences. This study was an assessment of the past three year reports and an analysis of baseline and midterm evaluation surveys. The community-based intervention model in Ethiopia utilizes 7,962 community volunteers who report cases of acute flaccid paralysis, which are essential to detect polio transmission. Over the past three years community volunteers have identified twice as many cases as expected. In addition, they identified and reported an increasing number of immunization defaulters from 1,648 in 2013 to 14,828 in 2015 and newborns from 14,384 in 2013 to 39,218 in 2015. This enables the immunization program to increase Pentavalent 3 coverage from 37.2% in 2013 to 60.5% in 2015. In addition, community volunteers alone identified 14%, 29% and 43% in 2013, 2014 and 2015 of the expected number 157,843 pregnant mothers and referred them for antenatal care services. Community volunteers can perform surveillance and improve immunization coverage in hard-to-reach areas. Community volunteers, if properly trained and supported, can make important contributions to disease surveillance and promotion of the utilization of essential services.
Planning of health education strategies, interventions, and programs Program planning Public health or related organizational policy, standards, or other guidelines
Abstract
Disseminating Cancer Education and Navigation Resources to CHWs in Texas
Katharine Nimmons, MSc, MPH1, Blanca Macaraeno2, Paula Saldana, CHW, CHWI3, Janet Helduser, MA4 and Jane N. Bolin, PhD, JD, BSN4
(1)TX A&M School of Public Health, College Station, TX, (2)Texas A&M National CHW Training Center, College Station, TX, (3)Texas A&M School of Rural Health, College Station, TX, (4)Texas A&M University, College Station, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
In Texas, disparities related to socio-demographic factors such as race/ethnicity, rural residence, and poverty contribute to low screening rates and poor cancer outcomes. These statistics indicate a need to develop statewide strategies to promote cancer education, improve screening rates, and increase early-stage diagnoses. Disseminating resources to more effectively engage CHWs in cancer education, training, and navigation is a strong model for combatting these disparities.
This presentation describes a CHW dissemination project targeting regions in Texas with significant disparities related to cancer incidence, mortality, screening, and risk factors. The project has two goals: 1) Train CHWs to disseminate resources for prevention, detection, treatment, survivorship, and navigation for breast, cervical, and colorectal cancers; 2) Equip CHW programs with best practices to implement resources related to cancer education and navigation.
Dissemination of culturally-competent training and resources to two audiences (CHWs and programs) occurs via two channels (in-person and online). CHWs have access to cancer education and navigation training via in-person workshops and online modules. Additionally, the project website provides downloadable toolkits (including presentation guides and materials), resource lists, case studies, project summaries, and other support content. Organizations with CHWs are also offered training and support. Through in-person workshops, online resources, and ongoing technical assistance, partner programs receive support for implementing successful cancer education and navigation programs of their own. This project provides a replicable, scalable model for engaging CHWs in community-based cancer education, navigation, and training in Texas and beyond.
Note: The presenter is a CHW instructor; a co-author is a CHW.
Administer health education strategies, interventions and programs Chronic disease management and prevention Public health or related education
Abstract
Promoting community health workers' roles in genomics education, service, and outreach
Lei-Shih Chen, Ph.D., P.T., CHES1, Donaji Stelzig , M.P.H.2, Shweta U. Dhar, M.D., M.S., FACMG3, Tanya Eble, M.S., C.G.C3, Yu-Chen Yeh, Ph.D.1, Shixi Zhao, B.S.1 and Jungkyung Min, B.S.N., R.N.1
(1)Texas A&M University, College Station, TX, (2)Texas A&M Health Science Center, College Station, TX, (3)Baylor College of Medicine, Houston, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Community health workers (CHWs), serving as a bridge between healthcare communities and lay (especially underserved) communities play an important role in genomics education, service, and outreach. CHWs can work with healthcare professionals to translate complex genomics information, collect family history (FH), conduct FH-based risk assessment, and identity high-risk individuals who can benefit from genetic evaluation/testing. Because CHWs are untrained in genomics, we delivered a genomics training workshop for CHWs in Texas. Methods: Working with a large CHW training center in Texas, 95 CHWs attended a genomics training workshop delivered by a CHWI (who is also the presenter of this study) and completed pre-assessment and post-assessment surveys. Participants obtained 6 hours CEU and $25 gift certificates as incentives. Results: Most participants were females (85.3%) with an average age of 45.2 years. Participants' average practice/work years were 10.1 years. The majority were ethnical/racial minorities (i.e., 54.7% were Latinos and 2.6% were Black). The mean scores in attitudes, self-efficacy, and intention in the pre-assessment survey were 87.6 (SD=26.3), 85.9 (SD=32.7), and 39.8 (SD=10.1), respectively. After completing the workshop training, the post-assessment scores significantly improved in attitudes (mean=109.7; SD=26.9; P < 0.001), self-efficacy (mean=102.4; SD=27.0; P < 0.001), and intention (mean=44.3; SD=9.6; P < 0.01). The knowledge score at the post-assessment was significantly higher than at the pre-assessment (P < 0.001). Discussion: CHWs participating in the genomics training workshop significantly improved their attitudes, self-efficacy, intention, and knowledge in genomics education, service, and outreach. Follow-up data are needed to evaluate their practice in genomics.
Other professions or practice related to public health Public health biology
Abstract
Sexual Violence Training for Community Health Workers and Promotoras: An Evaluation
Leah Meyers, Non-profit Director/Social Worker
Arizona Alliance for Community Health Centers, Phoenix, AZ
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The Arizona Rural Women's Health Network began as an initiative in 2006 to address gaps in services in the expansive rural regions of our state. In 2013, a needs assessment revealed a major lack of resources and services related to sexual violence. As 44% of Arizona women will experience sexual violence throughout their lives and women in rural Arizona have limited access to healthcare facilities overall, this was identified as a priority for the Network. The Sexual Violence Curriculum was developed to train Community Health Workers (CHWs) and Promotoras on how to identify, respond to, and advocate for victims of sexual violence in their communities. Community Health Workers participated in a 7-hour course that provided them with a general overview of sexual violence, prepared them to give appropriate support to survivors and victims, equipped them with strategies for addressing sexual violence, and offered a training experience that provided hope and empowerment. Through the first phase of this program, the Network has provided training to nearly 150 CHWs across Arizona, with plans to continue to offer more trainings, as well as add Spanish and online versions. This presentation will include details on both how this curriculum was implemented (to what audiences and with what strategies), as well as data on the effectiveness of the course based on participants' evaluations and assessments. This will help participants better understand the components of an effective CHW curriculum, in addition to considering whether this type of training would be beneficial to their own communities.
Assessment of individual and community needs for health education Conduct evaluation related to programs, research, and other areas of practice Diversity and culture Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
A Mixed Methods Evaluation of Peer Workforce Trainings: Problems and Prospects for Public Health
Isabel Garcia, MSW and Jana Spalding, MD, CPSS
Arizona State University, Phoenix, AZ
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The utilization of people with lived experience to work as behavioral health peer recovery/support specialists (PRSS) is increasing, but opportunities for the professional advancement of this workforce have been limited. To address this need, the Peer and Family Career Academy (PFCA) was designed to provide career advancement opportunities for PRSSs through a variety of professional development activities. Four advanced courses in the areas of housing, advocacy, health/wellness, and supported employment were designed and pilot tested with certified PRSSs. These focus areas were targeted, in part, due to their direct impact on social determinants of health and health disparities. This presentation will share the results of a mixed methods evaluation of the PFCA and the implications of developing a more specialized peer workforce.
PRSS demonstrated an increase in the core competencies of all four courses, and articulated plans to implement the course content in the workplace, suggesting potential organizational benefits as well. Despite these promising findings, evaluators found that current work demands, compensation, and other challenges PRSS identified in acquiring and applying advanced training were undermining their ability to leverage professional development resources to better serve their communities. Next steps in the PFCA evaluation include a statewide survey to identify supports and barriers PRSS encounter in continuing their education and progressing professionally. This research can inform policy and systems change to sustain career advancement efforts for PRSS and other community health professions.
The PFCA Program Coordinator is a certified PRSS and co-authored this abstract. She will be co-presenting.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Evaluating a multi-site, standardized training program for community health workers: Processes for evaluation design and implementation
Katherine Mitchell, MSW1, Katharine Zurek, MSW2, Edith Kieffer, PhD3, Melanie Ward, MPH4, Lee Anne Roman, PhD, MSN5, Mary Janevic, MPH PhD6, Rebeca Guzman, LMSW7, Celeste Sanchez-Lloyd, BS, MA8, Susie M. Williamson, BA, MA, MM8 and Linda Witte, MPA, RMA, CBSP9
(1)University of Michigan School of Social Work, Ann Arbor, MI, (2)Michigan Community Health Worker Alliance, Ann Arbor, MI, (3)University of Michigan, Ann Arbor, MI, (4)University of Michigan School of Public Health, Southfield, MI, (5)Michigan State University College of Human Medicine, East Lansing, MI, (6)University of Michigan School of Public Health, Ann Arbor, MI, (7)Institute for Population Health, Detroit, MI, (8)Spectrum Health, Grand Rapids, MI, (9)Grand Rapids Community College, Grand Rapids, MI
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The Michigan Community Health Worker Alliance (MiCHWA) Community Health Worker (CHW) Curriculum is an endeavor among MiCHWA partners to standardize CHW training in Michigan. MiCHWA's 126-hour curriculum covers eight core competencies, based on Minnesota's standard CHW curriculum. A standardized curriculum is part of larger MiCHWA efforts toward sustainable financing and recognition of the CHW profession.
Three pilot training cohorts using this curriculum launched in 2015, training 52 CHWs. Cohorts in Grand Rapids and Detroit met in-person, while a third cohort used in-person and webinar sessions to accommodate CHWs from diverse geographic areas. To evaluate the impact of this multi-site training, MiCHWA's Evaluation Advisory Board, comprised of academic, community, and CHW partners, worked with training partners to develop and implement a comprehensive evaluation of the CHW training curriculum and its implementation. The evaluation included pre- and post-questionnaires completed by CHW training participants, qualitative interviews with CHW participants three to five months post-training, and qualitative interviews with CHW employers four to six months post-training. A mid-point evaluation was conducted using facilitated dialogue in two of three training cohorts. Pre- and post-questionnaires included Skillset Confidence Scales that asked CHW trainees to assess their confidence per competency objective before and after training. This presentation will discuss the development and implementation of this evaluation, including tools, analysis, and reporting. Presenters will also discuss the participatory processes used to interpret evaluation data among CHWs and trainers, how evaluation can improve CHW training curricula content and delivery methods, and lessons learned. Examples of results will be presented.
Conduct evaluation related to programs, research, and other areas of practice Other professions or practice related to public health Public health or related education
Abstract
Development of a curriculum for CHWs focused on tobacco cessation
Blanca Macareno, MPH1, Jessica Escareno1, Katharine Nimmons, MSc, MPH1, Paula Saldana, CHW, CHWI1, Dinorah Martinez, B.M., CHW, CHWI1, Whitney Garney, PhD, MPH2, Idethia Harvey, DrPH2, Ernestina Constante1 and Esther Valdez1
(1)TX A&M School of Public Health, College Station, TX, (2)Texas A&M University, College Station, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
This presentation describes developing a curriculum for CHWs from existing, underutilized tobacco cessation trainings designed for other clinical providers. Smoking and tobacco use by the U.S. population is an important public health issue especially prominent in rural, low-income communities. CHWs are well-equipped to disseminate culturally-competent health promotion efforts in these communities.
This curriculum prepares CHWs to inform their communities about tobacco prevalence, health risks, traditional and emerging tobacco products, benefits of quitting, best practices for treating tobacco dependence, available resources for quitting, and the U.S. Public Health Services' Ask-Revise-Refer model. CHWs and instructors developed this tobacco cessation training curriculum in both in-person and online formats, in English and Spanish. This increases CHW access to curriculum focused on tobacco cessation, which is an unmet need in Texas.
Additionally, this training was submitted to the Texas Department of State Health Services for approval as a 4-hour Continuing Education Unit for CHWs. This certification creates another professional development opportunity for CHWs.
By definition, CHWs are well integrated within their communities. CHWs receive trust and respect from community members, which will enhance the impact of this training. When tobacco cessation curricula focused only on clinical providers, community networks were underserved due to disparities relating to access to healthcare systems among disadvantaged populations. By incorporating CHWs in the development and distribution of tobacco cessation information, the potential to decrease tobacco use within vulnerable populations represents a substantial opportunity.
Note: The presenter and a co-author are CHW instructors; co-authors are CHWs.
Advocacy for health and health education Chronic disease management and prevention Diversity and culture Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Provision of health care to the public
Abstract
Experience Gained in Using Community Health Workers to Promote Hypertension Self-Management in a Rural Community
Martha M. Phillips, PhD, MPH, MBA1, James M Raczynski, PhD1, Joseph Bates, MD, MS2, Anna Huff Davis, BS3 and Micheal Knox, MPH4
(1)University of Arkansas for Medical Sciences, Little Rock, AR, (2)Arkansas Department of Health, Little Rock, AR, (3)Mid Delta Community Consortium, West Helena, AR, (4)Arkansas Minority Health Commission, Little Rock, AR
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Uncontrolled hypertension (u-HTN) is a serious concern, particularly in southern communities experiencing high rates of stroke and cardiovascular diseases. In Arkansas, which commonly has the highest stroke mortality rate in the US, 29% of adults overall and 34% of black adults have u-HTN. Community health workers (CHWs) have been shown to be effective adjuncts to medical care in a variety of settings, promoting health and disease self-management in a variety of settings and for a range of chronic conditions (e.g., heart disease, diabetes, obesity, hypertension). The Arkansas Prevention Research Center (ARPRC), with funding from CDC and the Arkansas Minority Health Commission, is testing the cost-effectiveness of an innovative program using CHWs to deliver a novel, stepped-care, computer-assisted intervention to help individuals with u-HTN address financial, logistic, social, knowledge, and attitudinal barriers to HTN control and medication adherence. This presentation will describe the use of CHWs within the program, highlighting the strengths and challenges of such an approach for recruitment, data collection, and intervention delivery. Lessons learned during the first year of implementation will be shared along with plans for continuation.
Diversity and culture Implementation of health education strategies, interventions and programs Public health or related research
Abstract
Effect of community health worker interventions to promote psychosocial outcomes among people living with HIV
Kyounghae Kim, MSN, RN1, Jeanne Murphy, PhD2, Patty Wilson, PhD, RN3, Phyllis Sharps, PhD, RN, FAAN4, Jason Farley, PhD, MPH, ANP-BC, AACRN, FAAN5 and Hae-Ra Han, PhD, RN, FAAN1
(1)The Johns Hopkins University, Baltimore, MD, (2)National Cancer Institute, Rockville, MD, (3)The Johns Hopkins University School of Nursing, Baltimore, MD, (4)Johns Hopkins University School of Nursing, Baltimore, MD, (5)Johns Hopkins University, Baltimore, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background. Community health worker (CHW) interventions have been employed as a successful strategy to promote chronic care among HIV-negative individuals from resource-poor communities. Psychosocial factors are critical dimensions of HIV/AIDS care contributing to prognosis of the disease, yet it is unclear how CHW interventions improve psychosocial outcomes in people living with HIV (PLWH).
Objective. To critically appraise the types, scope, and nature of CHW interventions designed to address psychosocial outcomes in PLWH.
Methods. We performed electronic database searches—PubMed, EMBASE, CINAHL, and Cochrane—to identify randomized controlled trials published in English before January 2016. Twelve articles met the eligibility criteria.
Results. Half of the studies were conducted in the United States. Social cognitive theory was used in four of eight theory-guided studies. CHW interventions were focused on promoting prevention/treatment adherence self-efficacy (n=4), followed by increasing social support and quality of life (n=3 each) while reducing stigma related to HIV (n=3). CHWs provided support/counseling (n=9), education (n=4), or navigation assistance (n=4). CHW intervention fidelity was assessed in 4 studies. Eight studies found positive changes in psychosocial outcomes such as self-efficacy (3 of 4) and quality of life (2 of 3). CHW interventions had no effect on stigma or social support in 2 of 3 studies.
Conclusions. Evidence partially supported the use of CHWs in promoting psychosocial outcomes in PLWH. Future CHW intervention should be expanded in scope to address key psychosocial determinants of HIV/AIDS outcomes such as health literacy. Further, fidelity measures should be incorporated into intervention delivery.
Chronic disease management and prevention Diversity and culture Social and behavioral sciences
Abstract
A cross-sectional study on health behaviors of promotoras delivering programs to Latino communities in South Texas
Daniel Hughes, PhD1, Augusto Rodriguez, Ph.D.2, Alexis Ortiz, PT, PhD, SCS, CSCS, FACSM3, Mario Gil, PhD4, Laura Trevino, MS5, Patricia Sharpe, PhD, MPH6, Deborah Parra-Medina, PhD, MPH1 and Laura Esparza, MS, CHES1
(1)University of Texas Health Science Center at San Antonio, San Antonio, TX, (2)Rice University, Houston, TX, (3)Texas Woman’s University, Houston, TX, (4)The University of Texas Rio Grande Valley, Brownsville, TX, (5)Texas A&M University, Weslaco, TX, (6)University of South Carolina, Columbia, SC
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Latina women along the U.S.-Mexico border are among the most physically inactive and obese segment of the U.S. population, putting them at increased risk for chronic disease. There is widespread recognition of the cultural and linguistic appropriateness of promotoras (community health workers) in health education and outreach among Latino communities Promotoras generally have attributes of leadership, compassion, and familiarity with the community yet few studies have investigated health behaviors of promotoras relative to the community they serve. Enlace is a promotora-led physical activity (PA) intervention for women living in impoverished neighborhoods along the U.S.-Mexico border. We conducted a cross-sectional study with 17 promotoras who reside/work in the region to assess physical fitness/functioning and energy balance behaviors.
Measures include anthropometric assessments (body mass index (BMI), body fatness (%), waist and hip circumference), physical functioning/fitness tests (aerobic, strength, flexibility), accelerometry, and self-report dietary and PA behaviors.
Participants' average body mass index (BMI) was high (31.4±7.18 kg/m²); 76.5% were overweight or obese, 30% very or extremely obese. Physical functioning levels were low (cardiorespiratory capacity 26.0±9.1 VO2/kg/min; step test 77.4 steps/2-minutes). Objectively measured moderate-vigorous PA (114.6 ± 87.0 minutes/week) was less than PA recommendations. Accelerometry activity significantly correlated with self-report (r = 0.71, p=0.009). Participants self-reported consuming 1889.2±492.8 kCal/day.
Promotoras exhibited health behaviors similar to other women where they reside/work. Opportunities and incentives for promotoras to engage in health-promoting behaviors along with the intervention program participants, thereby modeling behavioral mastery and desirable health outcomes, may enhance their effectiveness as change agents.
Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs