Abstract
Adoption, reach, and implementation of a community health advisor evidence-based cancer education intervention in African American churches
Sherie Lou Z Santos, MPH, CHES1, Cheryl L. Holt, PhD2, Erin K. Tagai, MPH3, Randi M. Williams, MPH2, Mary Ann Scheirer, PhD4, Janice V. Bowie, PhD, MPH5, Jimmie Slade, MA6, Roxanne Carter6 and Muhiuddin Haider, PhD1
(1)University of Maryland, School of Public Health, College Park, MD, (2)University of Maryland, College Park, MD, (3)University of Maryland, College Park School of Public Health, College Park, MD, (4)Scheirer Consulting, Princeton, NJ, (5)Johns Hopkins University, Baltimore, MD, (6)Community Ministry of Prince George's County, Upper Marlboro, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Project HEAL (Health through Early Awareness and Learning) is a community-engaged implementation trial in 14 African American churches. Churches were randomized to one of two study groups in which peer Community Health Advisors (CHAs) with little to no health background were trained using either a classroom (“Traditional”; n=16 CHAs in 8 churches) or web-based (“Technology”; n=12 CHAs in 6 churches) approach. The CHAs conducted a 3-workshop series in their churches on cancer early detection (breast, prostate, colorectal). Guided by the RE-AIM framework, adoption, reach, and implementation were assessed at the organizational and participant level using multiple data sources including church level data, participant engagement at workshops, and staff observations of CHA performance. The project had a 42% church adoption rate. With regard to reach, a total of 375 participants enrolled—226 participants in the Traditional group (43% reach) and 149 participants in the Technology group (21% reach; p=.08). Implementation was evaluated in terms of adherence, dosage, and quality. Though all churches fully implemented the 3-workshop series, churches in the Technology group completed the workshops in a shorter timeframe than those in the Traditional group (NS). Quality variables (e.g., CHA engagement, presentation confidence, participant recruitment techniques) were comparable between the Traditional and Technology groups (NS). Though the Technology-trained CHAs underwent web-based training with limited technical assistance, adoption, reach, and implementation data compared reasonably well with the Traditional group. Project HEAL's web-based CHA training may be a promising method to train CHAs and increase the reach of evidence-based peer health educator-led interventions.
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
Abstract
Political economy theory in health education: A critical framework for examining social determinants of health
Marty Martinson, DrPH, MPH, MEd1 and Meredith Minkler, DrPH, MPH2
(1)San Francisco State University, San Francisco, CA, (2)UC Berkeley School of Public Health, Berkeley, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Community health education puts focused attention on social determinants of health (e.g., poverty, racial segregation, low quality education, income inequality), which include the structural inequalities that create these social determinants. Although health education theories have increasingly included frameworks for exploring health and health behavior beyond the individual level, further attention is needed on the broader institutional and policy level influences on health. This paper articulates how political economy theory provides a critical structural framework for analyzing the political and economic conditions that distribute power and resources unequally, systematically marginalize particular communities while privileging others, and lead to health inequities. Key constructs of this framework include historical analysis, power relations that create and reinforce inequities, the role of the state, community organizing and the raising of critical consciousness. We illustrate how health educators may use the core tenets of political economy to analyze public health concerns such as diabetes, to reveal, for example, the roles of U.S. food production systems, beverage industries, and austerity policies. We illustrate how political economic analyses of these systems reveal upstream influences on community health and health inequities, and help to inform the development of appropriate strategies for structural change to improve community and public health. Furthermore, we present political economy theory as a pedagogical tool in health education for teaching the structural contexts of public health issues and change strategies to address social determinants of health, with examples of specific learning activities.
Advocacy for health and health education Other professions or practice related to public health Planning of health education strategies, interventions, and programs Public health or related education Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Innovative use of ADAPT-ITT to develop a stigma management intervention for Spanish-speaking HIV-positive MSM in Puerto Rico: A case study
Edgardo Ortiz-Sanchez, MPHE, CHES1, Carlos E. Rodriguez-Diaz, PhD, MPHE, MCHES1, Brian Dodge, PhD2 and Scott Rhodes, PhD, MPH3
(1)University of Puerto Rico, San Juan, PR, (2)Indiana University School of Public Health-Bloomington, Bloomington, IN, (3)Wake Forest School of Medicine, Winston-Salem, NC
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Community-inclusive frameworks for adaptation of interventions, like ADAPT-ITT, often result in better outcomes, as community members participate in the application of more culturally congruent strategies. We used ADAPT-ITT to develop “from the ground up” a stigma management intervention for Spanish-speaking HIV-positive men who have sex with men (MSM) in Puerto Rico (PR), with the goal of embracing methodologically appropriate attention to the social environment of the affected community. Methods: Data were obtained using mixed methods, including a systematic review of scientific literature, qualitative in-depth interviews with MSM in PR, and a quantitative survey focusing, among other domains, on HIV and sexuality-related stigma, quality of life, sexual practices, also with HIV-positive MSM in PR. Data were triangulated and findings were interpreted and validated with iterative meetings with stakeholders, including HIV-positive MSM in PR. Results: Findings informed each of the eight ADAPT-ITT phases. During the Assessment phase, no interventions addressing stigma were found. As a result, the development of a new intervention responded the Decision phase. After completing the remaining phases, Contacto, a six-week, three-encounter intervention based on motivational interviewing, was developed. Discussion: ADAPT-ITT was a useful framework to develop the Contacto intervention, ensuring its cultural congruency tailored to the real-world needs and priorities of Spanish-speaking HIV-positive MSM living in PR. The innovative use of ADAPT-ITT for intervention development rather than as a framework for adaption of existing interventions may be useful for public health professionals, practitioners, and researchers who are in the process of systematically translating formative research into interventions.
Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Program planning Public health or related research Social and behavioral sciences Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Improving Mental Health in Rural Communities Using Appreciative Inquiry and Boot Camp Translation
Jack M. Westfall, MD, MPH1, Linda Zittleman, MSPH2, Maret Felzien, MA3, Jodi Holtrop, PhD2, Tristen Hall, MPH2 and Donald Nease Jr., MD2
(1)Eugene S. Farley, Jr. Health Policy Center, Aurora, CO, (2)University of Colorado Anschutz Medical Campus, Aurora, CO, (3)Northeastern Junior College, Sterling, CO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
background: Multiple challenges face rural community members in accessing mental health care, and medical and system guidelines do not exist. Appreciative Inquiry (AI) engages patients in identifying solutions to local health concerns through stories of success. Boot Camp Translation (BCT) translates findings into concepts and tools for patients and community members. This project tested using AI with BCT to develop a community-based intervention to improve access to mental health care and support. The project was a partnership between the High Plains Research Network Community Advisory Council and its academic research team.
methods: Qualitative data were collected from rural residents using an AI approach and analyzed using grounded theory to identify key elements of successful access to mental health care and support. Concepts and themes were translated into culturally relevant messages and dissemination strategies for rural communities using the BCT process.
results: 29 stories from 21 participants were collected. Relationships, safe venues, persistence, and presence of a health care provider emerged as core elements of success. The role of the “other person” was a key strategy in the resulting community intervention. The partnership developed a 5-question guide equivalent to a conversational PHQ, with messages around community responsibility, permission to ask, and methods for referring to appropriate services.
conclusion: AIBCT revealed several common elements of successful access to mental health care that are not part of a standard behavioral health guideline. The conversational guide provides community members with questions to identify and support others who may be experiencing mental health distress.
Chronic disease management and prevention Communication and informatics Diversity and culture Planning of health education strategies, interventions, and programs Public health or related research Social and behavioral sciences