Background: Diabetes Self-Management Education and Support (DSMES) programs effectively support adults with diabetes (AWD) to improve diabetes self-management and lower diabetes complication risks, but low-income Latino/a AWD have had low DSMES uptake. With CHWs, we co-designed a DSMES program (‘FAM-ACT’) to increase engagement for Latino/a AWD with low SES. FAM-ACT was culturally-tailored, CHW-delivered in Spanish and English, involved family/friend ‘support persons’ (SPs), and included online sessions during the COVID-19 pandemic.

Objective: To examine how both FAM-ACT and comparison individual-focused CHW-delivered DSMES engaged AWD and their SPs, pre and during the pandemic, and participant factors associated with intervention engagement.

Methods: 222 dyads (AWD with HbA1c≥7.5% and an SP) were enrolled from 09/2019 to 12/2022, randomized (FAM-ACT or I-DSMES), and invited to attend six DSMES sessions over 6 months. AWD and SPs completed surveys at enrollment.

Results: AWD enrollment decreased slightly during the pandemic (77/409 [19%] pre, 145/894 [16%] during). 47% of enrolled SPs were the AWD’s spouse/partner, 26% adult child, 27% sibling/friend/other. AWD enrollees consistently were majority women (61% pre-pandemic, 62% during). Enrolled AWD preference for Spanish was higher during-pandemic (87%) than it was pre-pandemic (74%). On average, AWDs completed 3.8/6 and SP 2.6/6 DSMES sessions. 135/222 (61%) AWD met pre-determined criteria for ‘engagement’ (≥4/6 sessions). ‘Engaged’ AWDs were more likely female (64%, 58% non-engaged), live separately from their SP (40%, 29%), have A1c>9 (51%, 43%), and prioritize diabetes management (56%, 47%). In the FAM-ACT arm (N=112 dyads), engaged AWDs were more likely to have engaged SPs (50/64 [78%], 3/48 [6%]), SPs with pre-diabetes (32%, 6%) and SPs with higher ‘patient activation’ (61%, 33%). Overall, AWD ‘engaged’ during the pandemic (85/145) were less likely to have graduated high school (30/85 [35%], 27/50 [54%] pre-pandemic) and more likely to prefer Spanish to English (70/85 [82%], 36/50 [72%]).

Conclusions: CHW-delivered, culturally tailored DSMES programs successfully reached and engaged low-SES Latino/a AWD and their SPs, even after pandemic adaptations for online delivery. Engaged AWD had higher A1c, prioritized diabetes and had SPs with pre-diabetes and higher patient activation. Engaged AWD had lower education and preferred Spanish to English. Women AWD enrolled at the same rate pre and during the pandemic.

Implications: SP engagement and cultural and contextual tailoring of CHW-delivered DSMES may support the ability of low SES Latino/a AWD to enroll and engage in DSMES. Assessing motivation and ‘competing demands’ may identify AWD who are able to better engage in the short term.

A concept model between the Mississippi State Department of Health (MSDH) and the Center for Research Evaluation (CERE) at the University of Mississippi has spearheaded the evaluation of a pivotal public health initiative. This alliance, deeply rooted in the historical context of rural Mississippi, navigates past distrust through a collaborative evaluation of the Community Health Worker (CHW) program. Our evaluation examines the MSDH’s adept implementation of training, deploying, and engaging community health workers (CHWs) in a concerted COVID-19 response. By interweaving quantitative and qualitative data—spanning from training logs to service delivery metrics—we scrutinize CHWs' enhanced capabilities and community impact. The integration of Implementation Ready (IR) performance measures enriches our analysis, focusing on the completion of COVID-19 response training (IR1), the reach of critical health messaging (IR2), and the variety of services provided (IR3).

The training evaluation focuses on multidisciplinary programs enhancing CHWs' public health roles, while deployment outcomes measure workforce growth against strategic service delivery needs. The engagement component details CHWs' contributions to social service provisions, particularly aiding high-poverty elderly populations, demonstrating concrete community support. Through the lens of the Capability, Opportunity, Motivation, and Behavior (COM-B) model, our concept model approach underscores the synergistic relationship between the CERE’s support mechanisms and MSDH’s on-ground expertise. It prioritizes Mississippi patients' perspectives, advancing equity and diluting power imbalances inherent in evaluation processes. Future evaluation plans involve comprehensive data gathering, aiming to further align CHW endeavors with community health improvements.

Incorporating IR performance measures—like the number and type of organizations integrating CHWs (IR4), CHWs' involvement in vaccine deployment plans (IR5), and their role in reaching high-risk individuals through education and messaging (IR6)—our evaluation framework offers a nuanced understanding of CHW impacts. Additionally, assessing connections made to services for high-risk health and social conditions (IR7, IR7a) enables a deeper dive into the CHWs' engagement efficacy.

By bridging MSDH’s executional knowledge and CERE's evaluative strength, we cast new light on CHWs’ integral role in health crises, providing a framework for sustainable, community-empowered public health strategies. This model of evaluation underscores the transformative potential of cooperative agreements in fostering public health resilience and well-being, showcasing the critical impact of CHWs in navigating pandemics and enhancing community well-being.

Background: Women with hypertensive disorders of pregnancy (HDP) have an increased risk of developing future cardiovascular disease (CVD). Evidence shows that Community Health Workers (CHWs) can effectively improve healthcare access and deliver behavioral change interventions related to blood pressure (BP) self-management.

Methods: A multidisciplinary team is conducting a CHW demonstration project at a large safety-net hospital for women with HDP in the postpartum period. CHWs provided health education and healthcare navigation support, connected patients to community resources, helped with appointment scheduling, and taught SMBP monitoring through home visits and phone calls throughout the 12-month program duration. Over 1 year, 18 in-depth interviews were conducted with 12 program participants. Six participants were interviewed twice at 3 and 12 months to allow comparisons. Recruitment considered differences in race and ethnicity for variability. The transcriptions were deductively and inductively analyzed in MAXQDA using framework and comparative analysis.

Results: Participants described various dimensions of the CHWs’ impact and role in interviews. First, participants highlighted the importance of their supportive relationships with the CHWs. They explained that consistent communication and guidance provided by CHWs during home visits showed a commitment to their well-being outside of the healthcare setting; they also valued the opportunity to attend group meetings facilitated by CHWs where participants could interact with and be inspired by their peers, developing a sense of community. Secondly, participants reported acquiring health education on BP self-management from the CHWs and improving their understanding of healthy lifestyle practices. For example, they detailed learning about the importance of SMBP monitoring, symptoms of high blood pressure, and what to do if they measure high BPs. They discussed adding physical activity into their routines and valuing the healthy cooking classes. Thirdly, participants mentioned appreciating CHWs acting as healthcare advocates and navigators, particularly assisting with appointment scheduling and reminders. Participants valued CHWs reducing the burden of navigating healthcare services by themselves. Finally, participants highlighted the CHW efforts to improve healthcare accessibility, such as helping to set up telehealth appointments and assisting with transportation needs, allowing them to overcome logistical barriers to healthcare access.

Conclusions: The findings of this qualitative evaluation suggest that incorporating CHW programs into postpartum health education and health promotion activities for women with HDP can increase participants’ adherence to healthy behaviors. This is likely due to the relationships they form with CHWs, the CHWs addressing SDOH, and their assistance to facilitate healthcare access.

Many residents of Syracuse public housing have significant health challenges. To help address these, in 2011, the Healthy Neighbors Partnership (HNP) was established, which is a joint effort between an academic medical center, Upstate Medical University and Syracuse Housing Authority (SHA). The HNP community outreach team consists of coordinators, and 8 community health workers (CHW), who live in public housing. Medical direction as needed is provided by physicians. The HNP is unique in that it uses expertise from an academic medical university translated into grassroots efforts to reach populations with little trust for the health care system. Upstate professionals work with CHWs in 4 areas: breast cancer, colon cancer, mental health, and chronic disease. The CHWs then educate their peers and facilitate navigation to cancer screening, mental health first aid courses, chronic disease classes, and more. Each CHW receives a monthly stipend for their work. CHWs make these programs successful.

Each CHW is an identified leader within their community and live in SHA. CHWs receive a general health training and a robust training in breast and colon cancer education by the program coordinator. CHWs are trained through PowerPoint, quiz questions, and role playing with the other CHWs. Many of the CHWs skills and knowledge develops during the job as they put their knowledge to work and come back to the coordinator and their peers with questions. Program health topics are determined based on feedback from needs assessments from residents who live in SHA.

This unique partnership has proved beneficial to the public housing community with the following significant outcomes: Each year, a minimum of 14 educational sessions are conducted by CHWs in the SHA community rooms within 10 different housing units. Since 2014, over 1,100 mammograms have been completed, with 9 cancers found and treated. Since 2016, 14 colonoscopies were completed, including the removal of 4 polyps, and 119 at home stool kits have been completed. Since 2021, four 6-week chronic disease courses have been completed by a total of 34 residents. Lastly, the newest program for mental health began in 2023 and has certified 29 residents in mental health first aid thus far.

The CHWs in SHA have helped to change the distrust that previously existed between the healthcare system and residents while creating a healthier community focused on prevention, as well as affording the public housing CHWs new skills and learning opportunities to enter the workforce.

Background: Despite knowledge of the COVID-19 vaccine's effectiveness, hesitancy particularly persisted in low-income and underserved communities since its rollout. Furthermore, the impact of COVID-19 on mental health was more pronounced in these communities which simultaneously have limited access to mental health resources. This study describes the opportunity to address vaccine hesitancy and enhance access to mental health support in underserved communities through community health workers (CHWs).

Methods: A team of 8 CHWs engaged in one-on-one phone calls with participants ranging from 15-60 minutes. During phone interactions, CHWs identified participant needs and connected them to requested wraparound resources and health education. A self-reported survey was administered across three communities in year 1 and six communities in year 2 to assess knowledge, attitudes, beliefs, and perceived barriers due to the impact of COVID-19. Descriptive statistics are reported.

Results: In year 1, participants (n=193) were primarily Hispanic (87.6%) and over half 52.1% reported being fully vaccinated. Barriers to COVID-19 vaccination included fear of vaccine side effects (13%), lack of trust in vaccine safety (6%), and other reasons (24%). For mental health status, 45% of participants reported feeling nervous, anxious, or on edge over the last 2 weeks, and 40% reported feeling depressed or hopeless. Participants requested wraparound resources from CHWs for rental assistance (20%), COVID-19 testing (16%), and food assistance (13%) with only 1% requesting information on mental health services.

In year 2, participants (n=714) were primarily Hispanic (80.8%) and most reported being fully vaccinated (69.71%). Fear of vaccine side effects (15%) remained a barrier, while different barriers included not trusting the vaccine will cure COVID-19 (27%) and concern about others’ safety (11.3%). Regarding mental health, 26.48% reported feeling nervous, anxious, or on edge up to nearly every day, and 27.3% depressed or hopeless over the last 2 weeks. Yet 28% and 27.6% preferred not to answer about feeling anxious or depressed, respectively. Over 650 requests were for assistance with COVID-19 testing and COVID-19 related information (25.5%), healthcare (19.62%), food (17.82%), and mental health resources (2.65%).

Conclusion: Opportunity exists for CHWs, as trusted messengers, to meet communities where they are through community assessment and resource navigation. Future studies should prioritize CHWs as interventionists to increase reach and overcome barriers to vaccine hesitancy, mental health, and other health promotion strategies.

This presentation will advance understanding and utilization of trust-building strategies by public health practitioners as they engage with CHW/P. Trust-building is an essential component of CHW/P capacity building. Successful engagement of CHW/Ps is necessary for local health jurisdictions to grow effective health navigators for vulnerable populations.

Public health practitioners should engage CHW/Ps in capacity building on a foundation of mutual respect, co-learning, and shared power. CHW/P training should include practices that improve population health and reduce health disparities; cultivate resilience, efficacy, and agency among individuals and communities; and promote accountability of and trust in public health institutions. Trust-building enables successful engagement of CHW/Ps and is an ethical practice of community health education.

Examples will be provided from an 80-hour, 11-session CHW/P training program. The CHW/P training program is an evidence-based learning series developed by the presenters using Community-Based Participatory Research. Evaluation methods have demonstrated training effectiveness in participant learning of 11 CHW/P core competencies. The 11 competencies include communication skills interpersonal and relationship-building, service coordination and navigation, capacity building, advocacy, education and facilitation, individual and community assessment, outreach, professional skills and conduct, evaluation and research, and knowledge base.

Participants will learn trust-building skills to utilize in the planning and implementation of health education and promotion programs and receive a toolkit of trust-building strategies to employ in CHW/P training delivery. Participants that identify as administrators and managers would benefit from this presentation to learn the ethical practice of investing resources in trust-building strategies to achieve quality and community-level outcomes.

Background

We performed a community-engaged rapid assessment of chronic disease knowledge and practices in Chicago, in partnership with the Chicago Department of Public Health (CDPH) and a team of community health workers (CHWs) known as the Community Health Response Corps. The objective of this study was to educate the public, remediate knowledge gaps, connect the public to resources, and rebuild community trust and participation in public health assessments.

Methods

Our community-based participatory approach included CHWs and academic partners who collectively defined objectives, shaped questions, collected data, and assessed results. CHWs interviewed a convenience sample of friends, family, and neighbors during an assessment targeting sensitive topics such as mental health, trust in public health, and health literacy. After the assessment, interested participants received resources to remediate knowledge gaps or access resources.

Results

CHWs interviewed 614 community members in 8 weeks. Assessments were conducted in English or Spanish. The sample was diverse, including 39% Black/African-American and 45% Hispanic participants, and representing 68 of 77 Chicago community areas, including every priority and high economic hardship community area defined by CDPH. We learned that 38% of participants had evidence of non-optimal literacy, 66% described experiencing stigma around mental health topics, and participants noted barriers to healthy behaviors (e.g., physical activity (55%), doctor’s visits (18%), mental health care (56%), including a lack of resources, distrust, insufficient access, and scheduling concerns.

Conclusion

Our approach demonstrated that an engaged academic-community partnership can assess community health beliefs and needs and respond quickly with resources to address those needs.

Background

In the US, Chinese Americans experience a disproportionate burden of stomach cancer. Helicobacter pylori (H. Pylori) infection is the strongest risk factor for stomach cancer. However, the complex treatment is challenging for Chinese New Yorkers with limited English proficiency and low health literacy. By linking bilingual/bicultural community health workers (CHWs) to Chinese-speaking patients, we aim to help participants facilitate H. pylori eradication and stomach cancer prevention.

Objective

We seek to analyze the encounter reports generated by CHWs to understand perspectives of the participant and CHW during the study.

Methods

Participants randomized to the intervention group were paired with a bilingual/bicultural CHW for 6 months and received a protocol of culturally and linguistically-adapted educational sessions, goal-setting and action planning (n=68). Encounter reports generated by CHWs after any significant contact with intervention group participants were combined into one transcript per participant and analyzed using an inductive approach.

Results

Main themes identified included: i) the critical role of CHWs; ii) economic, housing and food insecurities that make medication adherence and goal-setting challenging; iii) health literacy and medication adherence challenges; iv) the intervention’s impact on family members; and v) goal-setting facilitators and barriers.

Conclusions

H. pylori eradication in Chinese Americans is complex, compounded by social and structural determinants of health. Bilingual/bicultural CHWs served as an important source of support and trusted members of the healthcare team. More research is needed to understand the complexities of stomach cancer prevention and strengthen opportunities for engagement of this high-risk group to facilitate health equity outcomes.

The YMCA of South Florida's Community Health Strategies Department endeavors to rebuild trust in public health and science through innovative interdisciplinary approaches. Leveraging the rich history and trust associated with the YMCA as the oldest non-profit organization in the U.S., our department extends its programs beyond traditional walls and into high-need communities of South Florida. This approach coined "Y Without Walls," pushes away from the traditional Y model, and emphasizes community engagement, bringing health education and support directly to individuals.

Our evidence-based strategies, led by a team of Community Health Workers (CHWs), comprises: 1. Empowering group health education to promote healthy lifestyles and chronic disease self-management. 2. Targeted one-on-one support to address individual’s social and health needs by closing the clinic to community gap via the YMCA Health Navigation (YHN) Program. 3. Grassroots outreach for community engagement, understanding equity needs, and fostering trust.

Over 12 years, qualitative methods reveal the impactful transformation of "Y Without Walls." We have achieved a notable reduction in health disparities, empowering individuals to overcome barriers to self-management. Through grass roots efforts we have addressed both individual and community needs, strengthened community ties, bridged the clinic and community gap and advanced access to healthcare utilizing an equity lens.

Looking to the future, the "Y's Without Walls" approach has the ability to transform community health, reduce disparities and bridge the clinic-community gap if replicated. Through evidence-based strategies, we empower individuals and rebuild community’s trust in public health and science. Committed to equity, we drive impactful, resilient change.