Culturally Competent Training Program: A Key to Training Lay Health Advisors for Promoting Breast Cancer Screening
Healthy Asian Americans Project, University of Michigan, School of Nursing, Ann Arbor 48109-0482, USA. Health Education & Behavior
(Impact Factor: 2.23).
01/2008; 34(6):928-41. DOI: 10.1177/1090198107304577
The lay health advisor (LHA) training program for breast cancer screening was conducted among Chinese- English bilingual trainees residing in Southeast Michigan. Guided by Bandura's Social Learning Theory, the development of the training curriculum followed the health communication process recommended by the National Cancer Institute. Data analysis based on questionnaires completed by 79 LHAs indicated that the breast cancer screening training program significantly increased LHAs' knowledge and self-efficacy (p < .01, t test, two-tailed) and LHAs had a positive perception with regard to the training manual. Regression analysis found that LHAs who were younger, employed, and demonstrated a positive perception of the training manual tended to have higher self-efficacy in promoting breast cancer screening (R(2) = .30). This study suggests that a culturally competent training program effectively increases LHAs' self-efficacy. The findings have implications for developing effective LHA training programs in Asian American communities where LHA interventions are rarely implemented.
Available from: Cheryl Holt
- "Some studies using CHAs report on outcomes specific to the CHA. For example, a lay CHA program in breast cancer screening for Chinese-English bilingual individuals resulted in significant increases in CHAs’ knowledge and self-efficacy . Another intervention reported outcomes of training lay Filipino CHAs to conduct small-group sessions to increase colorectal cancer screening . "
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Community-based approaches have been increasing in the effort to raise awareness and early detection for cancer and other chronic disease. However, many times, such interventions are tested in randomized trials, become evidence-based, and then fail to reach further use in the community. Project HEAL (Health through Early Awareness and Learning) is an implementation trial that aims to compare two strategies of implementing evidence-based cancer communication interventions in African American faith-based organizations.
This article describes the community-engaged process of transforming three evidence-based cancer communication interventions into a coherent, branded strategy for training community health advisors with two delivery mechanisms. Peer community health advisors receive training through either a traditional classroom approach (with high technical assistance/support) or a web-based training portal (with low technical assistance/support).
We describe the process, outline the intervention components, report on the pilot test, and conclude with lessons learned from each of these phases. Though the pilot phase showed feasibility, it resulted in modifications to data collection protocols and team and community member roles and expectations.
Project HEAL offers a promising strategy to implement evidence-based interventions in community settings through the use of technology. There could be wider implications for chronic disease prevention and control.
Available from: Clement K Gwede
- "Despite the small number of LHAs trained, our experiences with the development of cancer health disparities training for LHAs in CEH are both unique and complementary to the few programs documented in the literature (O'Brien et al., 2009; Reinschmidt & Chong, 2007; Yu et al., 2007). Although most LHAs employed for cancer-specific initiatives have been used in the setting of specific research projects (Wells et al., 2011; typically focusing on one cancer site), our LHAs were primarily intended for general cancer health disparities outreach, education, and facilitation of screening access where indicated. "
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Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program.
Discussion and conclusions:
Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.
Available from: Katrina M Walsemann
- "The broad aim of training is to prepare promotoras with the necessary health-related information and skills critical for delivering community health programs (Jackson & Parks, 1997). Training also serves to cultivate social relationships among the promotoras and with health care team or project staff members (Matos, Rodriguez, Findley, & Catalani, 2009, Yu et al., 2007). Common recommendations for promotora-training components include practicing team building, enhancing interpersonal communication skills, and learning about the complexities of modifying health behaviors (Metzler et al., 2003; Pieper, 2008). "
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ABSTRACT: Training is an essential component of health programs that incorporate promotoras de salud (the Spanish term for community health workers) in the delivery of health education and behavioral interventions to Hispanics. During training sessions, promotoras are exposed to information and skill-building activities they need to implement the health programs. This analysis was one component of a broader study which explored program planners' approaches to recruiting and training promotoras to deliver and sustain health promotion programs for Hispanic women. The purpose of this study was to examine promotora-curriculum and training processes used to prepare promotoras to deliver health programs. The authors examined transcripts of 12 in-depth interviews with program planners and conducted a content analysis of seven different training materials used in their respective promotora programs. Interview themes and narratives included program planners' varying conceptualizations of promotora-training, including their personal definitions of "training the trainer," the practice of training a cadre of promotoras before selecting those best fit for the program, and the importance of providing goal-directed, in-depth training and supervision for promotoras. The content analysis revealed a variety of strategies used to make the training materials interactive and culturally competent. Study implications describe the importance of planners' provision of ongoing, goal-directed, and supervised training using both appropriate language and interactive methods to engage and teach promotoras.
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