Diffusion of cancer education information through a Latino community health advisor program

Interventions to promote health literacy among working-age populations experiencing socioeconomic disadvantage: systematic review

Background

Experiencing financial insecurity and being underserved is often associated with low health literacy, i.e., the ability to identify, obtain, interpret and act upon health information, which may result in poor health outcomes. Little is known about effective interventions for promoting health literacy among underserved populations. The objective of this systematic review is to summarize the literature on such interventions and identify characteristics that differentiate more effective interventions.

Methods

Following PRISMA guidelines we searched the databases SCOPUS, Pubmed, Web of Science core collection and CINAHL. We included primary studies with a quantitative study design and control groups testing interventions to increase health literacy or health knowledge in underserved populations between 18 and 65 years. Where possible, we converted effect sizes into Cohen's d and compared mean differences of intervention and control groups. Albatross plots were created to summarize the results according to different health literacy and health knowledge outcomes.

Results

We screened 3,696 titles and abstracts and 206 full texts. In total, 86 articles were analyzed, of which 55 were summarized in seven albatross plots. The majority of the studies (n = 55) were conducted in the United States and had a randomized controlled study design (n = 44). More effective intervention approaches assessed needs of participants through focus group discussions prior to conducting the intervention, used bilingual educational materials, and included professionals fluent in the first languages of the study population as intervention deliverers. Additionally, the use of educational materials in video and text form, fotonovelas and interactive group education sessions with role playing exercises were observed to be effective.

Discussion

Although the outcomes addressed in the included studies were heterogeneous, effective intervention approaches were often culturally sensitive and developed tailored educational materials. Interventions aiming to promote health literacy in underserved populations should hence consider applying similar approaches.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323801, PROSPERO registration ID: CRD42022323801.

Process of developing a cervical cancer education program for female university students in a Health and Physical Education teacher training course: an action research

BACKGROUND

The purpose of this study was to develop a cervical cancer education program for students and evaluate the process for female students of an HPE teacher education university who were training to become Japanese Health and Physical Education teachers.

METHODS

This study used Action Research (AR) methodology. In developing program, we analyzed the description of the teaching material development process, the lectures, and the students' report contents, which was the main activity in the program development. Thirty five third- and fourth-year students majoring in health promotion at a Health and Physical Education teacher education university, which trains Health and Physical Education teachers in Tokyo, Japan, participated in this study.

RESULTS

After a review of the prototype version of the cervical cancer education material, six out of nine reviewers determined that it can be published. In the revised cervical cancer education materials, messages from students, university lecturers, and gynecologists have been added as a column in the section on 'how to prevent cervical cancer. Analysis of the contents of the texts (16,792 characters in total) of 35 student reports resulted in the generation of 51 codes, 3 categories, and 15 subcategories.

CONCLUSIONS

This study reflects the intentions of female university students to contribute their knowledge to the development of educational materials on cervical cancer, which, alongside the lectures, have deepened the knowledge and awareness of cervical cancer. Based on this, the teaching material development process, lectures by experts, and students' mindset after learning about cervical cancer is reported in this study. There is a need for more educational programs on cervical cancer that are implemented through the education of female university students.

The Effect of a Learning Partner Model-Based Program on Spreading Cancer Prevention Knowledge Using Community Health Volunteers in Japan

Objectives:

This study examines the implementation and short-term effects of a Learning Partner Model (LPM)-based educational program on cancer prevention and control information for community health volunteers in Japan.

Methods:

The program was undertaken by 3 local governments in collaboration with a government initiative and offered a 90-min group workshop to community health volunteers. Community health volunteers (primary participants) recruited in turn friend or family members (secondary participants) with whom they were prepared to share the content of the workshop with the help of printed materials received in the workshop. We conducted self-administered paper and pencil questionnaire surveys before, immediately after, and 3 months after the workshop. The t-test, Fisher’s exact test, paired t-test, and McNemar test were used to compare the 2 groups’ demographic characteristics and healthy habits at pretest. Repeated measures ANOVA was used to compare cancer prevention knowledge between groups and over time.

Results:

Of 142 participants, 107 pairs of learning partners (primary and corresponding secondary participant) completed all questionnaires. All primary participants and 37.4% of the secondary participants were women, and 57.9% of the learning partners were spouses. The results showed significantly higher correct answers on the cancer-prevention knowledge questions in the post-workshop and follow-up surveys compared to the pre-workshop survey (P < .001). The increase in knowledge was observed in all learning-partner groups in all 3 sites.

Conclusion:

The study demonstrates a promising strategy that can be adapted to the health needs of the community beyond cancer prevention and control, building on the efforts of local governments and government health initiatives.

Impact of Peer-Led Cancer Education Program on Knowledge, Health Beliefs, Practice, and Self-Esteem Among Pairs of Nepalese High-School Students and Their Knowledge-Sharing Partners

Raising cancer awareness among adolescents can increase their confidence in identifying cancer symptoms and develop healthy habits. This study tested the effectiveness of cancer education based on a new model among high schoolers. A non-randomized control group pre-post-test design study was conducted among 313 pairs of adolescent students and their knowledge-sharing partners in Lalitpur, Nepal. A baseline test was conducted before the education program, and it was followed up at two weeks and three months. Results were measured using a chi-square test, binary logistic regression, and a two-way repeated-measures ANOVA. There was a significant interaction effect of intervention and time on students' knowledge, beliefs, self-esteem, and practice, along with a change in some scores of knowledge-sharing partners. Joint assignment supported the idea of diffusion of information within the family and in the neighborhood. The peer group discussion could encourage active learning and help students to participate visibly in problem-solving and reflecting more sustainably. Time constraints, lack of human resources, and support groups, might limit this program's usage; however, preparing guidelines, and connecting communities, organizations, hospitals, volunteer health workers, and survivors can help make it more sustainable and approachable.

Factors associated with colorectal cancer screening in a peer-counseling intervention study in partnership with African American churches

Colorectal cancer (CRC) mortality is 47% higher in African American men and 34% higher in African American women compared to non-Hispanic white men and women. This analysis assessed factors associated with CRC screening among 163 African American participants of a peer-counseling intervention study (2016-2018). In a one-group pre/post-test pilot study, trained Community Health Advisors (CHAs) at 9 African American churches in Los Angeles (LA) promoted CRC screening via one-on-one counseling, print materials and telephone reminder calls. Participants completed telephone surveys 3-6 months after the intervention. We fit bivariate and multivariate mixed effects logistic regression models to assess correlates, including participants' demographic characteristics, access to care, cancer-related knowledge and attitudes and receipt of CHA counseling of (1) discussion of CRC screening with provider and (2) receipt of CRC screening during follow-up. After controlling for gender and education, receipt of CHA counseling (OR 3.77) was significantly associated with discussing CRC screening with a provider during follow-up but not with CRC screening. Instead, a routine check-up in the past 12 months (OR 4.47) and discussion of CRC screening with a provider (OR 3.07) were significantly associated with CRC screening during follow-up. Residence in South LA (OR 0.38) was significantly associated with lack of CRC screening. Findings confirm the important role of health care providers and suggest that residence in South LA constitutes an additional barrier to CRC screening. Further research and additional resources are needed to address disparities in the uptake of CRC screening among African Americans, especially in South LA.

Training Community Health Advisors in African American Churches: Do Training Outcomes Predict Performance?

Programs that utilize Community Health Advisors (CHAs) to promote cancer screening are effective in community settings. However, predictors of CHA performance are not well understood. From 2016 to 2018, we partnered with 9 African American churches in South Los Angeles and trained 49 CHAs to promote cancer screening in an effort to build capacity for health promotion in a low-resource community. This paper examines CHA characteristics and training outcomes in African American faith-based settings and explores the relationship of these variables to successful recruitment of participants by CHAs. Pre- and post-tests showed statistically significant increases in knowledge of colorectal cancer screening guidelines (4 items) and human subjects protection rules (5 items) and CHAs' perceived self-efficacy to perform specific tasks for the study (13 items, Cronbach's alpha > 0.90). There were no significant differences between active CHAs who recruited at least 10 participants (N = 29) and inactive/less active CHAs (N = 20) with respect to demographic characteristics and training outcomes. We report challenges and facilitators to recruitment from CHA debriefings at 12 months follow-up. Based on our findings, we make recommendations for future studies to move this field forward.

Analyzing Awareness on Risk Factors, Barriers and Prevention of Cervical Cancer among Pairs of Nepali High School Students and Their Mothers

Providing information on increased cancer risks associated with certain behaviors might encourage adolescents to initiate protective behaviors. This study firstly determined the knowledge of risk factors and prevention of cervical cancer. Secondly, it checked an association between mothers' screening practice and student's knowledge. A descriptive, cross sectional study was conducted among 253 pairs of high school students and their mothers. Knowledge on cervical cancer was significantly lower among students and mothers. While cancer screening tests, maintenance of hygiene were considered as major preventive measures for cervical cancer, human papilloma vaccine was the least considered preventive measure. Students who were female, attended discussions on cancer and had a healthy diet had better awareness of cancer. Mothers of female students had better knowledge about cervical cancer than mothers of male students. Less perceived susceptibility and lack of knowledge were major obstacles among mothers, limiting cervical cancer screening to 15%. Although association between knowledge of students and screening practice of mothers was not clear, it was observed that cancer communication increased awareness of cervical cancer in both groups. Our findings showed a strong need for school-based cancer education program to address the issues of human papillomavirus vaccinations, cervical cancer risk and screening.

Providing Health Education to Mixtec Farmworkers in California via Workshops and Radio: A Feasibility Study

Originating from one of the poorest areas in Mexico, Mixtecs are one of the largest indigenous groups of workers in California. Providing health education to this group is challenging because many do not speak English or Spanish, and indigenous languages are mainly oral, not written. We explored the feasibility of conveying health information through the radio and in promotora-led workshops. The study included an evaluation of the workshops through surveys before the workshop and 4 to 6 months later in a subsample of 96 indigenous women. The number of radio listeners averaged more than 2,000 per month, and 500 community members attended a workshop. Among women who completed pre- and postworkshop assessments (N = 75), there was a statistically significant increase in knowledge of how to get a wellness visit, where to get a free mammogram, and mammography screening guidelines. Women who ever had a mammogram or wellness visit at baseline were significantly more likely to report receipt of this service during the follow-up period than women who never had this service. Educational workshops and radio are promising and culturally appropriate strategies to provide health information in this community. However, many women need additional assistance to navigate access to health care.

Health Volunteerism and Improved Cancer Health for Latina and African American Women and Their Social Networks: Potential Mechanisms

Health volunteerism has been associated with positive health outcomes for volunteers and the communities they serve. This work suggests that there may be an added value to providing underserved populations with information and skills to be agents of change. The current study is a first step toward testing this hypothesis. The purpose is to identify how volunteerism may result in improved cancer health among Latina and African American women volunteers. A purposive sample of 40 Latina and African American female adults who had participated in cancer volunteerism in the past 5 years was recruited by community advocates and flyers distributed throughout community venues in San Diego, CA. This qualitative study included semi-structured focus groups. Participants indicated that volunteerism not only improved their health but also the health of their family and friends. Such perceptions aligned with the high rates of self-report lifetime cancer screening rates among age-eligible patients (e.g., 83-93 % breast; 90-93 % cervical; 79-92 % colorectal). Identified mechanisms included exposure to evidence-based information, health-protective social norms and support, and pressure to be a healthy role model. Our findings suggest that train-the-trainer and volunteer-driven interventions may have unintended health-protective effects for participating staff, especially Latina and African American women.

Implementation of an evidence-based intervention to promote colorectal cancer screening in community organizations: a cluster randomized trial

The implementation of evidence-based strategies to promote colorectal cancer (CRC) screening remains challenging. The aim of this study is to evaluate two strategies to implement an evidence-based intervention to promote CRC screening in Filipino American community organizations. Twenty-two community organizations were randomized to either a basic or enhanced implementation strategy. In both arms, community health advisors recruited participants non-adherent to CRC screening guidelines, conducted educational sessions, distributed print materials and free fecal occult blood test kits, reminded participants to get screened, and mailed letters to participants' providers. In the enhanced arm, leaders of the organizations participated in implementation efforts. While the effectiveness was similar in both arms of the study (screening rate at 6-month follow-up was 53 % in the enhanced arm, 49 % in the basic arm), 223 participants were screened in the enhanced arm versus 122 in the basic arm. The enhanced implementation strategy reached 83 % more participants and achieved a higher public health impact.

TRIAL REGISTRATION

NCT01351220 (ClinicalTrials.gov).

Increasing Cervical Cancer Screening Among US Hispanics/Latinas: A Qualitative Systematic Review

Hispanic/Latina women experience the highest cervical cancer incidence rates of any racial/ethnic group in the USA and tend to present with more severe cases and experience higher mortality compared to most other populations. The goals of this qualitative systematic review were to explore existing interventions to increase cervical cancer screening among US Hispanics/Latinas and to identify characteristics of effective interventions and research gaps. Six online databases were searched from their inception through June 30, 2013, using designated search terms and keywords. Peer-reviewed articles that documented an intervention designed to improve screening for cervical cancer among Hispanics/Latinas ages 18 years and older living in the USA were reviewed. Data were abstracted using a standardized form to document intervention characteristics and results. Forty-five articles, describing 32 unique interventions, met inclusion criteria. Identified interventions consisted primarily of educational programs and/or provision of screening. Interventions used lay health advisors (LHAs), clinic-based outreach/delivery strategies, partnerships with churches, and mass media campaigns. Twelve interventions resulted in significant increases in cervical cancer screening rates. Interventions developed utilizing theory, applying community-based participatory research approaches, and using LHAs were identified as having the greatest potential for improving cervical cancer screening among Hispanics/Latinas. There continues to be a need for the development of interventions in geographic areas with new and emerging Hispanic/Latino populations and that are comprehensive, follow participants for longer periods of time, and broaden the roles and build the capacities of LHAs.

Building Capacity to Address Women's Health Issues in the Mixtec and Zapotec Community

INTRODUCTION

Mixtecs and Zapotecs are indigenous populations from Mexico. Many are unable to read and write, and speak only their native nonwritten languages, Mixteco and Zapoteco. About one-half of California's indigenous farm worker population is estimated to be Mixteco-speaking (82,000-125,000), and about 20,000 Mixtecs and a smaller number of Zapotecs live in Ventura County.

OBJECTIVES

A community-academic partnership conducted mixed-methods research with the aims of 1) collecting preliminary data on women's health needs, 2) training promotoras to assist with this effort, and 3) engaging community members and obtaining their input through community dialogues.

METHODS

Promotoras who were bilingual in Spanish and either Mixteco or Zapoteco were trained to conduct surveys that included questions on breast feeding and receipt of breast and cervical cancer screening examinations. Barriers to and facilitators of women obtaining these cancer screening tests were discussed in small groups.

RESULTS

In 2013, 813 Mixtec and Zapotec women completed surveys. Although most women reported breast feeding (94%), and receipt of a pelvic examination (85%) and a breast examination (72%), only 44% of women 40 years and older had ever heard of and 33% had ever had a mammogram. Community members recommended offering free mammograms on the weekend by female providers, having women accompanied by promotoras who can translate, conducting door-to-door outreach, advertising cancer screening on the radio and providing small incentives to women.

DISCUSSION

Trained bilingual promotoras can assist in increasing the capacity of indigenous communities to conduct collaborative research by engaging community members and collecting local data.

Translating evidence-based interventions for implementation: Experiences from Project HEAL in African American churches

BACKGROUND

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.

METHOD

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).

RESULTS

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.

CONCLUSIONS

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.

Breast cancer interventions serving US-based Latinas: current approaches and directions

Despite efforts to reduce morbidity and mortality in breast cancer, Latinas continue to have lower 5-year survival rates than their non-Latina white counterparts. All along the cancer continuum from screening to follow-up of abnormal screening to diagnosis and treatment to survivorship, Latinas fare poorer than non-Latina whites. To close this gap, a number of research projects across the continuum have attempted to improve breast cancer outcomes. In this review, we examine studies that have been carried out in breast cancer along the cancer continuum. We focus not only on randomized, controlled trials, but also on quasi-experimental, and pre- and post-test studies that provided interventions for positive breast cancer outcomes. We examine not only the intervention outcomes, but also the type of intervention targets and type of intervention implementation. In future breast cancer research among Latinas, more emphasis should be placed on the steps in detection and treatment that occur after screening.

Exploring Potential Use of Internet, E-mail, and Instant Text Messaging to Promote Breast Health and Mammogram Use among Immigrant Hispanic Women in Los Angeles County

Breast cancer is now the leading cause of death in Hispanic women (HW). Internet, e-mail, and instant text messaging may be cost-effective in educating HW about breast health and in reducing breast cancer mortality. We surveyed 905 HW women attending a free health fair about their technology use, acculturation, insurance status, mammography use, and breast cancer knowledge. Data were analyzed by t test or χ2 tests. Mean age was 51.9 ± 14.2 years (range, 18 to 88 years). Ninety-two per cent were foreign-born. Most had completed some high school (39%) or elementary (38%) education. Most (62%) were uninsured. The majority spoke (67%) and read (66%) only Spanish. Only 60 per cent of HW older than 40 years had a recent mammogram. HW older than 40 years who had not had a recent mammogram were younger (mean 54.9 ± 10.8 vs 58 ± 10.4 years) and less likely to have health insurance (25 vs 44%; P < 0.001). Most HW never use the Internet (58%) or e-mail (64%). However, 70 per cent have mobile phones (66% older than 40 years), and 65 per cent use text messaging daily (58% older than 40 years, P = 0.001). In fact, 45 per cent wish to receive a mammogram reminder by text. Text messaging may be an inexpensive way to promote breast health and screening mammography use among uninsured HW.

Evaluating the training of Filipino American community health advisors to disseminate colorectal cancer screening

Community health advisor-led interventions are associated with improved health promotion behaviors, such as cancer screening, but the process of training community health advisors is rarely described and evaluated. We trained 91 Filipino Americans from 19 organizations to conduct small-group sessions with members of their organizations to promote colorectal cancer screening. Community health advisors completed brief pre- and post-training surveys that included knowledge of colorectal cancer screening guidelines (four items), perceived self-efficacy of performing specific tasks (15-item scale, Cronbach's alpha > 0.90) and satisfaction with the training itself (five items). Community health advisors had high levels of knowledge and self-efficacy at pre-training, but levels increased significantly immediately after the 6-h training (percent of knowledge items answered correctly: 63-94 %; self-efficacy: 8.2-8.9 on a 10 point scale, both p < 0.001). Correlates of self-efficacy at pre- and post-test were high educational attainment, health care background, high level of participation in the organization, being perceived by others as a leader, and frequent participation in research activities in the past. Consistent evaluation measuring similar constructs across studies may help to standardize the quality of the training, and may improve the implementation of community health advisor-led programs.

Using Promotores Programs to Improve Latino Health Outcomes: Implementation Challenges for Community-based Nonprofit Organizations

Promotores are community lay health workers, who provide outreach and services to Latinos. Little research on the promotores programs exists and the focus of this article is to identify the challenges faced by community-based nonprofits when implementing promotores programs. To explore this type of program telephone interviews were conducted with ten promotores academic experts and nonprofit executives. The results suggest that implementation challenges fall into three major categories: the lack of standardized information on promotores programs, labor issues, and organizational costs. Future recommendations are made which highlight promotores recruitment and retention strategies, and the development of a clearinghouse of programmatic implementation information for community-based nonprofits.

Do community health worker interventions improve rates of screening mammography in the United States? A systematic review

BACKGROUND

Community health workers (CHW) are lay individuals who are trained to serve as liaisons between members of their communities and health care providers and services.

METHODS

A systematic review was conducted to synthesize evidence from all prospective controlled studies on effectiveness of CHW programs in improving screening mammography rates. Studies reported in English and conducted in the United States were included if they: (i) evaluated a CHW intervention designed to increase screening mammography rates in women 40 years of age or older without a history of breast cancer; (ii) were a randomized controlled trial (RCT), case-controlled study, or quasi-experimental study; and (iii) evaluated a CHW intervention outside of a hospital setting.

RESULTS

Participation in a CHW intervention was associated with a statistically significant increase in receipt of screening mammography [risk ratio (RR): 1.06 (favoring intervention); 95% CI: 1.02-1.11, P = 0.003]. The effect remained when pooled data from only RCTs were included in meta-analysis (RR: 1.07; 95% CI: 1.03-1.12, P = 0.0005) but was not present using pooled data from only quasi-experimental studies (RR: 1.03; 95% CI: 0.89-1.18, P = 0.71). In RCTs, participants recruited from medical settings (RR: 1.41; 95% CI: 1.09-1.82, P = 0.008), programs conducted in urban settings (RR: 1.23; 95% CI: 1.09, 1.39, P = 0.001), and programs where CHWs were matched to intervention participants on race or ethnicity (RR: 1.58, 95% CI: 1.29-1.93, P = 0.0001) showed stronger effects on increasing mammography screening rates.

CONCLUSIONS

CHW interventions are effective for increasing screening mammography in certain settings and populations.

IMPACT

CHW interventions are especially associated with improvements in rate of screening mammography in medical settings, urban settings, and in participants who are racially or ethnically concordant with the CHW.

Do community health worker interventions improve rates of screening mammography in the United States? A systematic review

BACKGROUND

Community health workers (CHW) are lay individuals who are trained to serve as liaisons between members of their communities and health care providers and services.

METHODS

A systematic review was conducted to synthesize evidence from all prospective controlled studies on effectiveness of CHW programs in improving screening mammography rates. Studies reported in English and conducted in the United States were included if they: (i) evaluated a CHW intervention designed to increase screening mammography rates in women 40 years of age or older without a history of breast cancer; (ii) were a randomized controlled trial (RCT), case-controlled study, or quasi-experimental study; and (iii) evaluated a CHW intervention outside of a hospital setting.

RESULTS

Participation in a CHW intervention was associated with a statistically significant increase in receipt of screening mammography [risk ratio (RR): 1.06 (favoring intervention); 95% CI: 1.02-1.11, P = 0.003]. The effect remained when pooled data from only RCTs were included in meta-analysis (RR: 1.07; 95% CI: 1.03-1.12, P = 0.0005) but was not present using pooled data from only quasi-experimental studies (RR: 1.03; 95% CI: 0.89-1.18, P = 0.71). In RCTs, participants recruited from medical settings (RR: 1.41; 95% CI: 1.09-1.82, P = 0.008), programs conducted in urban settings (RR: 1.23; 95% CI: 1.09, 1.39, P = 0.001), and programs where CHWs were matched to intervention participants on race or ethnicity (RR: 1.58, 95% CI: 1.29-1.93, P = 0.0001) showed stronger effects on increasing mammography screening rates.

CONCLUSIONS

CHW interventions are effective for increasing screening mammography in certain settings and populations.

IMPACT

CHW interventions are especially associated with improvements in rate of screening mammography in medical settings, urban settings, and in participants who are racially or ethnically concordant with the CHW.

Preventing cervical cancer in the Latina population

Cervical cancer causes great morbidity and mortality worldwide and in the United States. Infection with oncogenic human papillomavirus (HPV), the etiological agent of almost all cervical cancer cases, is common among sexually active women in the United States. Over the past 5 decades, the implementation of Papanicolaou screening programs in the United States has led to a significant decrease in cervical cancer cases. However, notable disparities in the incidence and mortality of cervical cancer and cervical screening rates among Hispanics in the United States remain. If current disparities persist without intervention, the Latina population in the United States may remain at a higher risk of developing and dying from cervical cancer. We discuss disparities in cervical cancer screening, incidence, and mortality among the Latina population, as well as the barriers that may propagate these disparities. We also address how these barriers can be overcome through the coordination of outreach programs and widespread prophylactic HPV vaccination to reduce cervical cancer disparities in Latinas.

Barbers against prostate cancer: a feasibility study for training barbers to deliver prostate cancer education in an urban African American community

The goal of this pilot study was to assess the feasibility of training barbers to deliver a brief culturally and literacy appropriate prostate cancer educational intervention to urban African American men. Eight barbers received training to deliver a 2-month educational intervention in the barbershop and completed pre- and posttest training assessments. The training workshops led to a significant increase in mean prostate cancer knowledge scores among the barbers (60% before vs. 79% after; P < 0.05). The barbers also reported positively on the intervention in terms of satisfaction and relative ease of engaging clients. Training barbers to deliver a prostate cancer educational intervention is a feasible strategy for raising prostate cancer awareness of the disease among a priority population.

Role development of community health workers: an examination of selection and training processes in the intervention literature

BACKGROUND

Research evaluating community health worker (CHW) programs inherently involves these natural community leaders in the research process, and often represents community-based participatory research (CBPR). Interpreting the results of CHW intervention studies and replicating their findings requires knowledge of how CHWs are selected and trained.

METHODS

A summative content analysis was performed to evaluate the description of CHW selection and training in the existing literature. First-level coding focused on contextual information about CHW programs. Second-level coding identified themes related to the selection and training of CHWs.

RESULTS

There was inconsistent reporting of selection and training processes for CHWs in the existing literature. Common selection criteria included personal qualities desired of CHWs. Training processes for CHWs were more frequently reported. Wide variation in the length and content of CHW training exists in the reviewed studies. A conceptual model is presented for the role development of CHWs based on the results of this review, which is intended to guide future reporting of CHW programs in the intervention literature.

CONCLUSIONS

Consistent reporting of CHW selection and training will allow consumers of intervention research to better interpret study findings. A standard approach to reporting selection and training processes will also more effectively guide the design and implementation of future CHW programs. All community-based researchers must find a balance between describing the research process and reporting more traditional scientific content. The current conceptual model provides a guide for standard reporting in the CHW literature.

Cervical cancer screening in medically underserved California Latina and non-Latina women: effect of age and regularity of Pap testing

BACKGROUND

This study focuses on age, race/ethnicity and regular cervical cancer screening of medically underserved Latina and non-Latina women enrolled in California's Cancer Detection Programs: Every Woman Counts (CDP: EWC).

METHODS

Data from a cohort of women were evaluated for regularity of screening and ethnicity utilizing multi-category logistic regression models to investigate Pap test and biopsy results.

RESULTS

There was no statistically significant difference among medically underserved Latina or non-Latina women in Pap test result and stage of cervical cancer after controlling for age and screening regularity. Rarely/never Pap-tested women were more likely to have 'SIL/ASC' (odds ratio=1.19; 95% confidence interval=1.08, 1.31) compared to women who were screened regularly. Medically underserved 25-39-year-old women were also more likely to be identified with 'SIL/ASC' (odds ratio=1.64; 95% confidence interval=1.50, 1.79) than women 50 and over. Younger were more likely to have low-grade 'HPV/Condylomata, Atypia/CINI/LSIL' (odds ratio=2.48; 95% confidence interval=1.66, 3.72) and high-grade 'CIN II/III/HSIL/CI/Other Cancers' (odds ratio=1.53; 95% confidence interval=1.08, 2.16) than women age 40 and above, similar to rarely/never Pap-tested women.

CONCLUSIONS

Women were more likely to be identified with high-grade precancerous cervical lesions and cancer process when they did not have regular screening, Ethnic differences in screening outcomes seem to be minimized by participation in a program that provides consistent screening resources to the medically underserved women who enroll. These findings support prevention strategies that expand screening to all medically underserved younger women or that provide HPV vaccination at an early age.

Intimate partner violence in Latina and non-Latina women

BACKGROUND

No single study has delineated the prevalence of intimate partner violence (IPV) over multiple time periods for Latina versus non-Latina women and compared the health of abused Latina women to the health of abused non-Latina women using multiple health indicators. The objective of this study was to describe the prevalence of IPV over multiple time periods and the association between lifetime IPV exposure and current health in Latina and non-Latina women.

METHODS

A total of 3429 women (mean age=47 years) were randomly sampled from a large U.S. healthcare system; 139 (4%) were Latina. During a telephone survey, past-5-year and past-year IPV prevalence was assessed using five questions on physical and psychological abuse from the Behavioral Risk Factor Surveillance System (BRFSS), and ten questions from the Women's Experience with Battering Scale; lifetime IPV prevalence was assessed using the BRFSS questions. Current physical, social, and mental health was assessed using well-validated questionnaires.

RESULTS

Prevalence of IPV for Latina versus non-Latina women was, respectively: 44.6% vs 44% lifetime; 20.1% vs 14.5% for the past 5 years; and 11.5% vs 7.8% for the past year. In models adjusted for age and income, women with a lifetime IPV history had significantly worse health compared to non-abused women across many health indicators; for example, Latina women with a lifetime IPV history had Short Form-36 Health Survey (SF-36) subscale scores that were 5.62 (mental health) to 7.77 (vitality) points lower than those for non-abused Latina women; depression prevalence more than two times higher; and more physical symptoms. Adverse IPV-related health was significantly worse for Latina than non-Latina women for overall mental health functioning (p<0.02), vitality (p<0.01), and emotional functioning (p<0.01) according to SF-36.

CONCLUSIONS

This exploratory study showed that IPV is common in Latina and non-Latina women, and adverse IPV-related mental health was pronounced in Latina women.