Health promotores' perceptions of their communities' health needs, knowledge, and resource needs in rural Nicaragua

What About Promotores? Promotores' Psychosocial Determinants That Influenced the Delivery of a Cervical Cancer Education Intervention to Hispanics

This study tested whether a cancer education intervention affected promotores' self-efficacy to deliver an intervention to Hispanics and which psychosocial determinants of promotores influenced the number of Hispanic residents reached by promotores in the subsequent education intervention. A quasi-experimental, pre/post-design with a treatment group (no control) assessed differences for promotores (n = 136) before and after exposure to the cancer education intervention. The design also included a cross-sectional evaluation of the number of residents promotores reached with the educational intervention. After being trained, the promotores delivered the intervention to Hispanic residents (n = 1,469). Paired t-tests demonstrated increases in promotores' self-efficacy from pre- to post-intervention. Regression models assessed associations between the numbers of residents reached and select psychosocial determinants of promotores. Age and promotores' years of experience influenced their delivery of a cervical cancer education intervention to Hispanics, but not their delivery of breast or colorectal cancer education interventions. This is the first study to examine which psychosocial determinants influence promotores delivery of cancer education interventions. The outcomes potentially have implications for CHW interventions and training by examining this potential connection between CHWs' psychosocial determinants and intervention outcomes.

Continuity of Care for Older Adults with Chronic Illness in China: An Exploratory Study

OBJECTIVE

To explore nurses' understanding of continuity of care and existing problems in implementation of continuity of care for Chinese elders with chronic illnesses.

DESIGN AND SAMPLE

Cross-sectional survey and semi-structured interview were performed on 15 nurses and older patients and 1,902 older patients between July 2010 and February 2011.

MEASURES

Semi-structured interview guideline and four-section scale were used.

RESULTS

The interviews showed nurses lacked knowledge of continuity of care, and nurses from small towns or rural areas had less understanding of continuity of care and discharge planning than nurses from central cities. Significant differences were found among patients located in referred areas in selection of medical institutions for treatment, suggesting older adults were more likely to choose general hospitals for treatment. Self-reported surveys demonstrated more than 70% of hospitalized elders chose community hospitals for further recovery after discharge from general hospitals.

CONCLUSIONS

Chinese nurses lack knowledge of continuity of care, and significant discontinuity exists between health care provided by general hospitals, community hospitals and other institutions for elders. A further model for the development of continuity of care should be established that addresses older patients' demands and current barriers in China.

Implementation of a training program for low-literacy promotoras in oral rehydration therapy

OBJECTIVE

The purpose of this study was to ascertain the effectiveness of a culturally appropriate promotora training program related to oral rehydration therapy and diarrheal management. Factors that influenced the development, implementation, and evaluation of the program provided to low-literacy women in Guatemala are explored.

DESIGN AND SAMPLE

Promotora training was conducted with 15 Mayan women from a rural community in the highlands of Guatemala. Women were selected by leaders of the community to participate in the program.

MEASURES

Quantitative data were collected and analyzed to determine descriptive statistics and reliability coefficients for the pretests and posttests. A nonparametric Wilcoxon test for paired-samples was conducted. The qualitative data from the program evaluations were analyzed for themes.

RESULTS

Mean scores increased from 41.73 (SD = 9.65) to 70.33 (SD = 21.29) on the pretest and posttest. The Cronbach's alpha was 0.54 on the pretest with 0.65 on the posttest. The Wilcoxon test demonstrated a significant difference between the pretest and posttest scores (Z = 3.040, p < .05).

CONCLUSIONS

Extremely low-literacy levels played a major role in the ability of the women to successfully complete the requirements of the training program. The curriculum demonstrated effectiveness, but will benefit from replication with a larger sample.