A Male Promotores Network for Latinos: Process Evaluation From a Community-Based Participatory Project

Use of Community Health Workers Among U.S. Male Latino Population: A Scoping Review

Community Health Workers (CHWs) are an effective strategy to address the health needs of specified communities. The purpose of this scoping review was to explore the use of CHWs to address the health needs of the Latino male population. This project used specific search terms to identify relevant articles from PubMed, PsycINFO, and Google Scholar. Eligible articles included studies, conducted in the U.S. and in English from 2010 to 2022, that assessed the use of CHWs among a predominantly male (≥ 50%) Latino population. Twenty articles consisting of 13 interventions were identified for review and were further categorized into male-only participant samples (n = 10) and mixed-gender but predominantly-male participant samples (n = 10) for synthesis. Male-only participant samples focused on occupational health and participant's social support and networks. Predominantly-male, mixed-gender participant sample interventions were disease-centered and emphasized the longitudinal support of CHWs as well as social networks. Of the 13 interventions reviewed, almost all (n = 10) utilized existing social networks for engagement and nearly half (n = 6) employed community-based participatory research (CBPR) principles. Findings suggest that recruiting CHWs from within existing social networks and using CBPR are important factors for successful health promotion among male Latinos.

Feasibility of student-designed, peer-led classroom physical activity breaks in graduate school

Objective: We evaluated the feasibility of Pitt Moves, a classroom-based, peer-led physical activity break (PAB) intervention developed by graduate students to improve mood, focus, and boredom among students. Participants: One hundred and thirty-two graduate-level students in 10 courses during an academic semester. Methods: Process evaluation with a formative focus involving document review, surveys, and interviews with students and facilitators. Results: Eighty-four percent of eligible students participated in ≥1 of 65 PABs. Participants said Pitt Moves provided a mental break, promoted community building, and increased their physical activity. They recommended increasing accessibility. Organizers' time was a constraint in running this program. Conclusion: Pitt Moves was feasible based on successful recruitment of participants, delivery of PABs as planned, and participant acceptability. A formal study should evaluate whether Pitt Moves can improve mood, focus, and boredom among graduate students. Organizational encouragement and audiovisuals could enhance marketing and program implementation.

Feasibility and acceptability of CRiSOL: A pilot peer-based intervention to address syndemic health issues afflicting Latino immigrants in the U.S

Substance use, HIV/AIDS, domestic violence and mental health (SAVAME) are syndemic health issues that disproportionately burden Latinos in the U.S. Yet, there are limited evidence-based interventions to address these interrelated syndemic issues and their shared socio-ecological determinants. This study sought to test the feasibility and acceptability of CRiSOL, a peer-based, resilience-focused intervention to reduce the impact of the SAVAME syndemic on Latino immigrants. Fifteen Latino immigrant community leaders were recruited and trained to serve as health promotion agents in their naturally existing social networks. The training was implemented with high fidelity, received with high satisfaction by the peer leaders, and associated with significant improvements in their knowledge, leadership skills, and social capital. During an 8-month outreach phase, nine leaders remained active in the program and documented 825 one-on-one interactions with community members, during which they provided advice/counseling (52.2% of interactions), health information/education (32.5%), referrals to health and social services (38.5%), food aid (39.9%), and service navigation/assistance (10.2%). While future research must be conducted to establish the effectiveness of CRiSOL, findings from this pilot evaluation indicate the feasibility, acceptability, and high level of reach of this intervention and suggest significant potential to reduce the SAVAME syndemic burden in Latino communities.

Design, implementation, and evaluation of community health worker training programs in Latinx communities: A scoping review

This review examines the current reporting trends of program design, implementation, and evaluation of training programs for Latinx community health workers. Five scholarly databases were searched using a scoping review methodology to identify articles describing training programs for Latinx community health workers. The timeframe was 2009 to 2021. We identified 273 articles, with 59 meeting inclusion criteria. Researchers thematically coded the articles to identify reporting strategies related to program design, implementation, and evaluation. Findings suggest a lack of consensus in reporting elements critical to program resources, instructor qualifications, frequency and length of training implementation, theoretical background, and pedagogical tools associated with the training program. We offer detailed reporting recommendations of community health worker training programs to support the consistent dissemination of promising practices and facilitate the initiation of new programs for Latinx community health workers.

Conditions for the success and the feasibility of health mediation for healthcare use by underserved populations: a scoping review

OBJECTIVE

This article aims to analyse the conditions under which health mediation for healthcare use is successful and feasible for underserved populations.

METHOD

We conducted a scoping review on the conditions for effective health mediation according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews standards. We searched for articles in the following databases: PubMed, PsychINFO, Scopus and Cairn published between 1 January 2015 and 18 December 2020. We selected the articles concerning health mediation interventions or similar, implemented in high-income countries and conducted among underserved populations, along with articles that questioned their effectiveness conditions. We created a two-dimensional analysis grid of the data collected: a descriptive dimension of the intervention and an analytical dimension of the conditions for the success and feasability of health mediation.

RESULTS

22 articles were selected and analysed. The scoping review underlines many health mediation characteristics that articulate education and healthcare system navigation actions, along with mobilisation, engagement, and collaboration of local actors among themselves and with the populations. The conditions for the success and the feasability were grouped in a conceptual framework of health mediation.

CONCLUSION

The scoping review allows us to establish an initial framework for analysing the conditions for the success and the feasability of health mediation and to question the consistency of the health mediation approach regarding cross-cutting tensions and occasionally divergent logic.

Effectiveness of a Promotores Network to Improve Health in an Emerging Latino Community

BACKGROUND

Latinos living in emerging communities (i.e., nontraditional destinations with a small but growing population) face obstacles to their mental and physical health. This study evaluated the effectiveness of a 6-month, promotor-led intervention on access to care, physical activity, dietary practices, and perceived social support among Latino adults living in an emerging community, compared with a nonrandomly assigned control group.

METHOD

Participants (n = 81 intervention; n = 86 control) were drawn from Allegheny county, Pennsylvania. Promotores used an intervention tool offering nondirective social support to assist participants in developing SMART goals to address their life concerns in eight domains (e.g., social, diet, and exercise/recreation); the control group received printed materials. Participants completed a survey in Spanish at baseline and follow-up to assess outcomes and had their height and weight measured. Adjusted linear mixed effects models compared change in outcomes over time.

RESULTS

There was a marginally significant improvement in dietary practices in the intervention group at follow-up, and no change in access to care. Both groups experienced an improvement in social support. There was a significant intervention-by-time interaction such that the intervention group increased physical activity by 259 minutes/week compared with the control group.

CONCLUSION

This study demonstrates the potential effectiveness of a promotores network in assisting individuals living in an emerging Latino community to address their life concerns and improve health behaviors. Future studies should include objective and more rigorous measures with a larger sample to replicate these results.

Community health workers promote perceived social support among Latino men: Respaldo

Promotores or community health workers are trusted community members who offer information and support to marginalized groups in society. Latinx immigrants in new growth communities or emerging communities (areas with a small yet growing Latinx population) confront many challenges in their settling processes. De la Mano con la Salud was a community-based participatory project that trained Latino immigrant men as promotores. Promotores recruited 182 Latino immigrant men helped them to attain their own goals, connected them with health and social services and connected them to the larger community. We present data from 23 in-depth interviews with project participants conducted after six months of enrollment. Qualitative analysis confirmed participants’ vulnerabilities and showed that promotores addressed many of the health, legal, and occupational needs of participants. Emerging themes showed that 1) participants had a thirst for a united Latinx community; and 2) felt that promotores had their back (respaldo). The need for community may reflect the current invisibility of this Latinx population, as well as the desires for recognition and ethnic identity affirmation. Respaldo strongly resembles perceived social support, which is the kind of support most associated with health outcomes. Future research can determine what intervention components best foster respaldo.

Participatory approaches in the development of health interventions for migrants: a systematic review

OBJECTIVE

Analysis of participatory approaches to developing health interventions for migrants and how approaches embody core participatory principles of inclusivity and democracy.

DESIGN

A systematic review of original articles. Electronic searches within the databases MEDLINE, Embase, Global Health and PsychINFO (from inception-November 2020).

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Original peer-reviewed articles reporting research to develop and implement a health intervention for migrants, incorporating participatory approaches. We defined migrants as foreign-born individuals. Only articles reporting the full research cycle (inception, design, implementation, analysis, evaluation, dissemination) were included.

DATA EXTRACTION

We extracted information related to who was involved in research (migrants or other non-academic stakeholders), the research stage at which they were involved (inception, design, implementation, analysis, evaluation, dissemination), the method of their involvement and how this aligned with the core principles of participatory research-categorising studies as exhibiting active or pseudo (including proxy and indirect) participation.

RESULTS

1793 publications were screened, of which 28 were included in our analysis. We found substantial variation in the application of participatory approaches in designing health interventions targeting migrants: across 168 individual research stages analysed across the 28 studies, we recorded 46 instances of active participation of migrants, 30 instances of proxy participation and 24 instances of indirect participation. All studies involved non-academic stakeholders in at least one stage of the research, only two studies exhibited evidence of active participation of migrants across all research stages. Evidence is limited due to the variability of terms and approaches used.

CONCLUSIONS

Important shortfalls in the meaningful inclusion of migrants in developing health interventions exist, suggesting a more rigorous and standardised approach is warranted to better define and deliver participatory research and improve quality.

REGISTRATION

This review followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and is registered on the Open Science Framework (osf.io/2bnz5).

Implementation Monitoring of a Promotora-Led, Home-Based Obesity Prevention Pilot Study With Latino Preschool Children and Their Mothers

BACKGROUND

Latino preschool children have higher rates of obesity than children from other racial/ethnic backgrounds. Few effective, culturally-tailored obesity prevention interventions exist that have focused on Latino preschool children, and even fewer have published results of the process evaluation. The purpose of this paper was to monitor reach, fidelity, and completeness of implementation to determine whether ANDALE, a promising promotora-led, home-based pilot study to prevent obesity in Latino preschool children, was implemented as planned.

METHODS

Guided by a logic model, we assessed reach, implementation fidelity and completeness through descriptive analyses of multiple data sources. Reach was assessed through attendance records. Fidelity was assessed via observation checklist and completeness was assessed via survey with both parents and promotoras in a subsample of 12 families.

RESULTS

Promotoras recruited participants primarily through their own social networks and delivered the intervention to 50 families (mother-child dyads); the majority were of Mexican-origin, low-acculturation, dual-parent households. Nearly all (98%) families completed the whole 10-week intervention. Results demonstrated completeness and fidelity of implementation were acceptable in a subsample of 12 families. In sum, 75% of families in the subsample met the criteria (≥75%) for overall implementation of essential program elements (i.e., reach, completeness, and fidelity).

CONCLUSION

Evidence suggests that ANDALE was delivered with high levels of completeness and fidelity in this sample of Latino families with preschool-aged children. These results support implementation of ANDALE in a large, randomized trial.

A Cancer Education-Plus-Navigation Intervention Implemented Within a Federally Qualified Health Center and Community-Based Settings

Despite the availability of effective cancer screening tests, Latinos are screened at lower rates than non-Hispanic Whites. We implemented and evaluated the effectiveness of an evidence-based community health worker (CHW) cancer education-plus-navigation intervention designed to increase cancer screening, knowledge of screening guidelines, and the benefit of early detection. The project included a community and clinic component and served a primarily Latino population. In collaboration with a federally qualified health center (FQHC) and three community-based organizations, bilingual/bicultural CHWs recruited men and women (not up-to-date with the cancer screening guidelines) from a FQHC and the community. Participants received education plus navigation and no-cost cancer screening tests. Together with the FQHC, we outlined eligibility criteria, project protocols, project implementation, and evaluation activities. With the community organizations, we outlined recruitment protocols-when to recruit, how to recruit, and connections with other organizations. CHWs enrolled 3045 men and women into the education-plus-navigation intervention. Overall, 71% received at least one cancer screening. Stratifying by gender, 72% of women received at least one cancer screening test whereas 63% of enrolled men received a test for colorectal cancer. Knowledge of screening guidelines and the belief in early detection also increased from baseline to follow-up. Our evidence-based education-plus-navigation intervention successfully reached large numbers of underserved men and women and yielded positive changes in cancer screening and knowledge of screening guidelines and the belief in early detection. The inclusion of a clinic and community component ensured success of the project.

Participant engagement in a community based participatory research study to reduce alcohol use among Latino immigrant men

Although Latino immigrant men experience many health disparities, they are underrepresented in research to understand and address disparities. Community Based Participatory Research (CBPR) has been identified to encourage participant engagement and increase representation in health disparities research. The CBPR conceptual model describes how partnership processes and study design impact participant engagement in research. Using this model, we sought to describe how these domains influenced participant engagement in a pilot randomized controlled trial of brief intervention for unhealthy alcohol use (n = 121) among Latino immigrant men. We conducted interviews with a sample of study participants (n = 25) and reviewed logs maintained by 'promotores'. We identified facilitators of participant engagement, including the relevance of the study topic, alignment with participants' goals to improve their lives, partnerships with study staff that treated participants respectfully and offered access to resources. Further, men reported that the study time and location were convenient and that they appreciated being compensated for their time. Barriers to participant engagement included survey questions that were difficult to understand and competing demands of work responsibilities. Findings suggest that engaging underserved communities requires culturally responsive and community engagement strategies that promote trust. Future studies should further investigate how CBPR partnership processes can inform intervention research.

Outcomes from a Male-to-Male Promotores Intervention in an Emerging Latino Community

Emerging Latino communities experience social isolation and lack services tailored to their culture. Few male-to-male promotores (community health workers in Spanish) interventions exist. This 6-month participatory study aimed to improve social support, healthcare access, depressive symptoms, and decrease alcohol consumption among Latino immigrant men. Promotores delivered non-directive social support to participants recruited from community venues. We analyzed baseline and 6-month questionnaires data (n = 89) using paired chi square tests. All participants were immigrants; 47% had not finished high school, 29% had depression symptoms, 35% reported past month binge drinking and 93% were uninsured. The intervention significantly improved having a usual source of care (24 to 43%), doctor's visits (41 to 62%) and dentist's visits (27 to 42%) in the past year. Other outcomes did not improve. Male promotores increased healthcare access among vulnerable Latino men. Addressing drinking behavior and depression may require longer interventions or specialized providers.

Evaluation of Healthy Fit: A Community Health Worker Model to Address Hispanic Health Disparities

Introduction

Hispanics in the United States have disproportionately high rates of obesity, hypertension, and diabetes and poorer access to preventive health services. Healthy Fit uses community health workers to extend public health department infrastructure and address Hispanic health disparities related to cardiovascular disease and access to preventive health services. We evaluated the effectiveness of Healthy Fit in 1) reaching Hispanic Americans facing health disparities, and 2) helping participants access preventive health services and make behavior changes to improve heart health.

Methods

Community health workers recruited a sample of predominantly low-income Hispanic immigrant participants (N = 514). Following a health screening, participants received vouchers for breast, cervical, and colorectal cancer screening, and received vaccinations as needed for influenza, pneumonia, and human papillomavirus. Participants who were overweight or had high blood pressure received heart health fotonovelas and referrals to community-based exercise activities. Community health workers completed follow-up phone calls at 1, 3, and 6 months after the health screening to track participant uptake on the referrals and encourage follow-through.

Results

Participants faced health disparities related to obesity and screening for breast, cervical, and colorectal cancer. Postintervention completion rates for breast, cervical, and colorectal cancer screening were 54%, 43%, and 32%, respectively, among participants who received a voucher and follow-up phone call. Among participants with follow-up data who were overweight or had high blood pressure, 70% read the fotonovela, 66% completed 1 or more heart health activities in the fotonovela, 21% attended 1 or more community-based exercise activities, and 79% took up some other exercise on their own.

Conclusion

Healthy Fit is a feasible and low-cost strategy for addressing Hispanic health disparities related to cancer and cardiovascular disease.

Study Protocol for a Home-based Obesity Prevention Program in Latino Preschool Children

PURPOSE

This paper describes the study design for ANDALE Pittsburgh, a culturally-appropriate, family-based intervention to promote a healthy weight in Latino preschool children.

METHODS/DESIGN

The study was organized into two major phases: Phase I: Conduct focus groups with 30 Latino parents of preschool children to inform the development of a culturally-appropriate intervention; Phase II: Test the feasibility and effectiveness of the intervention with 50 families. Participants were recruited from an emerging Latino community through community gatherings, flyers, and word of mouth. Six promotoras (females >18 years, active in community) received 25 hours of training using the intervention curriculum finalized after Phase I. Promotoras delivered the home-based intervention to families over 10, 90-minute weekly sessions that included education, practice, and action (i.e., goal setting). Behavior modification constructs and strategies (e.g., goal setting, problem solving, social support), and building of self-efficacy through healthy recipe preparation and physical activity breaks, were also included. Outcomes (e.g., child BMI) were assessed pre- and post-intervention. Process evaluation assessed fidelity, dose, reach, recruitment, and contextual factors using multiple data sources and mixed methods.

DISCUSSION

The ANDALE Pittsburgh study will expand the body of knowledge on interventions to promote a healthy weight in Latino preschool children living in an emerging Latino community. If successful, this approach will be evaluated in a future, larger-scale intervention and provide a potential model to help to address and prevent obesity in this population.