An Evaluation of a Train-the-Trainer Workshop for Social Service Workers to Develop Community-Based Family Interventions

A cluster randomized controlled trial of a brief positive healthy eating intervention

Excessive sugar intake poses a significant risk factor for non-communicable diseases. A positive healthy eating (PHE) intervention was developed to promote low-sugar dietary practices in families. The PHE intervention capitalized on positive psychological constructs to overcome barriers to health behavior change by helping families associate feelings of joy, gratitude, and savoring with healthy eating. In a cluster randomized controlled trial, 1983 participants from 1467 families were recruited in Hong Kong. PHE included a core and booster session. Data were collected at pre-intervention, post-intervention, and at 1-month and 3-month follow-up. Compared to the control, PHE showed greater increase in intention to change at post-intervention, engagement in low-sugar dietary practices individually and with family members at 3-month follow-up, and greater reduction in sugar-sweetened beverage intake at 1-month and 3-month follow-up. Intentions to change mediated PHE's effects on low-sugar dietary practices. Focus group interviews revealed the behavior-change process and family quality of life.

Training-of-trainers program for community health workers involved in an innovative and community-based intervention against malaria among goldminers in the Guiana shield: a quality and effectiveness evaluation

Introduction

An innovative and community-based intervention is implemented in the Guiana Shield to eliminate malaria among people involved in artisanal and small-scale gold mining. The intervention consists of the distribution of malaria self-management kits to goldminers and the presumptive treatment for individuals at risk of carrying Plasmodium vivax hypnozoites. The intervention is possible owing to community health workers (CHWs) who are previously trained to master all intervention procedures, including health education activities and goldmining training. This study aimed to evaluate the training program provided to CHWs in terms of quality and effectiveness.

Methods

A training-of-trainers program for CHWs has been developed based on the CDC framework. A mixed-method case study was implemented in two steps between February and March 2023. The evaluation was based on a knowledge survey, satisfaction test, observations, and semi-structured interviews. Quantitative and qualitative data were analyzed and triangulated.

Results

A total of 20 CHWs participated in the training and the first-step evaluation. For the second step, four semi-structured interviews were conducted. The Qualitative data showed that group dynamics and adaptations were central elements of a high-quality training program. Quantitative analysis found that CHWs' satisfaction was elevated (> 4/5 overall), especially regarding format and learning results. Improvements in knowledge level demonstrated good effectiveness (pre-training vs. post-training, p < 0.05). Nevertheless, some difficulties persisted regarding tasks of the intervention procedure, such as informed consent and smartphone application procedures (with an inaccuracy rate of 29.2% and 16.7%, respectively). Further on-the-job training permitted to address these issues. The project team's previous experience and the Guiana Shield countries' commitment to the WHO-E-2025-initiative were identified as levers for the quality of the training, while the complexity of the project context was a challenge.

Discussion

High-quality, effective, and appropriate training programs are required for effective and sustainable interventions involving CHW profiles. Training design is a crucial point to address to accomplish quality and effectiveness. The training-of-trainers model has been shown to allow a high level of satisfaction, good learning results, and satisfactory implementation in the field. Initial and continuing training is an indispensable continuum to sustain good practices in the field and CHWs' motivation. Training evaluation permits standardizing methods and facilitates transferability.

Nutrition programmes for individuals living with disadvantage in supported residential settings: a scoping review

OBJECTIVE

Health inequities such as chronic disease are significantly higher among individuals living with disadvantage compared with the general population and many are reported to be attributable to preventable dietary risk factors. This study provides an overview of the current nutrition interventions for individuals living with extreme disadvantage, in supported residential settings, to develop insights into the development and implementation of policies and practices to promote long-term nutritional health and well-being.

DESIGN

A scoping review searched Scopus, ProQuest, CINAHL Plus, MEDLINE, and Web of Science databases using the terms 'resident', 'nutrition', 'disadvantage', 'intervention' and their synonyms, with particular emphasis on interventions in residential settings.

SETTING

Residential services providing nutrition provision and support.

PARTICIPANTS

People experiencing extreme disadvantage.

RESULTS

From 5262 articles, seven were included in final synthesis. Most interventions focused on building food literacy knowledge and skills. Study designs and outcome measures varied; however, all reported descriptive improvements in behaviour and motivation. In addition to food literacy, it was suggested that interventions need to address behaviour and motivations, programme sustainability, long-term social, physical and economic barriers and provide support for participants during transition into independent living. Socio-economic issues remain key barriers to long-term health and well-being.

CONCLUSIONS

In addition to food literacy education, future research and interventions should consider utilising an academic-community partnership, addressing nutrition-related mental health challenges, motivation and behaviour change and a phased approach to improve support for individuals transitioning into independent living.

Fostering food preservation practice: Lessons from a community train-the-trainer program on Canada's west coast

Local food systems programs in Canada's rural and remote communities support residents to improve their access to healthy food by strengthening various social practices within the system. Designing programs to strengthen social practices can help address food insecurity by providing a support structure where people can build competencies and access materials necessary to engage in practices like food preservation, and make meanings that will encourage them to sustain their engagement. The elements needed for successfully establishing a social practice–competencies, materials, and meanings–must be present. Unfortunately, food preservation programs in Canada's local food systems have not fully embedded structures to bring all three elements of social practice together or undertake a participant-focused program assessment. Consequently, we do not know the potential of local food preservation to meet peoples' various needs or the challenges that program participants experience practicing food preservation. This paper uses a social practice framework to determine the extent to which a community food preservation program on Canada's west coast strengthened the three elements of social practice. Findings from interviews show that in line with the paper's three objectives, participants of a community train-the-trainer program (1) built and shared food preservation competencies, (2) accessed materials to practice food preservation, and (3) formed meanings to support their continuous engagement in food preservation. The paper shows how a social practice framework can support a participant-focused program evaluation and provide a practical and straightforward tool for assessing food systems programs.

Identifying "real-world" initiatives for knowledge translation tools: a case study of community-based physical activity programs for persons with physical disability in Canada

"Real-world" initiatives represent an important source of information for evidence-based practice; however, accessing information about initiatives is often challenging. Casebooks are an innovative knowledge translation (KT) tool for researchers, practitioners, and end-users to address "research-to-implementation gaps" through sharing "real-world" experiences. Several casebooks have been published; yet, they remain inconsistent in their methodological approach for identifying "real-world" initiatives. The purpose of this project is to describe and apply systematic scoping study methods for the identification of "real-world" initiatives relevant for the development of KT tools. Specifically, systematic scoping study methods were developed to identify community-based physical activity (PA) programs for persons with physical disabilities across Canada. To identify PA programs, a search strategy was developed and included five distinct search approaches: (i) peer-reviewed literature databases, (ii) grey literature databases, (iii) customized Google search engines, (iv) targeted websites, and (v) consultation with content experts. Title screening and hand searching identified 478 potentially relevant PA programs. Full record review identified 72 PA programs that met KT tool criteria. The most comprehensive search approach was targeted websites, which identified 25 (35%) unique PA programs, followed by content experts (n = 12; 17%). Only four (5.6%) unique PA programs were identified via custom Google searching. No PA programs were uniquely identified through peer- or grey literature database searches. This study describes and applies a systematic scoping study methodology that serves as a basis for identifying and selecting "real-world" initiatives that are central to the development of evidence-based KT tools.

Development and evaluation of a training workshop for lay health promoters to implement a community-based intervention program in a public low rent housing estate: The Learning Families Project in Hong Kong

This paper presents the development and evaluation of the train-the-trainer (TTT) workshop for lay resident leaders to be lay health promoters. The TTT workshop aimed to prepare the trainees to implement and/or assist in conducting a series of community-based family well-being activities for the residents in a public low rent housing estate, entitled “Learning Families Project”, under the FAMILY project. The four-hour TTT workshop was conducted for 32 trainees (72% women, 43% aged ≥ 60, 41% ≤ elementary school education). The workshop aimed to promote trainees’ knowledge, self-efficacy, attitude and practice of incorporating the positive psychology themes into their community activities and engaging the residents to join these activities and learn with their family members. Post-training support was provided. The effectiveness of the TTT was examined by self-administered questionnaires about trainees’ reactions to training content, changes in learning and practice at three time points (baseline, and immediately and one year after training), and the difference in residents’ survey results before and after participating in the community activities delivered by the trainees. The trainees’ learning about the general concepts of family well-being, learning family, leadership skills and planning skills increased significantly with medium to large effect sizes (Cohen’s d: 0.5–1.4) immediately after the training. The effects of perceived knowledge and attitude towards practice were sustained to one year (Cohen’s d: 0.4–0.6). The application of planning skills to implement community activities was higher at one year (Cohen’s d: 0.4), compared with baseline. At one year, the residents’ survey results showed significant increases in the practice of positive communication behaviours and better neighbour cohesions after joining the family well-being activities of LFP. Qualitative feedback supported the quantitative results. Our TTT workshop could serve as a practical example of development and evaluation of training programs for lay personnel to be lay health promoters.

Trial registration: ClinicalTrials.gov NCT02844244