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Holt CL, Tagai EK, Santos SLZ, Scheirer MA, Bowie J, Haider M, Slade J. Web-based versus in-person methods for training lay community health advisors to implement health promotion workshops: participant outcomes from a cluster-randomized trial. Transl Behav Med 2020; 9:573-582. [PMID: 29955889 DOI: 10.1093/tbm/iby065] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Project HEAL (Health through Early Awareness and Learning) is an implementation trial that compared two methods of training lay peer community health advisors (CHAs)-in-person ("Traditional") versus web-based ("Technology")-to conduct a series of three evidence-based cancer educational workshops in African American churches. This analysis reports on participant outcomes from Project HEAL. Fifteen churches were randomized to the two CHA training methods and the intervention impact was examined over 24 months. This study was conducted in Prince George's County, MD, and enrolled 375 church members age 40-75. Participants reported on knowledge and screening behaviors for breast, prostate, and colorectal cancer. Overall, cancer knowledge in all areas increased during the study period (p < .001). There were significant increases in digital rectal exam (p < .05), fecal occult blood test (p < .001), and colonoscopy (p < .01) at 24 months; however, this did not differ by study group. Mammography maintenance (56% overall) was evidenced by women reporting multiple mammograms within the study period. Participants attending all three workshops were more likely to report a fecal occult blood test or colonoscopy at 24 months (p < .05) than those who attended only one. These findings suggest that lay individuals can receive web-based training to successfully implement an evidence-based health promotion intervention that results in participant-level outcomes comparable with (a) people trained using the traditional classroom method and (b) previous efficacy trials. Findings have implications for resources and use of technology to increase widespread dissemination of evidence-based health promotion interventions through training lay persons in community settings.
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Affiliation(s)
- Cheryl L Holt
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Erin K Tagai
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Sherie Lou Zara Santos
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | | | - Janice Bowie
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Muhiuddin Haider
- School of Public Health, Institute for Applied Environmental Health, University of Maryland, College Park, MD, USA
| | - Jimmie Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
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Williams RM, Zhang J, Woodard N, Slade J, Santos SLZ, Knott CL. Development and validation of an instrument to assess institutionalization of health promotion in faith-based organizations. Eval Program Plann 2020; 79:101781. [PMID: 31991309 DOI: 10.1016/j.evalprogplan.2020.101781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
Institutionalization of health promotion interventions occurs when the organization makes changes to support the program as a component of its routine operations. To date there has not been a way to systematically measure institutionalization of health promotion interventions outside of healthcare settings. The purpose of the present study was to develop and evaluate the initial psychometric properties of an instrument to assess institutionalization (i.e., integration) of health activities into faith-based organizations (i.e., churches). This process was informed by previous institutionalization models led by a team of experts and a community-based advisory panel. We recruited African American church leaders (N = 91) to complete a 22-item instrument. An exploratory factor analysis revealed four factors: 1) Organizational Structures (e.g., existing health ministry, health team), 2) Organizational Processes (e.g., records on health activities; instituted health policy), 3) Organizational Resources (e.g., health promotion budget; space for health activities), and 4) Organizational Communication (e.g., health content in church bulletins, discussion of health within sermons) that explained 62.3 % of the variance. The measure, the Faith-Based Organization Health Integration Inventory (FBO-HII), had excellent internal consistency reliability (α = .89) including the subscales (α = .90, .82, .81, and .87). This measure has promising initial psychometric properties for assessing institutionalization of health promotion interventions in faith-based settings.
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Affiliation(s)
- Randi M Williams
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
| | - Jing Zhang
- University of Maryland, School of Public Health, Department of Epidemiology and Biostatistics, United States.
| | - Nathaniel Woodard
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
| | - Jimmie Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, United States.
| | - Sherie Lou Zara Santos
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
| | - Cheryl L Knott
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
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Knott CL, Bowie J, Mullins CD, Santos SLZ, Slade J, Rosenberg E, Woodard N, Williams R, Williams RM. An Approach to Adapting a Community-Based Cancer Control Intervention to Organizational Context. Health Promot Pract 2020; 21:168-171. [PMID: 31959002 DOI: 10.1177/1524839919898209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There has been increasing attention in implementation science to optimizing the fit of evidence-based interventions to the organizational settings where they are delivered. However, less is known about how to maximize intervention-context fit, particularly in community-based settings. We describe a new strategy to customize evidence-based health promotion interventions to community sites. Specifically, leaders in African American churches completed a memorandum of understanding where they were asked to identify two or more health promotion implementation strategies from a menu of 20 and select a planned implementation time frame for each. In a pilot phase with three churches, the menu-based strategy and protocols were successfully implemented and finalized in preparation for a subsequent randomized trial. The three pilot churches identified between two and nine strategies (e.g., form a health ministry, allocate space or budget for health activities, include health in church communications/sermons). The selected strategies varied widely, reinforcing the need for interventions that can be customized to fit the organizational context. Despite the challenges of integrating health promotion activities into non-health focused organizations, this approach has promise for fostering sustainable health activities in community settings.
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Affiliation(s)
- Cheryl L Knott
- University of Maryland, College Park, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | | | | | | | - Jimmie Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
| | | | | | - Ralph Williams
- Access to Wholistic and Productive Living, Inc, Brentwood, MD, USA
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Holt CL, Shelton RC, Allen JD, Bowie J, Jandorf L, Zara Santos SL, Slade J. Development of tailored feedback reports on organizational capacity for health promotion in African American churches. Eval Program Plann 2018; 70:99-106. [PMID: 30041105 PMCID: PMC6077099 DOI: 10.1016/j.evalprogplan.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/12/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
Standard community-engaged research methods involve reporting research findings back to study participants. Project HEAL is an implementation trial conducted in 14 African American churches. This paper reports on a strengths-based approach to reporting Project HEAL organizational capacity data back to church leadership, through use of individualized church reports. Pastors in each church completed a church organizational capacity assessment. The study team, including community partners representing church leadership, co-created a channel and content to disseminate the capacity data back to Project HEAL church leaders. This consisted of a 4-page lay report that included the church's capacity scores, and recommendations for future evidence-based health promotion programming matched to their capacity. The study team was able to meet with nine of the 14 churches to review the report, which took an average of six and a half weeks to schedule. The individualized church reports were well-received by pastors, who expressed an intention to share the information with others in the church and to sustain health promotion activities in their organizations. Though the individualized reports were embraced by the pastors, it is unknown whether this process will result in sustainable health promotion in these organizations without further follow-up.
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Affiliation(s)
- Cheryl L Holt
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, 1234W Public Health Building (255), College Park, MD 20742, USA.
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Columbia's Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, USA.
| | - Jennifer D Allen
- Department of Community Health, Tufts University, 574 Boston Avenue-Suite 208, Medford, MA 02155, USA.
| | - Janice Bowie
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD 21205, USA.
| | - Lina Jandorf
- Icahn School of Medicine at Mount Sinai, Department of Oncological Sciences, 1425 Madison Avenue, New York, NY 10029, USA.
| | - Sherie Lou Zara Santos
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, 1234W Public Health Building (255), College Park, MD 20742, USA.
| | - Jimmie Slade
- Community Ministry of Prince George's County, P.O. Box 250, Upper Marlboro, MD 20773, USA.
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Williams RM, Tagai EK, Santos SLZ, Slade JL, Carter RL, Holt CL. The Role of Leadership Support in a Church-Based Cancer Education Implementation Study. J Relig Health 2018; 57:146-156. [PMID: 28597333 PMCID: PMC5723241 DOI: 10.1007/s10943-017-0427-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Leadership plays a role in the success of an organization's initiatives. We examined church leaders' support-as perceived by lay community health advisor (CHA) interventionists-and implementation outcomes in a cancer early detection trial. CHAs perceived that their pastors: helped promote the intervention (M = 3.1/4, SD 1.2) and attended about half (M = 1.6/3, SD 1.3) the workshops. CHAs used marginally more techniques to recruit members when they perceived pastors were engaged in promoting the program (r s = .44, p = .08). Pastor attendance was positively associated with member enrollment (r s = .50, p < .05). Pastor support may be related to receptivity of both CHAs and congregants to engage in church health promotion.
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Affiliation(s)
- Randi M Williams
- Department of Behavioral and Community Health, School of Public Health (255), University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA.
| | | | - Sherie Lou Zara Santos
- Department of Behavioral and Community Health, School of Public Health (255), University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA
| | - Jimmie L Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
| | - Roxanne L Carter
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
| | - Cheryl L Holt
- Department of Behavioral and Community Health, School of Public Health (255), University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA
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Santos SLZ, Tagai EK, Scheirer MA, Bowie J, Haider M, Slade J, Wang MQ, Holt CL. Adoption, reach, and implementation of a cancer education intervention in African American churches. Implement Sci 2017; 12:36. [PMID: 28292299 PMCID: PMC5351199 DOI: 10.1186/s13012-017-0566-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Use of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)-a community-based implementation trial of a cancer educational intervention in 14 African American churches. We compare adoption, reach, and implementation at the organizational and participant level for churches in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new online system. METHODS Fifteen churches were randomized to one of two study groups in which two CHAs per church were trained through either classroom ("Traditional"; n = 16 CHAs in 8 churches) or web-based ("Technology"; n = 14 CHAs in 7 churches) training methods. Once trained and certified, all CHAs conducted a series of three group educational workshops in their churches on cancer early detection (breast, prostate, and colorectal). Adoption, reach, and implementation were assessed using multiple data sources including church-level data, participant engagement in the workshops, and study staff observations of CHA performance. RESULTS The project had a 41% overall adoption rate at the church level. In terms of reach, a total of 375 participants enrolled in Project HEAL-226 participants in the Traditional group (43% reach) and 149 in the Technology group (21% reach; p < .10). Implementation was evaluated in terms of adherence, dosage, and quality. All churches fully completed the three workshops; however, the Traditional churches took somewhat longer (M = 84 days) to complete the workshop series than churches in the Technology group (M = 64 days). Other implementation outcomes were comparable between both the Traditional and Technology groups (p > .05). CONCLUSIONS Overall, the Project HEAL intervention had reasonable adoption, though reach could have been better. Implementation was strong across both study groups, suggesting the promise of using web-based methods to disseminate and implement evidence-based interventions in faith-based settings and other areas where community health educators work to eliminate health disparities.
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Affiliation(s)
- Sherie Lou Zara Santos
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, 4200 Valley Dr., 1101 E SPH Building 255, College Park, MD, 20742, USA.
| | - Erin K Tagai
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, 4200 Valley Dr., 1101 E SPH Building 255, College Park, MD, 20742, USA
| | | | - Janice Bowie
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Muhiuddin Haider
- Institute for Applied Environmental Health, University of Maryland, School of Public Health, College Park, MD, USA
| | - Jimmie Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, 4200 Valley Dr., 1101 E SPH Building 255, College Park, MD, 20742, USA
| | - Cheryl L Holt
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, 4200 Valley Dr., 1101 E SPH Building 255, College Park, MD, 20742, USA
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Santos SLZ, Holt CL, Scheirer MA, Haider M, Slade J, Carter R. Abstract A45: Informing community participants of research: Multiple strategies from Project HEAL. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-a45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Project HEAL (Health through Early Awareness and Learning) is a community-based participatory research (CBPR) project utilizing a community health advisor (CHA) model that aims to improve cancer screening behaviors among African Americans in 14 churches throughout Prince George's County, Maryland. Participants attend a CHA-led 3-workshop series on cancer early detection that is based on three evidence-based interventions. Follow-up workshops are held at 12- and 24-months to assess project sustainability and health-related behavior change. The success of longitudinal CBPR and implementation studies such as Project HEAL rely heavily on relationship building in the early phases at all participant levels (e.g., pastor, CHA, workshop participant) and relationship maintenance throughout the study period. A key aspect of CBPR studies and maintaining rapport with participants and community members is reporting back findings in a lay accessible, health-literate fashion. Project HEAL utilized multiple strategies and channels to report data and research findings and share project-related news back to project participants: annual reports; PowerPoint presentations delivered at the 12- and 24- month follow-up workshops; and a final testimonial video featuring project pastors, CHAs, and workshop participants. Each piece was developed and implemented with health literacy, lay person accessibility, and various platform preferences (e.g., paper-based, audio [workshop presentation], video) in mind. These methods were successful in maintaining good relationships with workshop participants as shown by the 84% response rate achieved on the final participant survey 24 months after the workshop intervention. We present our experiences to provide guidance for future longitudinal implementation CBPR research in community- and faith-based contexts.
Citation Format: Sherie Lou Zara Santos, Cheryl L. Holt, Mary Ann Scheirer, Muhiuddin Haider, Jimmie Slade, Roxanne Carter. Informing community participants of research: Multiple strategies from Project HEAL. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A45.
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Affiliation(s)
| | - Cheryl L. Holt
- 1University of Maryland, School of Public Health, College Park, MD,
| | | | - Muhiuddin Haider
- 1University of Maryland, School of Public Health, College Park, MD,
| | - Jimmie Slade
- 3Community Ministry of Prince George's County, Upper Marlboro, MD
| | - Roxanne Carter
- 3Community Ministry of Prince George's County, Upper Marlboro, MD
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