Abstract 37: Experiences and Perspectives of Low Income Patient Populations in Using a Mobile Health Application with Tailored Assistance of a Community Health Worker

Mobile health (mHealth) apps are increasingly leveraged to support community health workers (CHWs) in delivering high-quality care, particularly in low- and middle-income countries. However, despite the proliferation of mHealth tools, few have been implemented at scale, partly due to limited attention to usability and acceptability among end users. In sub-Saharan Africa, mHealth tools designed for CHWs often lack systematic evaluation using validated instruments tailored to local contexts. Without such assessments, it is difficult to ensure that these tools can be integrated effectively into CHW workflows and scaled sustainably. This study aimed to adapt and validate existing mHealth usability and acceptability assessment tools to be contextually appropriate for CHWs in Rwanda. Specifically, we sought to ensure contextual appropriateness for CHWs supporting postoperative home follow-up for women after cesarean delivery. The resulting tool was designed for use in an implementation study of a novel CHW-led mHealth app. This study was conducted in the Kirehe district, Rwanda, from October 2022 to March 2023. We adapted 2 established tools-the mHealth App Usability Questionnaire and selected items from the Practitioner Opinion (Acceptability) Scale-and added new items that reflect core functions of the CHW-focused mHealth app. All items were translated into Kinyarwanda and simplified to align with CHWs' educational levels. We conducted a three-stage validation that consisted of (1) content validity testing with 8 local and international experts using a recommended content validity index threshold of >0.78; (2) face validity testing with 10 CHWs using a recommended face validity index threshold of ≥0.60; and (3) reliability testing using responses from 30 CHWs, with a Cronbach α coefficient of ≥0.70 indicating acceptable internal consistency. Of the 25 items assessed, 22 (88%) achieved a content validity index score of >0.78 for both clarity and relevance. The face validity index across all 22 items was 0.991, indicating strong comprehensibility and relevance to CHWs. Internal consistency was high: the Cronbach α was 0.86 for the mHealth App Usability Questionnaire items, 0.73 for the Practitioner Opinion (Acceptability) Scale items, and 0.87 for the newly developed questions. The final tool-named the Community Health Worker mHealth Usability and Acceptability Assessment Tool-included 22 items with strong content validity, face validity, and internal reliability. This study presents a rigorously adapted and validated tool for assessing mHealth usability and acceptability among CHWs in Rwanda. The Community Health Worker mHealth Usability and Acceptability Assessment Tool can guide future evaluations of mHealth interventions in similar contexts and serve as a model for localizing mHealth assessment tools in low- and middle-income country settings to ensure fit-for-purpose implementation.

BackgroundHigh blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison.ObjectiveThe present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients’ preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc).MethodsBased on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses.ResultsAs expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians.ConclusionsIn summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research.

BackgroundWith the dramatic growth in smartphones, mobile health applications (apps) in the field of healthcare or medicine, which are characterized by strong operability, flexibility and interactivity, provide a supplementary approach to medical learning. The aims of this study were to awaken medical students to pay more attention to the learning function of mobile health app and gain deeper insight into our understanding of the factors influencing medical students’ mobile health apps continuance intention for enhancing practical utilization.MethodsA cross-sectional survey was conducted with a self-designed questionnaire administered to medical students at Chongqing Medical University. Data were collected from 450 participants from March to April 2019. SPSS V.25 was used for the descriptive statistical analysis of the results. Smart PLS 3.2.7 was used to construct a structural equation modelling framework to estimate the influencing factors of medical students’ continuance intention to use mobile health apps.ResultsThe external characteristics of mobile health apps had a positive influence on perceived ease of use (β = 0.378, P < 0.001). Perceived ease of use had a positive impact on perceived usefulness (β = 0.573, P < 0.001). Perceived ease of use (β = 0.195, P = 0.011), perceived usefulness (β = 0.450, P < 0.001) and subjective norms (β = 0.255, P < 0.001) had a positive impact on attitude towards using mobile health apps. Additionally, perceived usefulness (β = 0.202, P < 0.001) and attitude (β = 0.730, P < 0.001) had a remarkable influence on continuance intention. Furthermore, the mediating effect of attitude between perceived usefulness and continuance intention was significant (β = 0.329, P < 0.001).ConclusionBoth perceived usefulness and attitude have a significant effect on medical students’ mobile health apps continuance intention. So, we suggest apps providers and developers evoking and maintaining users’ interest in mobile health apps and perfecting apps’ features from various aspect. Also, more attention should be paid on social relationship to introduce medical students to familiarize mobile health apps and strengthen adhesiveness of medical students.

BackgroundGastrointestinal diseases are associated with substantial cost in health care. In times of the COVID-19 pandemic and further digitalization of gastrointestinal tract health care, mobile health apps could complement routine health care. Many gastrointestinal health care apps are already available in the app stores, but the quality, data protection, and reliability often remain unclear.ObjectiveThis systematic review aimed to evaluate the quality characteristics as well as the privacy and security measures of mobile health apps for the management of gastrointestinal diseases.MethodsA web crawler systematically searched for mobile health apps with a focus on gastrointestinal diseases. The identified mobile health apps were evaluated using the Mobile Application Rating Scale (MARS). Furthermore, app characteristics, data protection, and security measures were collected. Classic user star rating was correlated with overall mobile health app quality.ResultsThe overall quality of the mobile health apps (N=109) was moderate (mean 2.90, SD 0.52; on a scale ranging from 1 to 5). The quality of the subscales ranged from low (mean 1.89, SD 0.66) to good (mean 4.08, SD 0.57). The security of data transfer was ensured only by 11 (10.1%) mobile health apps. None of the mobile health apps had an evidence base. The user star rating did not correlate with the MARS overall score or with the individual subdimensions of the MARS (all P>.05).ConclusionsMobile health apps might have a positive impact on diagnosis, therapy, and patient guidance in gastroenterology in the future. We conclude that, to date, data security and proof of efficacy are not yet given in currently available mobile health apps.

Numerous mobile health apps are marketed globally, and these have specific features including physical activity tracking, motivational feedback, and recipe provision. It is important to understand which features individuals prefer and whether these preferences differ between consumer groups. In this study, we aimed to identify consumers' most preferred features and rewards for a mobile app that targets healthy eating and physical activity and to reduce the number of individual mobile health app features to a smaller number of key categories as perceived by consumers. In addition, we investigated the impact of differences in consumers' BMI and self-efficacy on their intention to use and willingness to pay for such an app. Finally, we identified the characteristics of different target groups of consumers and their responses toward app features via cluster analysis. A total of 212 participants from France, Italy, the United Kingdom, and Germany were recruited via the web to answer questions about app features, motivation, self-efficacy, demographics, and geographic factors. It is important to note that our study included an evenly distributed sample of people in the age range of 23 to 50 years (23-35 and 35-50 years). The app features in question were generated from a 14-day cocreation session by a group of consumers from the United Kingdom and the Republic of Ireland. "Home work out suggestions," "exercise tips," and "progress charts" were the most preferred app features, whereas "gift vouchers" and "shopping discounts" were the most preferred rewards. "Connections with other communication apps" was the least preferred feature, and "charitable giving" was the least preferred reward. Importantly, consumers' positive attitude toward the "social support and connectedness and mindfulness" app feature predicted willingness to pay for such an app (β=.229; P=.004). Differences in consumers' health status, motivational factors, and basic demographics moderated these results and consumers' intention to use and willingness to pay for such an app. Notably, younger and more motivated consumers with more experience and knowledge about health apps indicated more positive attitudes and intentions to use and willingness to pay for this type of app. This study indicated that consumers tend to prefer app features that are activity based and demonstrate progress. It also suggested a potential role for monetary rewards in promoting healthy lifestyle behaviors. Moreover, the results highlighted the role of consumers' health status, motivational factors, and socioeconomic status in predicting their app use. These results provide up-to-date, practical, and pragmatic information for the future design and operation of mobile health apps.

BackgroundMobile health apps can help to change health-related behaviors and manage chronic conditions in patients with cardiovascular diseases (CVDs) and diabetes mellitus, but a certain level of health literacy and electronic health (eHealth) literacy may be needed.ObjectiveThe aim of this study was to identify factors associated with mobile health app use in individuals with CVD or diabetes and detect relations with the perceived effectiveness of health apps among app users.MethodsThe study used population-based Web-based survey (N=1500) among Germans, aged 35 years and older, with CVD, diabetes, or both. A total of 3 subgroups were examined: (1) Individuals with CVD (n=1325), (2) Individuals with diabetes (n=681), and (3) Individuals with CVD and diabetes (n=524). Sociodemographics, health behaviors, CVD, diabetes, health and eHealth literacy, characteristics of health app use, and characteristics of apps themselves were assessed by questionnaires. Linear and logistic regression models were applied.ResultsOverall, patterns of factors associated with health app use were comparable in individuals with CVD or diabetes or both. Across subgroups, about every fourth patient reported using apps for health-related purposes, with physical activity and weight loss being the most prominent target behaviors. Health app users were younger, more likely to be female (except in those with CVD and diabetes combined), better educated, and reported more physical activity. App users had higher eHealth literacy than nonusers. Those users who perceived the app to have a greater effectiveness on their health behaviors tended to be more health and eHealth literate and rated the app to use more behavior change techniques (BCTs).ConclusionsThere are health- and literacy-related disparities in the access to health app use among patients with CVD, diabetes, or both, which are relevant to specific health care professionals such as endocrinologists, dieticians, cardiologists, or general practitioners. Apps containing more BCTs had a higher perceived effect on people’s health, and app developers should take the complexity of needs into account. Furthermore, eHealth literacy appears to be a requirement to use health apps successfully, which should be considered in health education strategies to improve health in patients with CVD and diabetes.

Breast cancer is the most common cancer in women worldwide, with nearly 14.1 million cases diagnosed globally in 2012. In the same year, there were 8.2 million deaths from cancer in the world making breast cancer the second most common cancer overall. Also, India has one of the highest cases of breast cancer. According to WHO, for the year 2012, an estimated 144,937 women in India were newly detected with breast cancer and 70,218 women died of breast cancer in the same year, more than any other country in the world. This indicates a beginning of an epidemic which requires effective intervention to reduce the incidence of breast cancer, thereby reducing mortality. In the last few years, a lot of global initiatives on breast cancer have been taken by the World Health Organization (WHO), the International Breast Cancer Research Foundation (IBCRF) and Pink Ribbon International (PBI). These international bodies are addressing and creating awareness on breast cancer. One such initiative is the mobile applications that can can provide people with breast cancer, survivors, and caregivers convenient resources and tools to guide them through their treatment and keep their life more organized. Many researchers and scientists have come up with mobile health (m-health) apps to prevent and promote breast cancer awareness to the public. Though there are many mobile apps available on itunes and google play, people are not aware of the apps' purpose or it is not promoted well. The main purpose of this article is to analyse how breast cancer health apps (such as iBreastCheck) can help in primary prevention, early diagnosis and palliative care of breast cancer in India from doctors' perspective. Focus group and questionnaire survey was carried out to understand the adoption and acceptance of mobile health apps for breast cancer awareness by doctors for the Indian public. The focus group and the online survey statistical results demonstrates the need and importance of using mobile health apps to prevent, detect and treat breast cancer, which means Indian doctors have a positive approach towards recommending breast cancer mobile health apps to women.

Background:Mobile health (mHealth) apps have the potential to facilitate convenient health care delivery and self-management of health. However, many users have concerns about their privacy when they use mHealth apps. Different apps provide different solutions for protecting users' privacy.Objective:The purpose of this study was to determine user preferences among the several privacy protection methods used in current mHealth apps and the reasons behind their preferences.Methods:Five privacy protection methods currently used in mHealth apps were presented to a group of study participants who had mild or moderate depression and expressed concerns about privacy of information when they used mental health apps. After a demonstration of the methods, study participants were asked to fill out a questionnaire and indicate their perceived privacy protection level (PPPL) of each method, their preference rating for each method, and the privacy protection methods they had used in the past. A brief interview was then conducted to collect study participants' comments on these methods and elicit the reasons for their preference ratings. Statistical analysis was performed to determine the statistical significance of differences in participants' preference ratings and in the PPPLs obtained for the five methods. Study participants' comments on the privacy protection methods and suggestions were noted and summarized.Results:Forty (40) study participants were selected from a large candidate pool using the IRB approved selection criteria. All study participants viewed the app demonstration and understood the five privacy protection methods properly, which was indicated by their correct sorting of the PPPL of the five methods in their answers to the questionnaire. All study participants specified their preferences with respect to these methods and provided the rationale behind their selections on the questionnaire and during the brief interview. The results indicate that the users preferred privacy protection methods with customizable modules in multi-purpose apps because of their convenience and strong privacy protection, where the customization can be done either in the app or via a Web portal.Conclusions:This study identified user preferred privacy protection methods. These identified privacy protection methods may be used in many types of apps that perform sensitive health information management to better protect users' privacy and encourage more users to adopt these mHealth apps.

BackgroundDespite a doubling of osteoarthritis-targeted mobile health (mHealth) apps and high user interest and demand for health apps, their impact on patients, patient outcomes, and providers has not met expectations. Most health and medical apps fail to retain users longer than 90 days, and their potential for facilitating disease management, data sharing, and patient-provider communication is untapped. An important, recurrent criticism of app technology development is low user integration design. User integration ensures user needs, desires, functional requirements, and app aesthetics are responsive and reflect target user preferences.ObjectiveThis study aims to describe the co-design process for developing a knee osteoarthritis minimum viable product (MVP) mHealth app with patients, family physicians, and researchers that facilitates guided, evidence-based self-management and patient-physician communication.MethodsOur qualitative co-design approach involved focus groups, prioritization activities, and a pre-post quality and satisfaction Kano survey. Study participants included family physicians, patient researchers and patients with knee osteoarthritis (including previous participants of related collaborative research), researchers, key stakeholders, and industry partners. The study setting was an academic health center in Southern Alberta.ResultsDistinct differences exist between what patients, physicians, and researchers perceive are the most important, convenient, desirable, and actionable app functional requirements. Despite differences, study participants agreed that the MVP should be electronic, should track patient symptoms and activities, and include features customized for patient- and physician-identified factors and international guideline-based self-management strategies. Through the research process, participants negotiated consensus on their respective priority functional requirements. The highest priorities were a visual symptom graph, setting goals, exercise planning and daily tracking, and self-management strategies. The structured co-design with patients, physicians, and researchers established multiple collaborative processes, grounded in shared concepts, language, power, rationale, mutual learning, and respect for diversity and differing opinions. These shared team principles fostered an open and inclusive environment that allowed for effective conceptualization, negotiation, and group reflection, aided by the provision of tangible and ongoing support throughout the research process, which encouraged team members to question conventional thinking. Group-, subgroup-, and individual-level data helped the team reveal how and for whom perspectives about individual functional requirements changed or remained stable over the course of the study. This provided valuable insight into how and why consensus emerged, despite the presence of multiple and differing underlying rationales for functional requirement prioritization.ConclusionsIt is feasible to preserve the diversity of perspectives while negotiating a consensus on the core functional requirements of an mHealth prototype app for knee osteoarthritis management. Our study sample was purposely constructed to facilitate high co-design interactivity. This study revealed important differences between the patient, physician, and researcher preferences for functional requirements of an mHealth app that did not preclude the development of consensus.

Frontiers Events is a rapidly growing calendar management system dedicated to the scheduling of academic events. This includes announcements and invitations, participant listings and search functionality, abstract handling and publication, related events and post-event exchanges. Whether an organizer or participant, make your event a Frontiers Event!

Mobile digital wellness and health apps play a significant role in optimizing health and aiding in cancer management and decision-making. This study aims to identify the factors influencing the use of mobile health and wellness apps among cancer information seekers in the United States. We conducted a cross-sectional study using data from the Health Information National Trends Survey. Our analysis focused on 4770 participants who sought cancer information. We performed weighted univariate and multivariable logistic regression to determine the association between the use of health and wellness apps and socioeconomic factors, medical history and conditions, and lifestyle and behavioral factors. A total of 4770 participants who sought cancer information were included in the final analysis. Of these, 80.9% (n=2705) were health and wellness app users, while 19.1% (n=793) were nonusers. In the final adjusted model, participants with household incomes ≥US $50,000 had 49% higher adjusted odds of using these apps than those with incomes <US $50,000 (adjusted odds ratio [aOR]=1.49, 95% CI 1.02-2.14). College graduates and those with higher educational levels were avid users compared to those with a high school diploma or less (aOR=1.87, 95% CI 1.30-2.67). Internet users had over 3 times the odds of using these apps compared to nonusers (aOR=3.28, 95% CI 1.70-6.33). Participants within the age group 18-34 years were 3.70 times more likely (aOR=3.70, 95% CI 1.90-7.23) to use a health and wellness app compared to participants within the age group of 75 years and older. Age, education, household income, and use of the internet are the major determinants of the adoption of digital health and wellness apps among seekers of cancer information. Hence, public health programs could be directed toward addressing these factors to improve cancer diagnosis, treatment, and management using these apps.

Globally, governments and public health authorities are integrating Artificial Intelligence (AI) techniques in mobile apps to improve public health. For example, during the COVID-19 outbreak, AI-driven chatbots were deployed to provide immediate health information and advice. AI-based mobile apps are also used to support mental health or for preventive healthcare, such as personalized dietary recommendations. Moreover, the use of generative AI for public health purposes is rapidly increasing. In 2024, the WHO launched S.A.R.A.H - a generative AI chatbot designed to provide information on major health topics such as healthy lifestyles and mental health. By integrating AI, public institutions could potentially achieve better health outcomes, improve efficiency, and enhance access to healthcare. However, the rapid adoption of AI public health apps also raises significant ethical, legal, and regulatory challenges. The large amounts of sensitive personal data collected and processed by such apps may create issues for privacy, data protection, and cybersecurity. At the same time, the tendency of AI to exhibit biases may deepen existing health inequities. The new EU ‘digital’ legal framework does not directly address these challenges. This workshop aims to convene leading experts working on AI in health to address these issues. We bring together scholars from different disciplines (health law, health policy, bioethics, biosciences). The workshop objectives are twofold: (1) to critically assess the current landscape of AI in public health apps from a legal, ethical, and regulatory point of view, and (2) to lay the groundwork for policy recommendations on how to ensure the deployment of AI apps for public health in compliance with ethical principles and fundamental rights. First, the panel explores the differences in the data protection regulation of AI public health apps in the EU and the US (speaker: James Hazel). Second, it discusses how these apps are regulated under the new EU Artificial Intelligence Act (speaker: Hannah van Kolfschooten). Third, it investigates the consequences of the European Health Data Space regulation on how health data can be processed through public health apps (speaker: Mahsa Shabani). Finally, as the cross-border use of apps complicates regulatory efforts, it discusses the need for international cooperation in establishing and enforcing guidelines (speaker: Vasiliki Rahimzadeh). The workshop will be conducted as a round table discussion with 4 short presentations of 5 minutes each. Speakers first present a key challenge posed by AI in mobile health apps, and then suggest a potential regulatory solution. This will be followed by a dialogue between panelists and the audience to share best practices on how to regulate AI in mobile public health apps from a legal, ethical, and regulatory perspective. The input will be used to develop a submission for the Call for papers of BMC Bioinformatics. Key messages • As public institutions are increasingly integrating AI technologies into their mobile public health solutions, it is crucial to evaluate the ethical, legal, and regulatory implications. • In light of current gaps in the EU legal framework, we convene scholars from different disciplines and legal systems to design guidelines on the ethical use of AI mobile apps for public health. Speakers/Panelists James Hazel University of Amsterdam, Amsterdam, Netherlands Mahsa Shabani University of Amsterdam, Ghent University, Amsterdam, Netherlands Hannah van Kolfschooten University of Amsterdam, Amsterdam, Netherlands Vasiliki Rahimzadeh Baylor College of Medicine, Houston, USA Pramiti Parwani University of Amsterdam, Amsterdam, Netherlands

Community health workers’ continuance of mobile health applications: An extended expectation confirmation model

In recent years, the spread of mobile communication devices such as smartphones has been markedly rapid. With this technological diffusion, mobile health (mHealth) has become an increasingly important issue. In particular, there is an increasing interest in smartphone apps improving public health. Although there is increased availability of mobile devices and health apps, little is known about motivational factors predicting health app adoption and use. The aim of this study was to identify motivational factors that predict the adoption and use of health apps (i.e. health app engagement). To identify the motivational factors, 391 college students were surveyed and survey questions considered the effects of media exposure to health information, interpersonal communication on health issues, and psychological factors (e.g. attitude, usefulness, peer norm, and self-efficacy) on health app engagement. Our results confirm the effect of attitude ( β = 0.36) and usefulness are ( β = 0.33) on mHealth App usage. Furthermore, we found that age ( β = 0.11) and reading news articles about health ( β = 0.13) predict mHealth App usage. Theoretical and practical implications and suggestions for future research are discussed.

Community Health Worker Insights on Their Training and Certification Caricia E. C. Catalani, Sally E. Findley, Sergio Matos, and Romelia Rodriguez What Is the Purpose of This Review? • To develop a consensus definition of community health workers (CHW) informed by practitioners of the field. • To document CHW training needs, both in content and training methods. • To identify CHW concerns for potential impact of the growing regulation on certification and reimbursement. • To engage CHW leadership and input to inform the study. What Is the Problem? • Uncertainty among employers, funders, stakeholders, and CHWs themselves regarding the definition of a CHW. • Confusion about CHW training needs, both in content and training methods. • Lack of research is hampering the development of training, certification, and reimbursement strategies and policies. What Are the Findings? • CHWs in New York have developed a consensus definition with uniformity of opinion on core elements of the definition. • Community trust is central to CHW identity, essential to the conduct of the practice, and inviolate. • We identified CHW training needs in the area of core competencies often neglected by health care systems, employers, or academia. • We identified characteristics of a credentialing process that would be acceptable to CHW practitioners and help advance and support the field. • Community-based participatory research (CBPR) methods provided unique insights into the definition, training needs, and credentialing concerns of CHWs. Who Should Care Most? • CHWs. • CHW employers, including community- and faith-based organizations, government agencies, hospitals, community health centers, and other health care providers. • CHW program funders, including state, local, and national governments, foundations, and philanthropies. • Primary care providers. • Chronic disease management programs. • Public health professionals and other allied health workers. [End Page 201] Recommendation for Action • CBPR is uniquely adaptable for research to address the growing interest in CHWs and their practice. • CBPR provides a mechanism for CHWs to inform policy makers and regulators about their credentialing desires and concerns and the potential impact of the growing certification and regulation movement across the country. • The CHW definition generated through the CBPR methods applied in this study is a potentially acceptable standard. • CPBR provided a view into a potentially acceptable process for developing a CHW credential. CHWs in New York City are generally supportive of credentialing, but only for a process that involves them and their leaders in its development. • This study has identified various content and methods training parameters that could lead to acceptable statewide credentialing standards for CHWs. CHWs in New York City have articulated specific training needs in two categories, including core competencies and health-specific topics. a Core competencies include skills training in communication, documentation, behavior change, adult learning, informal counseling, goal setting, negotiation/mediation, conflict resolution, and community organizing. b Training in health-specific topics includes chronic disease management, prevention and control, health care systems, insurance eligibility and enrollment, and immigration issues in health. • CHWs recognize the individual and organizational maturity required of institutions to adapt to their specific training needs, both in content and methods, and are eager to advance a supportive relationship. • CHWs identified themselves as nontraditional adult learners and therefore demand that educational institutions interested in providing training develop adult learning, participatory and interactive teaching skills to better serve the practice. CHWs further mentioned that evaluation of their competence should involve performance evaluation as opposed to standard test taking. • CHWs are uniquely qualified to help address some of the persistent disparities in health and health care access for isolated populations traditionally hard to reach with more conventional strategies. • CHWs must be involved in any certification, credentialing or training design from the very beginning. The integration of CHWs at all levels in program planning, implementation, and evaluation will provide the strongest foundation for creating a truly responsive educational program that builds on the CHWs’ knowledge of the communities where they live and work. Every opportunity in program development and implementation must be taken to ensure the voice of CHWs are included and respected. • This study exposes the need for further inquiry into the feasibility of CHW-centered and CHW-led credentialing. [End Page 202] Caricia E. C. Catalani Columbia University, Mailman School of Public Health Sally E. Findley Columbia University, Mailman School of Public Health Sergio Matos Columbia University, Mailman...