Impact of cancer awareness training for community-based health workers: a cross-sectional repeated measures survey

Abstract

BackgroundCommunity-based health workers (CHWs) are well placed to discuss cancer prevention and early diagnosis with members of the public to improve cancer outcomes, particularly among underserved groups. Cancer Research UK developed Talk Cancer in 2012, a training programme for CHWs that aims to increase awareness of cancer prevention and early diagnosis, and promote more positive beliefs about and confidence in discussing cancer. This study aimed to evaluate the efficacy of Talk Cancer among CHWs. MethodsCHWs were recruited during registration at the Talk Cancer workshops, which were held between September, 2014, and February, 2015. Their awareness of cancer risk factors and screening programmes, beliefs about cancer, and confidence in discussing cancer, was assessed immediately before and after workshop attendance with paper-based questionnaires. These views were also assessed at a 2 month follow-up by telephone questionnaire. Linked data were analysed with McNemar's tests. Application of training was assessed at follow-up. Findings178 CHWs were recruited. Talk Cancer led to statistically significant improvements in CHWs' beliefs about and confidence in discussing cancer, which were sustained at the 2 month follow-up. There was a statistically significant improvement in awareness of risk factors and screening programmes from before to after workshop attendance. At follow-up, this improvement was only sustained for some risk factors (eg, sunburn) and screening programmes (eg, bowel screening). For risk factors and screening programmes for which awareness was not sustained, awareness remained statistically significantly higher than before attendance. 152 participants (86%) reported applying their learning in their role and 105 (59%) reported having had more conversations about cancer and lifestyle changes than before workshop attendance. Of the 152 CHWs who reported applying their learning in their role, 27 (18%) gave examples regarding prevention and lifestyle (eg, discussing lifestyle changes during medication reviews) and 27 (18%) discussed screening programmes (eg, recommending the bowel screening programme with service users and patients aged over 60). InterpretationTalk Cancer was particularly effective in improving CHWs' beliefs about and confidence in discussing cancer. Continuing support for trainees after workshop attendance may help consolidate learning and maintain the impact of training, particularly for awareness of risk factors and screening programmes. Training could also emphasise opportunities for trainees to initiate conversations about cancer prevention and early diagnosis to increase and sustain the application of training. Ways in which follow-up support could be delivered are currently being explored. FundingCancer Research UK (for AR).