Community Health Advisors Research Articles

Weight loss and improved metabolic outcomes amongst rural African American women in the Deep South: six-month outcomes from a community-based randomized trial.

Obesity is highly prevalent in African American women, especially those in the rural southern USA, resulting in persistent health disparities. To test the effectiveness of an evidence-based behavioural weight loss intervention delivered by community health advisors to African American women in the rural south. Overweight or obese African American women (30-70 years) from eight counties in Mississippi and Alabama participated in a 24-month randomized controlled trial of an evidence-based behavioural weight loss programme augmented with community strategies to support healthy lifestyles (Weight Loss Plus, N = 154) compared to the weight loss programme alone (Weight Loss Only, N = 255). This study reports on 6-month outcomes on primary (weight change) and secondary (waist circumference, blood pressure, lipids, fasting blood glucose) outcomes, coinciding with the completion of the intensive weight loss phase. Weight Loss Only participants lost an average of 2.2 kg (P < 0.001). Weight Loss Plus participants lost an average of 3.2 kg (P < 0.001). The proportion of the total sample that lost at least 5% of their body weight was 27.1% with no difference between treatment groups. Similarly, we observed statistically significant reductions in blood pressure, waist circumference and triglycerides in each treatment group, with no statistical differences between groups. Trained lay health staff and volunteers from the rural southern USA were able to deliver a translation of a high-intensity behavioural intervention targeted to African American women, resulting in clinically meaningful weight loss and improvement in other metabolic outcomes in a significant proportion of participants.

Barriers to Healthcare Seeking and Provision Among African American Adults in the Rural Mississippi Delta: Community and Provider Perspectives

The objective of this project was to identify barriers to healthcare seeking and healthcare provision among rural African American adults in the Mississippi Delta from the perspective of volunteer community health advisors (CHAs), community residents, and healthcare providers. Ten focus groups (20 males, 37 females) were conducted with CHAs and community residents from nine counties in one public health district. An additional focus group was conducted with healthcare providers (3 males, 2 females, 4 African American, 1 Other) from medical clinics and a hospital located in the same public health district. Two key informant interviews were also conducted with a district public health officer and a chairman of a local health advocacy foundation board of directors. All interviews were transcribed and data were analyzed using the constant comparative method to identify major themes and sub‐themes related to barriers to healthcare seeking and provision. Findings were broadly categorized as structural and interpersonal barriers with structural barriers encompassing issues of poverty (unemployment/underemployment), lack of health insurance, rurality (such as lack of transportation and medical specialists), perceptions of racism, and medical mistrust. Interpersonal barriers included fear of a serious medical diagnosis, gender socialization (going to the doctor as a sign of weakness among men) and age (not going to see the doctor until age 50 for first screening). Differences also emerged in the perceptions between community members and healthcare providers. While both groups were critical of medical insurance, providers viewed insurance guidelines as restricting their ability to provide the most current treatment. Community members and some CHAs viewed providers as conspiring with insurance and pharmaceutical companies to receive “kick‐backs.” Additionally, whereas racism emerged as a major structural barrier in the community interviews, this topic was not mentioned in any of the provider interviews. Results indicate significant efforts are needed to overcome both structural and interpersonal barriers to healthcare seeking and provision in order to reduce health disparities.Support or Funding InformationThis project was funded through a Patient‐Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award (1514‐USM). The statements presented in this abstract are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee.

Dimensions of sustainability for a health communication intervention in African American churches: a multi-methods study

BackgroundSustainability of evidence-based health promotion interventions has received increased research attention in recent years. This paper reports sustainability data from Project HEAL (Health through Early Awareness and Learning) a cancer communication implementation trial about early detection, based in African American churches. In this paper, we used a framework by Scheirer and Dearing (Am J Publ Health 101:2059-2067, 2011) to evaluate multiple dimensions of sustainability from Project HEAL.MethodsWe examined the following dimensions of sustainability: (a) continued benefits for intervention recipients, (b) continuation of intervention activities, c) maintaining community partnerships, (d) changes in organizational policies or structures, (e) sustained attention to the underlying issues, (f) diffusion to additional sites, or even (g) unplanned consequences of the intervention. Project HEAL provided a three-workshop cancer educational series delivered by trained lay peer community health advisors (CHAs) in their churches. Multiple sources of sustainability were collected at 12 and 24 months after the intervention that reflect several levels of analysis: participant surveys; interviews with CHAs; records from the project’s management database; and open-ended comments from CHAs, staff, and community partners.ResultsOutcomes differ for each dimension of sustainability. For continued benefit, 39 and 37% of the initial 375 church members attended the 12- and 24-month follow-up workshops, respectively. Most participants reported sharing the information from Project HEAL with family or friends (92% at 12 months; 87% at 24 months). For continuation of intervention activities, some CHAs reported that the churches held at least one additional cancer educational workshop (33% at 12 months; 24% at 24 months), but many more CHAs reported subsequent health activities in their churches (71% at 12 months; 52% at 24 months). No church replicated the original series of three workshops. Additional data confirm the maintenance of community partnerships, some changes in church health policies, and continued attention to health issues by churches and CHAs.ConclusionsThe multiple dimensions of sustainability require different data sources and levels of analysis and show varied sustainability outcomes in this project. The findings reinforce the dynamic nature of evidence-based health interventions in community contexts.

Adoption, reach, and implementation of a cancer education intervention in African American churches

BackgroundUse 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.MethodsFifteen 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.ResultsThe 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).ConclusionsOverall, 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.

A Community Health Advisor Program to Reduce Cancer Screening Disparities in the Deep South and Appalachia: The American Cancer Society's CHA Collaborative.

Cancer disparities continue to exist in the United States. Community health advisors (CHAs) can play a critical role in addressing cancer disparities. The American Cancer Society (ACS) implemented a 3-year pilot CHA program in the South based on an evidence-based program to increase breast cancer screening. Evaluation assessed the extent to which ACS successfully implemented the program. Quantitative data were tracked and reported by ACS staff, and qualitative data were collected through focus groups and interviews with volunteer participants. The pilot was implemented in 28 communities in nine states. ACS staff recruited volunteer community network partners (CNPs) as local advisory groups, and volunteer CHAs to conduct outreach, education, and screening navigation. Outcome measures included number of individuals educated and screened, and number of communities reaching education and screening targets. Process measures included number of volunteers recruited, number of communities reaching recruitment targets, and implementation process, challenges, and successes. A total of 383 CHAs were recruited and recruitment goals were met in 68%; 31,439 individuals were educated, and 93% of communities reached education goals. In all, 5,056 individuals were screened, but screening goals were attained in only 36% of communities. This pilot demonstrates the ability of ACS to adapt and disseminate an evidence-based program to fit into its volunteer-based outreach model. ACS built community network partnerships, recruited a cadre of volunteers, and trained them to conduct education and screening navigation.

Abstract A15: Using the RE-AIM framework to evaluate a community-based participatory project

Abstract Background There are many situations where randomization control trial is not feasible. Interventions that can be adopted, delivered broadly, consistently implemented, and sustained over time are important to public health, as well as population health research. The RE-AIM framework evaluates interventions in five dimensions (reach, efficacy, adoption, implementation, and maintenance) providing an alternation. The purpose of this study was to demonstrate the feasibility of using the RE-AIM framework to evaluate the effectiveness and sustainability of a community-based participatory (CBPR) project to improve the adoption of colorectal cancer (CRC) screening guidelines in seven Asian American (AA) communities. Method This project consisted of three phases. Phase 1 focused on assessing community organizations' capacity and readiness for the project, as well as conducting consumer research (focus group and survey) to understand the adopters. Phase 2 was the implementation of a multilevel and multicomponent intervention. The intervention included using social marketing campaigns at the community level to generate public awareness and the use of community health advisors (CHAs) for social influence at the individual level. All CHAs were received a 6 –hour training course and a 3-hour refreshed course. Phase 3 was to evaluate the effectiveness of the project using the RE-AIM framework. Both quantitative and qualitative data were collected before, during and after the intervention period. Qualitative data were collected through weekly activity logs, site visits notes, focus groups with implementation CHAs and in-depth interviews with organizational level leaderships. Quantitative data were collected through reports and community resident survey. Seven communities (Cambodian, Chinese, Filipino, Korean, Laotian, South Asians and Vietnamese) were involved in Phase 2 and were randomized to two cohorts. A wait-list cross-over random design was used to evaluate the effectiveness of the intervention. Primary outcomes included educational session attendance, Fecal Immunochemical Test (FIT) kits distribution and returned rates. Data were collected over three different time periods. Results Of the eight community-based organizations that joined the project, seven of them agreed to participate in Phase 2. Across the seven communities, ten CHAs reached out to over 2,400 community residents over a 12-week intervention period. No significant deviation or inconsistency of delivery across program components was found during site visits. Project satisfaction rates were high, ranging from 8 to 10 out of a 10 point scale (0=not at all satisfy and 10 = extremely satisfy). Screening rates for cohort 1 and 2 were 63% (93/148) and 57% (58/101), respectively. Community screening rates ranged from 100% in Cambodian, 89% in Vietnamese and 84% in Chinese, to 42% in Korean and Filipinos, and 32% in South Asians. After the 12-week intervention period, significant increase was observed in education session attendance (p = .010), FIT kits distributed (p = .008), and returned (p = .014) compared to baseline data. A cross-over effect was observed. Leaderships reported the project addressed organizations' mission, and aligned with their values and priorities. All sites indicated that they would continue to promote CRC screening as part of their health program. Conclusion The RE-AIM framework is crucial in evaluating community-based projects when randomized control trial is infeasible. Each RE-AIM dimension is an opportunity for future improvement and intervention. Partial or all dimensions can be addressed within a given study, but they are not necessary to be intervened upon. RE-AIM evaluation can increase transparency and help potential adopters to make more informed judgement about the intervention and its applicability. Citation Format: Helen Lam, Michael Quinn, Edwin Chandrasekar, Karen Kim. Using the RE-AIM framework to evaluate a community-based participatory project. [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 A15.

Abstract A45: Informing community participants of research: Multiple strategies from Project HEAL

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.

Abstract A29: Disseminating colorectal cancer screening guidelines in Asian-American communities using a market-oriented and multilevel approach

Abstract BACKGROUND There was a significant increase in colorectal cancer (CRC) screening rates in the U.S. population between 2008 and 2010; however, Asian Americans (AA) remained the only racial/ethnic subgroup without any improvement and was at 47%. Therefore, accelerating the dissemination and adoption of CRC screening guidelines in the AA communities has the potential to reduce unnecessary cancer burden. The traditional top-down dissemination model views communities as passive distribution or delivery systems rather than as rich sources of knowledge and skills and dynamic places in which prevention programs will ultimately need to survive and thrive. In this study, we developed a community-centered dissemination model using a multilevel approach to accelerate the adoption of CRC screening guidelines in seven Asian communities. METHODS We integrated a market-oriented Push-Pull-Infrastructure framework with Diffusion of Innovation Theory, and Community-Based Participatory Research (CBPR) to create a community-centered dissemination model. Community focus groups were conducted to identify salient CRC screening beliefs and attitudes, and were used to develop survey measures to more broadly sample community residents. Findings from the survey were used to develop both training content for community outreach and tailored social marketing campaigns for our intervention. The seven partner AA communities were randomly divided into two cohorts. A wait-list cross-over random design was used to evaluate the effectiveness of our outreach intervention. Primary outcomes included educational session attendance, Fecal Immunochemical Test (FIT) kits distribution and returned rates. Data were collected over three different time periods. RESULTS Collaboration took place between an academic institution and eight community-based organizations from seven Asian subgroups (Cambodian, Chinese, Filipinos, Korean, Laotian, South Asians and Vietnamese). A sample of 72 AAs participated in focus groups, and differences were noted across ethnic subgroups. Furthermore, 464 community members participated in a community-wide survey. Most participants agreed that early detection of cancer was important (94%) and cancer could happen to anyone (87%). However, 36% of participants also felt that people were better off not knowing they had cancer, and 46% would screen only when they had symptoms. Outreach activities included distribution of printed educational materials, one-on-one counseling and group education. Across the seven communities, ten community health advisors reached out to over 2,400 community residents over a 12-week intervention period. In cohort 1, 148 people attended the post-intervention education session where no-cost FIT kit was offered compared to 17 people at baseline; while in cohort 2, 101 people attended the post-intervention session compared to 27 at baseline. The screening rates for cohort 1 and 2 were 63% (93/148) and 57% (58/101), respectively. Community screening rates ranged from 100% in Cambodian, 89% in Vietnamese and 84% in Chinese, to 42% in Korean and Filipinos, and 32% in South Asians. After an intensive 12-week outreach activity and social marketing campaigns, significant increase was observed in attendance (p = .010), FIT kits distributed (p = .008) and returned (p = .014) compared to baseline data. A cross-over effect was observed. CONCLUSION There is a limited research base to inform the design of successful action plans for dissemination and implementation CRC screening guidelines, especially in underserved populations. Our new model outlines a complementary role for researchers and community-based organizations, focuses on understanding potential adopters and incorporates social interaction and influence to move individuals from simple awareness to decisions towards positive action. Citation Format: Karen Kim, Mike Quinn, Edwin Chandrasekar, Reena Patel, Helen Lam. Disseminating colorectal cancer screening guidelines in Asian-American communities using a market-oriented and multilevel approach. [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 A29.

Using Community Feedback to Improve Community Interventions: Results From the Deep South Network for Cancer Control Project.

The Deep South Network for Cancer Control (DSNCC), initiated in 2000, is a dual-state, community-based participatory research infrastructure composed of academic and community partners committed to reducing cancer disparities among underserved African Americans in 12 designated counties of the Alabama Black Belt and the Mississippi Delta, 2 historically underserved areas of the country. Local residents trained as Community Health Advisors as Research Partners implemented a 3-tier community action plan (CAP) focused on promoting cancer screening, physical activity, and nutrition. Breast, cervical and colorectal cancer screening, healthy eating habits, and physical activity levels increased among many, but not all, African American women in the 12-county DSNCC coverage area. Seeking to improve our reach to include participants who reported they had never heard of the DSNCC or participated in the CAP, we conducted in-depth conversations with community residents about reasons for selective nonparticipation and ways to improve participation in the DSNCC community health interventions. Three patterns and their associated themes described ways to improve the penetration of CAP strategies and tailor them to effectively reach underserved African Americans in the intervention counties. We conclude with lessons learned for future interventions.

Partnership for Healthier Asians: Disseminating Evidence-Based Practices in Asian-American Communities Using a Market-Oriented and Multilevel Approach.

BackgroundOne of the greatest challenges facing health promotion and disease prevention is translating research findings into evidence-based practices (EBP). There is currently a limited research base to inform the design of dissemination action plans, especially within medically underserved communities.ObjectiveThe objective of this paper is to describe an innovative study protocol to disseminate colorectal cancer (CRC) screening guidelines in seven Asian subgroups.MethodsThis study integrated a market-oriented Push-Pull-Infrastructure Model, Diffusion of Innovation Theory, and community-based participatory research approach to create a community-centered dissemination framework. Consumer research, through focus groups and community-wide surveys, was centered on the adopters to ensure a multilevel intervention was well designed and effective.ResultsCollaboration took place between an academic institution and eight community-based organizations. These groups worked together to conduct thorough consumer research. A sample of 72 Asian Americans participated in 8 focus groups, and differences were noted across ethnic groups. Furthermore, 464 community members participated in an Individual Client Survey. Most participants agreed that early detection of cancer was important (434/464, 93.5%), cancer could happen to anyone (403/464, 86.9%), CRC could be prevented (344/464, 74.1%), and everyone should screen for CRC (389/464, 83.8%). However, 35.8% (166/464) of participants also felt that people were better off not knowing it they had cancer, and 45.5% (211/464) would screen only when they had symptoms. Most participants indicated that they would screen upon their doctor’s recommendation, but half reported that they only saw a doctor when they were sick. Data collection currently is underway for a multilevel intervention (community health advisor and social marketing campaign) and will conclude March 2016. We expect that analysis and results will be available by June 2016.ConclusionsThis study outlines a complementary role for researchers and community organizations in disseminating EBP, and incorporates social interactions and influences to move individuals from simple awareness to decisions towards positive action.

Erratum to: Implementation of an evidence-based intervention to promote colorectal cancer screening in community organizations: a cluster randomized trial.

The implementation of evidence-based strategies to promote colorectal cancer (CRC) screening remains challenging. The aim of this study is to evaluate two strategies to implement an evidence-based intervention to promote CRC screening in Filipino American community organizations. Twenty-two community organizations were randomized to either a basic or enhanced implementation strategy. In both arms, community health advisors recruited participants non-adherent to CRC screening guidelines, conducted educational sessions, distributed print materials and free fecal occult blood test kits, reminded participants to get screened, and mailed letters to participants’ providers. In the enhanced arm, leaders of the organizations participated in implementation efforts. While the effectiveness was similar in both arms of the study (screening rate at 6-month follow-up was 53 % in the enhanced arm, 49 % in the basic arm), 223 participants were screened in the enhanced arm versus 122 in the basic arm. The enhanced implementation strategy reached 83 % more participants and achieved a higher public health impact. Trial registration: NCT01351220 (ClinicalTrials.gov) Electronic supplementary material The online version of this article (doi:10.1007/s13142-015-0349-5) contains supplementary material, which is available to authorized users.

Sowing the Seeds of Health: Training of Community Health Advisors to Promote Breast and Cervical Cancer Screening among Latina Immigrants in Alabama.

Latinas in the U.S. are disproportionately affected by breast and cervical cancer. This project sought to develop and evaluate a culturally relevant training for Community Health Advisors (CHA) to promote breast and cervical cancer screening among Latina immigrants in Alabama. The Empowerment Model guided training development and implementation supported by a formative evaluation and a Community Advisory Committee. The 16-hour CHA training included two intertwined components: knowledge and skills.Fifty-six (56) Latinas participated in the CHA training in six Alabama counties. The training increased the CHAs' (1) knowledge of cancer screening and other health topics and (2) their perceived confidence to communicate with women in their communities about cancer screening and to motivate them to attain cancer screenings. This work demonstrates the application of a transformative philosophical framework to promote capacity-building among CHAs toward the development and implementation of strategies to promote breast and cervical cancer screening among Latina immigrants.

Using technology for improving population health: comparing classroom vs. online training for peer community health advisors in African American churches

Methods Fourteen African American churches located throughout Prince George’s County, MD were randomized to receive the traditional/classroom (N = 8 churches) or the online (N = 6 churches) training approach. The CHAs received Project HEAL workshop intervention materials and led a 3-part workshop series in his/her church encouraging breast, prostate, and colorectal cancer early detection. Study participants completed surveys at workshops 1 and 3 and another at 12 months post-baseline, which were used to evaluate the intervention impact on Health Belief Model-based outcomes and self-reported cancer screening.

Shifting Community-Based Participatory Infrastructure from Education/Outreach to Research: Challenges and Solutions.

For 10 years, the Deep South Network for Cancer Control (DSNCC) focused on training and deploying community health advisors (CHAs) to promote cancer screening and healthy lifestyle through education/outreach activities. In 2009, the request for application (RFA) for renewal of the DSNCC required a controlled research intervention. Converting from education/outreach to research proved more problematic than expected. The objective of this article was to describe the challenges and solutions during this conversion and to describe the importance of education/outreach to community infrastructure. This is a qualitative assessment of the challenges and solutions encountered in conducting a controlled weight loss trial in a community setting in which education/outreach had been the priority. The DSNCC provides a model for overcoming the unique challenges of converting a longstanding education/outreach program into a controlled research program. Although multiple challenges were encountered in conducting a community-based participatory research (CBPR) controlled trial, solutions were developed and the trial continues as proposed.

Evaluating Community Health Advisor (CHA) Core Competencies: The CHA Core Competency Retrospective Pretest/Posttest (CCCRP).

Health care and academic systems are increasingly collaborating with community health advisors (CHAs) to provide culturally relevant health interventions that promote sustained community transformation. Little attention has been placed on CHA training evaluation, including core competency attainment. This study identified common CHA core competencies, generated a theoretically based measure of those competencies, and explored psychometric properties of that measure. A concept synthesis revealed five CHA core competencies (leadership, translation, guidance, advocacy, and caring). The CHA Core Competency Retrospective Pretest/Posttest (CCCRP) resulted from that synthesis, which was administered using multiple approaches to individuals who previously received CHA training (N= 142). Exploratory factor analyses revealed a two-factor structure underlying the posttraining data, and Cronbach's alpha indicated high internal consistency. This study suggested some CHA core competencies might be more interrelated than previously thought, and two major competencies exist rather than five and supported the CCCRP's use to evaluate core competency attainment resulting from training.

Abstract A20: Wii Can: Merging technology and support from community health advisors

Abstract Introduction and Purpose: Despite the benefits of physical activity, many cancer survivors fail to meet activity recommendations. Moreover, African American cancer survivors are less active than other survivor racial/ethnic groups. To address this disparity, we designed an intervention (Wii Can). Wii Can combines the appeal of emerging technology (Nintendo Wii) with the strength of social support from community health advisors (CHAs). The purpose of the current abstract is to describe the recruitment and retention of CHAs and African American cancer survivors to Wii Can. Methods: CHAs from the NCI-funded Deep South Network (DSN) for Cancer Control were identified and recruited to participate. CHAs completed training to deliver a 12 week intervention to increase physical activity in survivors. The intervention was based on Self Determination Theory. African American colorectal cancer survivors 45 to 75 years old who were not physically active, were recruited primarily through a hospital registry. Results: 10 CHAs were successfully recruited and trained as interventionists. Their mean age was 59.9 ± 3.9 years, 70% were female, 40% had some college, 40% had BA or BS, 20% had associate degrees. On average, they had been a DSN CHA for 3.1 ± 0.99 years. Reasons for deciding to participate in our study as a Wii Can CHA included: Family or friend with cancer; believe physical activity is important in general or for cancer survivors; helping others and being a role model; and encourage black people to participate in studies. All CHAs trained for the study have been retained. 170 letters were mailed to African American CRC survivors to invite their participation in the study. We were able to reach and screen 40 survivors. Incorrect mailing address, deceased, disconnected/incorrect telephone, or lack of interest were some of the reasons we were unable to screen a larger number. Of those screened, 25 were eligible. Of this group, 6 withdrew prior to enrollment (most common reason was lack of time to participate), 16 have received medical clearance to participate in the study (13 of these have enrolled and have been randomized; mean age of enrollees is 61 years). Three participants remain in the recruitment pipeline. The most common reason for ineligibility was currently receiving treatment. Only 2 individuals were ineligible due to already being too physically active. Study participants have been 100% adherent with baseline and follow-up assessments in addition to 100% adherent to receiving the planned intervention sessions (home visits and phone calls). Conclusions: A technology-based physical activity intervention is both acceptable to community health advisors who were trained to deliver the intervention and to African American CRC survivors. Challenges remain for some, as almost one quarter of those interested and eligible later determined that lack of time for the study was a barrier. Further, lack of accurate contact information provided by a hospital registry precluded optimal recruitment. Researchers need to identify efficient ways to engage African American survivors in health promotion interventions if we are to significantly impact the burden of this disease. Funding Acknowledgement: NCI: 1U54CA153719 Citation Format: Michelle Y. Martin, Hon Yuen, Claudia M. Hardy, Maria Pisu. Wii Can: Merging technology and support from community health advisors. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A20. doi:10.1158/1538-7755.DISP13-A20

Informed Decision-Making and Satisfaction with a Church-Based Men's Health Workshop Series for African-American Men: Men-Only vs. Mixed-Gender Format.

Prostate cancer incidence and mortality are highest among African-American men, and coupled with the controversy around routine prostate cancer screening, reaching African-American men with interventions to help them make an informed decision about whether or not to be screened is critical. This study compares two approaches to delivering a church-based peer community health advisor intervention consisting of a series of four men's health workshops on informed decision-making for prostate cancer screening. In the men-only group, male community health advisors teach group workshops consisting only of men. In the health partner group, male-female pairs of community health advisors teach workshops in a mixed-gender format in which enrolled men are asked to invite a significant woman in their lives (e.g., wife/partner, sister, daughter, friend) with them to the workshops. Eighteen African-American churches were randomized to receive one of the two approaches, and 283 eligible men enrolled in the intervention. Main findings suggested that the workshops had an impact on stage of decision-making, and this increased significantly over time in the health partner group only. The intervention was highly rated by men in both groups, and these ratings increased over time, with some study group differences. Within-workshop study group differences favored the health partner group in some instances; however, men in the men-only groups reported greater increases in their ratings of trust in the workshops over time. The health partner intervention strategy appears to be promising for reaching men of color with health information.

Feasibility of a web-based training system for peer community health advisors in cancer early detection among african americans.

We describe the feasibility of a Web-based portal for training peer community health advisors (CHAs). We conducted a community-based implementation trial in African American churches between 2012 and 2014. The Web-based portal allows CHAs to log in and view 13 training videos, preparing them to deliver 3 cancer early detection workshops in their churches. Of 8 churches, 6 completed the training, each certifying 2 CHAs. These CHAs took an average of 26 days to complete the training, requiring little technical assistance. Additional technical assistance was required to implement the workshops. The Web-based system appears to be a feasible method for training lay individuals for the CHA role and has implications for increasing the reach of evidence-based interventions.

Assessing environmental support for better health: Active living opportunity audits in rural communities in the southern United States

ObjectiveLeisure-time physical activity in the United States is lower rural areas and the South and has been linked to socioeconomic and environmental aspects of where people live. The purpose of this study is to assess the built environment and policies for physical activity in rural communities. MethodsEight rural communities in Alabama and Mississippi were assessed in 2011 using the Rural Active Living Assessment (RALA) street segment (SSA), town-wide (TWA), and town program and policies (PPA) assessment tools. Community Health Advisors Trained as Research Partners (CHARPS) and local staff conducted the assessments. The TWA and PPA were scored by domain and total scores. Data were analyzed using descriptive and nonparametric statistics. Results117 segments were assessed in 22 towns in 8 counties. Built environmental barriers existed in all communities. Sidewalks were available in only 10–40% of the segments. TWA identified parks and playgrounds as the most available community feature. PPA scores indicated few policies for physical activity outside of school settings with mean scores higher in Mississippi compared to Alabama (61 vs. 49, respectively). ConclusionsMultiple components of rural communities can be successfully assessed by CHARPs using RALA tools, providing information about resources and barriers for physical activity.

Translating evidence-based interventions for implementation: Experiences from Project HEAL in African American churches.

BackgroundCommunity-based approaches have been increasing in the effort to raise awareness and early detection for cancer and other chronic disease. However, many times, such interventions are tested in randomized trials, become evidence-based, and then fail to reach further use in the community. Project HEAL (Health through Early Awareness and Learning) is an implementation trial that aims to compare two strategies of implementing evidence-based cancer communication interventions in African American faith-based organizations.MethodThis article describes the community-engaged process of transforming three evidence-based cancer communication interventions into a coherent, branded strategy for training community health advisors with two delivery mechanisms. Peer community health advisors receive training through either a traditional classroom approach (with high technical assistance/support) or a web-based training portal (with low technical assistance/support).ResultsWe describe the process, outline the intervention components, report on the pilot test, and conclude with lessons learned from each of these phases. Though the pilot phase showed feasibility, it resulted in modifications to data collection protocols and team and community member roles and expectations.ConclusionsProject HEAL offers a promising strategy to implement evidence-based interventions in community settings through the use of technology. There could be wider implications for chronic disease prevention and control.