Lay Health Advisers Research Articles

A community approach to engaging Gypsy and Travellers' in cancer services.

While cancer outcomes in the UK have improved, inequalities remain with poorer and some ethnic minority populations experiencing lower survival rates. Research has addressed Gypsies' and Travellers' cancer-related beliefs, experiences and practices as part of wider studies but this is the first study in the UK to specifically focus on cancer. Findings suggest that health beliefs and practices are shaped by historical and contemporary social processes and the marginal position of Gypsies and Travellers in the UK society can result in a preference for seeking information and support from within the community. Starting from a health assets perspective, findings indicate that the structure of social relations in Gypsy and Traveller communities could be more widely utilized in health promotion programmes. Developing and extending techniques employed by Gypsy and Traveller Non-governmental Organisations such as community-based interventions and the use of lay health advisers, could be an effective method of health promotion by raising knowledge of cancer, engaging community members in preventative programmes and encouraging earlier access to services.

Lay health advisers: scoping the role and intervention landscape.

The use of lay health advisers has become an established approach within public health, in particular for impact on health inequalities and engaging socially excluded groups. Evidence on how differences in terms of the multiple role dimensions impact the outcomes of programs is limited. This creates ambiguity for decision makers on which roles should be implemented in different contexts for different needs. This paper applies realist logic to an inquiry to explore the mechanisms that may operate in lay-led intervention models and understand how, why, and in what respect these lead to particular outcomes. It draws on a project focusing on health-related lifestyle advisers and further insights gained from a subsequent related project about outreach with traveler communities. Analysis highlights multiple and potentially interacting aspects of lay health-adviser roles that may influence their success, including characteristics of lay health advisers, characteristics of target populations, purpose or intent of interventions, and how advice is given. A model is proposed from which to examine the contexts and mechanisms of lay health advisers that may impact outcomes, and is subsequently applied to two examples of reported lay health-adviser interventions. The combination of skills and characteristics of lay health advisers must be considered when planning which interventions might be appropriate when targeting specific needs or target populations. Focus only on the peer/layperson distinction may overlook other potentially important skills and mechanisms of action integral to lay health-adviser roles.

Adolescents and parental caregivers as lay health advisers in a community-based risk reduction intervention for youth: baseline data from Teach One, Reach One

Adolescents and parental caregivers as lay health advisers in a community-based risk reduction intervention for youth: baseline data from Teach One, Reach One

Adolescents and parental caregivers as lay health advisers in a community-based risk reduction intervention for youth: baseline data from Teach One, Reach One

ABSTRACTThe purpose of the current study is to describe the demographic, behavioral, and psychosocial characteristics of adolescent and caregiver lay health advisers (LHAs) participating in an intervention designed to reduce risk behaviors among rural African-American adolescents. Teach One, Reach One integrates constructs from the Theory of Planned Behavior and Social Cognitive Theory. It acknowledges that changing the sexual behaviors of African-American adolescents requires changing one's knowledge, attitudes, normative beliefs about the behavior of peers, and self-efficacy regarding adolescent sexual behavior, parent–teen communication about sex, and healthy dating relations among adolescents. Study participants completed baseline questionnaires assessing demographics and psychosocial determinants (knowledge, attitudes, perceived social norms, and self-efficacy) of sexual behaviors. Sixty-two adolescent and caregiver dyads participated. Caregivers included biological parents, legal guardians, or other parental figures. Strengths and areas in need of improvement were determined using median splits. Few adolescents had initiated sex. Their strengths included high levels of open parent–teen communication; positive attitudes and normative beliefs regarding both sex communication and healthy dating relationships; and high knowledge and self-efficacy for healthy dating behaviors. Areas needing improvement included low knowledge, unfavorable attitudes, poor normative beliefs, and low self-efficacy regarding condom use. Caregiver strengths included positive attitudes, normative beliefs, and self-efficacy for sex communication; positive attitudes and self-efficacy for condom use; and low acceptance of couple violence. Areas needing improvement included low levels of actual communication about sex and low knowledge about effective communication strategies and condom use. The current study highlights the value of assessing baseline characteristics of LHAs prior to intervention implementation, as it enables a better understanding of the key characteristics necessary for planning and implementing interventions, as well as engaging in targeted training activities.

Treatment adherence in a lay health adviser intervention to treat tobacco dependence.

Lay health advisers (LHAs) are increasingly used to deliver tobacco dependence treatment, especially with low-socioeconomic status (SES) populations. More information is needed about treatment adherence to help interpret mixed evidence of LHA intervention effectiveness. This study examined adherence to behavioral counseling and nicotine patches in an LHA intervention with 147 Ohio Appalachian female daily smokers. Participants were randomly selected from clinics and randomized to the intervention condition of a randomized controlled trial. Overall, 75.5% of participants received all seven planned LHA visits, 29.3% used patches for >7 weeks and approximately half received high average ratings on participant responsiveness. Depressive symptoms and low nicotine dependence were associated with lower patch adherence while high poverty-to-income ratio was associated with high responsiveness. Compared with those with fewer visits, participants who received all visits were more likely to be abstinent (22.5 versus 2.8%, P=0.026) or have attempted quitting (85.0 versus 47.4%, P=0.009) at 3 months. High participant responsiveness was associated with 12-month abstinence. LHA interventions should focus on improving adherence to nicotine patches and managing depression because it is an independent risk factor for low adherence.

East Meets West: A Brief Report of a Culturally Sensitive Breast Health Education Program for Chinese-Australian Women

Chinese-Australian women are less likely to undergo breast health examination compared to women born in Australia, and cultural beliefs have been identified as a barrier to screening participation and breast health practices. We sought to promote awareness using trained lay health advisers (breast health advocates). This paper discusses the impact of the training program on advocate knowledge and beliefs, and women's experience as advocates. Thirty-seven of 50 women approached participated in an education program. The education was delivered over one full day and one half-day follow-up. Data were collected using questionnaires, focus groups and interviews. The program increased participant knowledge of breast health, decreased misperceptions about breast cancer and enhanced participants' readiness to discuss these topics with other Chinese women. Advocates enjoyed the role but did not always remember to promote awareness. The program appears effective and is suitable for further, more widespread testing.

What do men who serve as lay health advisers really do?: Immigrant Latino men share their experiences as Navegantes to prevent HIV.

HoMBReS was a lay health adviser (LHA) intervention designed to reduce sexual risk among recently arrived, nonEnglish-speaking Latino men who were members of a multicounty soccer league in central NC. Our community-based participatory research (CBPR) partnership collected, analyzed, and interpreted qualitative life-story narratives to characterize the roles of male LHAs known as Navegantes. Nine Navegantes were interviewed. Their mean age was 39 years (range: 26-62 years); six were from Mexico and three from El Salvador. Navegantes described the function and facilitators of serving as LHAs and identified leverage points for future HIV and STD prevention strategies. They highlighted psychosocial and sociocultural influences on HIV risk, settings for risky behavior, and personal changes from serving as Navegantes. This study provides preliminary evidence that an LHA approach is feasible and appropriate for Latino men, and can be effective in reaching men who might otherwise be difficult to reach.

What Do Men Who Serve as Lay Health Advisers Really Do?: Immigrant Latino Men Share their Experiences as Navegantes to Prevent HIV

What Do Men Who Serve as Lay Health Advisers Really Do?: Immigrant Latino Men Share their Experiences as Navegantes to Prevent HIV

Environmental health promotion interventions: considerations for preparation and practice.

Interventions to address current, future, and potential public health dilemmas, such as air pollution, urban sprawl, brown field reclamation, and threats of intentional toxic exposures would benefit from a synergy between the disciplines of environmental health and health education. A comparison between the Protocol for Assessing Community Excellence in Environmental Health and the PRECEDE-PROCEED model used in health education illustrates some similarities and differences in terminology, assessment procedures, intervention design, and types of evidence used by the two disciplines. Promising intervention strategies draw on the expertise of both fields and include social action, policy and media advocacy, coalition building, organizational change, lay health advisers, risk communication, and tailored educational messages. Appropriate targets of change can range from the equitable distribution of resources to individual behavior change. Significant interdisciplinary evaluation research is necessary to accelerate the identification of successful models for reducing the burden of environmental health problems in communities.

Native American recruitment into breast cancer screening: the NAWWA project.

American Indian women's historically low breast cancer incidence and mortality rates have gradually increased such that in many parts of the United States they equal "U.S. All Races" rates. Thus, American Indian women need screening to maintain their low rates. In an outreach program, local American Indian women were trained as lay health advisers, "Native Sisters," to locate and contact American Indian women in the Denver metropolitan area and provide education and encouragement to increase participation in mammography screening. Participation was monitored and interviews collected descriptive information and information about risk factors for breast cancer. An interrupted-time-series design was used to assess changes in mammography participation. The NAWWA program increased recruitment of American Indian women (p < 0.05). Women recruited by the Native Sisters were more likely to be currently on hormone replacement therapy and to be menopausal. The lay health adviser program was effective in recruiting American Indian women to have screening mammography. Barriers to participation were complex and often involved cultural values and beliefs.

Maternal care coordination for migrant farmworker women: program structure and evaluation of effects on use of prenatal care and birth outcome.

Nearly three fourths of the migrant farmworkers in the U.S. are Hispanic. Cultural and social barriers, along with constant travel, make coordination of care a significant concern for migrant health centers providing perinatal services to female farmworkers. As part of a demonstration project, a migrant-specific maternal care coordination program was developed that used bilingual staff, outreach services, lay health advisers, and a multistate tracking system. Following the initiation of the project, first-trimester entry into prenatal care and number of prenatal visits increased over a five-year period among the target population. Successful tracking methods provided outcome data on more than 80 percent of participants during the project period. The results of this study suggest that migrant health centers should focus on employing public health-oriented bilingual or bicultural health professionals and that an outreach strategy must be an integral part of a health care delivery system serving migrant farmworkers. Without these key ingredients, health care services will not be accessible or acceptable for this hard-to-reach population. Collaboration among the National Migrant Resource Program, the Migrant Clinicians Network, and the National Perinatal Association can facilitate development of a regionwide perinatal service system for female migrant farmworkers.