Skip to main content
Log in

Training Community Health Advisors in African American Churches: Do Training Outcomes Predict Performance?

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript

Abstract

Programs that utilize Community Health Advisors (CHAs) to promote cancer screening are effective in community settings. However, predictors of CHA performance are not well understood. From 2016 to 2018, we partnered with 9 African American churches in South Los Angeles and trained 49 CHAs to promote cancer screening in an effort to build capacity for health promotion in a low-resource community. This paper examines CHA characteristics and training outcomes in African American faith-based settings and explores the relationship of these variables to successful recruitment of participants by CHAs. Pre- and post-tests showed statistically significant increases in knowledge of colorectal cancer screening guidelines (4 items) and human subjects protection rules (5 items) and CHAs’ perceived self-efficacy to perform specific tasks for the study (13 items, Cronbach’s alpha > 0.90). There were no significant differences between active CHAs who recruited at least 10 participants (N = 29) and inactive/less active CHAs (N = 20) with respect to demographic characteristics and training outcomes. We report challenges and facilitators to recruitment from CHA debriefings at 12 months follow-up. Based on our findings, we make recommendations for future studies to move this field forward.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Gibbons MC, Tyus NC (2007) Systematic review of U.S.-based randomized controlled trials using community health workers. Prog Community Health Partnersh 1(4):371–381. https://doi.org/10.1353/cpr.2007.0035

    Article  Google Scholar 

  2. Viswanathan M, Kraschnewski J, Nishikawa B, Morgan LC, Thieda P, Honeycutt A, Lohr KN, Jonas D (2009) RTI International-University of North Carolina Evidence-based Practice Center. Outcomes of community health worker interventions. Evid Rep Technol Assess (Full Rep) (181):1–144, A1-2, B1-14

  3. Swider SM (2002) Outcome effectiveness of community health workers: an integrative literature review. Public Health Nurs 19(1):11–20

    Article  Google Scholar 

  4. Navarro AM, Raman R, McNicholas LJ, Loza O (2007) Diffusion of cancer education information through a Latino community health advisor program. Prev Med 45(2–3):135–138. https://doi.org/10.1016/j.ypmed.2007.05.017

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wells KJ, Luque JS, Miladinovic B, Vargas N, Asvat Y, Roetzheim RG, Kumar A (2011) Do community health worker interventions improve rates of screening mammography in the United States? A systematic review. Cancer Epidemiol Biomark Prev 20(8):1580–1598. https://doi.org/10.1158/1055-9965.EPI-11-0276

    Article  Google Scholar 

  6. Freeman HP, Muth BJ, Kerner JF (1995) Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract 3(1):19–30

    PubMed  CAS  Google Scholar 

  7. Freeman HP, Rodriguez RL (2011) History and principles of patient navigation. Cancer 117(15 Suppl):3539–3542. https://doi.org/10.1002/cncr.26262

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jandorf L, Braschi C, Ernstoff E, Wong CR, Thelemaque L, Winkel G, Thompson HS, Redd WH, Itzkowitz SH (2013) Culturally targeted patient navigation for increasing African Americans’ adherence to screening colonoscopy: a randomized clinical trial. Cancer Epidemiol Biomark Prev 22(9):1577–1587. https://doi.org/10.1158/1055-9965.EPI-12-1275

    Article  Google Scholar 

  9. Robinson-White S, Conroy B, Slavish KH, Rosenzweig M (2010) Patient navigation in breast cancer: a systematic review. Cancer Nurs 33(2):127–140. https://doi.org/10.1097/NCC.0b013e3181c40401

    Article  PubMed  Google Scholar 

  10. Maxwell AE, Jo AM, Crespi CM, Sudan M, Bastani R (2010) Peer navigation improves diagnostic follow-up after breast cancer screening among Korean American women: results of a randomized trial. Cancer Causes Control 21(11):1931–1940. https://doi.org/10.1007/s10552-010-9621-7

    Article  PubMed  PubMed Central  Google Scholar 

  11. American Cancer Society (2016) Cancer facts & figures for African Americans 2016–2018. American Cancer Society, Atlanta

    Google Scholar 

  12. Lucas-Wright A, Bazargan M, Jones L, Vadgama JV, Vargas R, Sarkissyan M et al (2014) Correlates of perceived risk of developing cancer among African-Americans in South Los Angeles. J Commun Health 39(1):173–180. https://doi.org/10.1007/s10900-013-9756-z

    Article  Google Scholar 

  13. Bazargan M, Lucas-Wright A, Jones L, Vargas R, Vadgama JV, Evers-Manly S et al (2015) Understanding perceived benefit of early cancer detection: community-partnered research with African American women in South Los Angeles. J Women's Health (2002) 24(9):755–761. https://doi.org/10.1089/jwh.2014.5049

    Article  Google Scholar 

  14. Allen JD, Linnan LA, Emmons KM (2012) Fidelity and its relationship to implementation effectiveness, adaptation, and dissemination. In: Brownson RC, Colditz GA, Proctor EK (eds) Dissemination and implementation research in health. Oxford University Press, New York, pp 281–304

    Google Scholar 

  15. Han HR, Kim KB, Kim MT (2007) Evaluation of the training of Korean community health workers for chronic disease management. Health Educ Res 22(4):513–521. https://doi.org/10.1093/her/cyl112

    Article  PubMed  Google Scholar 

  16. Maxwell AE, Danao LL, Cayetano RT, Crespi CM, Bastani R (2012) Evaluating the training of Filipino American community health advisors to disseminate colorectal cancer screening. J Community Health 37(6):1218–1225. https://doi.org/10.1007/s10900-012-9557-9

    Article  PubMed  PubMed Central  Google Scholar 

  17. Yu MY, Song L, Seetoo A, Cai C, Smith G, Oakley D (2007) Culturally competent training program: a key to training lay health advisors for promoting breast cancer screening. Health Educ Behav 34(6):928–941

    Article  Google Scholar 

  18. Bastani R, Glenn BA, Taylor VM, Chen MS Jr, Nguyen TT, Stewart SL, Maxwell AE (2010) Integrating theory into community interventions to reduce liver cancer disparities: The Health Behavior Framework. Prev Med 50(1–2):63–67. https://doi.org/10.1016/j.ypmed.2009.08.010

    Article  PubMed  Google Scholar 

  19. Israel BA, Coombe CM, Cheezum RR, Schulz AJ, McGranaghan RJ, Lichtenstein R et al (2010) Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities. Am J Public Health 100(11):2094–2102. https://doi.org/10.2105/AJPH.2009.170506

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jones L, Wells K (2007) Strategies for academic and clinician engagement in community-participatory partnered research. JAMA 297(4):407–410. https://doi.org/10.1001/jama.297.4.407

    Article  PubMed  CAS  Google Scholar 

  21. Hatcher J, Schoenberg NE (2007) Human subjects protection training for community workers: an example from “Faith Moves Mountains”. Prog Community Health Partnersh 1(3):257–265. https://doi.org/10.1353/cpr.2007.0022

    Article  PubMed  Google Scholar 

  22. Gu J, Maxwell AE, Ma GX, Qian X, Tan Y, Hsieh HC, Tu SP, Wang JHY (2018) Evaluating the training of Chinese-speaking community health workers to implement a small-group intervention promoting mammography. J Cancer Educ. doi: https://doi.org/10.1007/s13187-018-1361-5

    Article  Google Scholar 

  23. Maxwell AE, Danao LL, Cayetano RT, Crespi CM, Bastani R (2016) Implementation of an evidence-based intervention to promote colorectal cancer screening in community organizations: a cluster randomized trial. Transl Behav Med 6(2):295–305. https://doi.org/10.1007/s13142-015-0349-5

    Article  PubMed  Google Scholar 

  24. Woodruff SI, Candelaria JI, Elder JP (2010) Recruitment, training outcomes, retention, and performance of community health advisors in two tobacco control interventions for Latinos. J Community Health 35(2):124–134. https://doi.org/10.1007/s10900-009-9207-z

    Article  PubMed  Google Scholar 

  25. Shelton RC, Thompson HS, Jandorf L, Varela A, Oliveri B, Villagra C, Valdimarsdottir HB, Redd WH (2011) Training experiences of lay and professional patient navigators for colorectal cancer screening. J Cancer Educ 26(2):277–284. https://doi.org/10.1007/s13187-010-0185-8

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hill BC, Black DR, Shields CG (2017) Barbershop prostate cancer education: factors associated with client knowledge. Am J Mens Health 11(5):1415–1425. https://doi.org/10.1177/1557988315607958

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bandura A (2004) Health promotion by social cognitive means. Health Educ Behav 31(2):143–164. https://doi.org/10.1177/1090198104263660

    Article  PubMed  Google Scholar 

  28. Becker M, Maiman L (1974) The health belief model: origins and correlates in psychological theory. Health Educ Monogr 2:336–353

    Article  Google Scholar 

  29. Ajzen I, Madden T (1986) Prediction of goal-directed behavior: attitudes, intentions and perceived behavioral control. J Exp Soc Psychol 22:453–474

    Article  Google Scholar 

  30. Maxwell AE, Crespi CM, Arce AA, Bastani R (2017) Exploring the effects of longstanding academic-community partnerships on study outcomes: a case study. Prev Med Rep 8:101–107. https://doi.org/10.1016/j.pmedr.2017.09.003

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work was supported by the Charles R. Drew University/UCLA Cancer Center Partnership to Eliminate Cancer Health Disparities, NIH/NCI no. U54 CA143931. CMC was also supported by NIH/NCI grant P30CA16042. We would like to thank the leaders of the African American churches and the Community Health Advisors who participated in this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Annette E. Maxwell.

Ethics declarations

This study was approved by the University of California Los Angeles Institutional Review Board and all CHAs and study participants provided informed consent.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maxwell, A.E., Lucas-Wright, A., Gatson, J. et al. Training Community Health Advisors in African American Churches: Do Training Outcomes Predict Performance?. J Canc Educ 35, 395–402 (2020). https://doi.org/10.1007/s13187-019-1478-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-019-1478-1

Keywords

Navigation