Community Health Advisors’ Participation in a Dissemination and Implementation Study of an Evidence-Based Physical Activity and Healthy Eating Program in a Faith-Based Setting
Community health advisors (CHAs) have been widely involved in health promotion, but few details on role expectations, retention, and evaluation have been reported. In a dissemination and implementation (D&I) study of an evidence-based healthy eating and physical activity program, 59 churches were randomized to an intervention (n = 39) or control (delayed intervention) (n = 20) condition. In a novel approach, CHAs worked with church committees rather than congregants by providing training (n = 59) and technical assistance (n = 54) to the committees to implement a program focused on structural and policy-level changes to support congregants’ behavioral changes. CHA training comprised self-study via electronic training modules, in-person training, and telephone-based training. Evaluation methods were pilot test participants’ and CHAs’ ratings of their training; observers’ ratings of CHAs’ church training delivery; church committee members’ ratings of the training experience, including CHAs’ performance; and data from the TA database to assess CHAs’ adherence to the protocol. The main challenge was the early dropout of one CHA and the reduced role of another. CHAs trained 142 intervention and 60 control church committee members in nine sessions; they covered 99% (intervention) and 90% (control) of training content, indicating high fidelity. Observers’ scored CHAs’ teaching and facilitation skills at 96.7% (intervention) and 80% (control) of the possible score. CHAs completed 92% of intervention and 93% of control TA calls. The great majority of church participants’ comments regarding CHAs were positive. This study demonstrates that with training and support, CHAs demonstrate high levels of intervention fidelity, confidence, and competence.
KeywordsCommunity health advisors Dissemination Nutrition Physical activity Faith-based
This work was supported by the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion by Cooperative Agreement Number U48-DP-005000. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Department of Health and Human Services. The authors appreciate the contributions and input of the Fairfield Community Coordinating Council, Fairfield Behavioral Health Services, and the Research Advisory Committee to this study and thank the participating churches from Fairfield County.
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest to report.
The faith-based healthy eating and exercise D&I study was granted exempt status from the University’s Institutional Review Board.
Human and Animal Rights and Informed Consent
Written informed consent was not required of church participants, who completed only an anonymous training evaluation form for this CHA evaluation. This manuscript is focused on the Community Health Advisors’ role in the D&I study rather than the church participants. Community Health Advisors were not enrolled as research participants in the intervention; rather, they were a paid staff person and volunteers.
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