Journal of Community Health

, Volume 43, Issue 4, pp 694–704 | Cite as

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

  • Patricia A. Sharpe
  • Sara Wilcox
  • Deborah Kinnard
  • Margaret D. Condrasky
Original Paper


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.


Community 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.

Ethical Approval

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.


  1. 1.
    Glasgow, R. E., & Emmons, K. M. (2007). How can we increase translation of research into practice? Types of evidence needed. Annual Review of Public Health, 28, 413–433.CrossRefPubMedGoogle Scholar
  2. 2.
    Green, L. W. (2008). Making research relevant: If it is an evidence-based practice, where’s the practice-based evidence? Family Practice, 25(Suppl 1), i20–24.CrossRefPubMedGoogle Scholar
  3. 3.
    Glasgow, R. E., Vinson, C., Chambers, D., Khoury, M. J., Kaplan, R. M., & Hunter, C. (2012). National Institutes of Health approaches to dissemination and implementation science: Current and future directions. American Journal of Public Health, 102(7), 1274–1281.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Rabin, B. A., et al. (2008). A glossary for dissemination and implementation research in health. Journal of Public Health Management and Practice, 14(2), 117–123.CrossRefPubMedGoogle Scholar
  5. 5.
    Tabak, R. G., Khoong, E. C., Chambers, D., & Brownson, R. C. (2012). Bridging research and practice: Models for dissemination and implementation research. American Journal of Preventive Medicine, 43(3), 337–350.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Wilcox, S., Laken, M., Parrott, A. W., Condrasky, M., Saunders, R., Addy, C. L., et al. (2010). The Faith, Activity, and Nutrition (FAN) program: Design of a participatory research intervention to increase physical activity and improve dietary habits in African American churches. Contemporary Clincial Trials, 31, 323–335.CrossRefGoogle Scholar
  7. 7.
    Wilcox, S., Parrott, A., Baruth, M., Laken, M., Condrasky, M., Saunders, R., et al. (2013). The Faith, Activity, and Nutrition program: A randomized controlled trial in African-American churches. American Journal of Preventive Medicine, 44, 122–131.CrossRefPubMedGoogle Scholar
  8. 8.
    Brownson, R. C., Jacobs, J. A., Tabak, R. G., Hoehner, C. M., & Stamatakis, K. A. (2013). Designing for dissemination among public health researchers: Findings from a national survey in the United States. American Journal of Public Health, 103(9), 1693–1699.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Fleury, J., Keller, C., Perez, A., & Lee, S. M. (2009). The role of lay health advisors in cardiovascular risk reduction: A review. American Journal of Community Psychology, 44, 28–42.CrossRefPubMedGoogle Scholar
  10. 10.
    Alcalay, R., Alvarado, M., Balcazar, H., Newman, E., & Huerta, E. (1999). Salud para su Corazon: A community-based Latino cardiovascular disease prevention and outreach model. Journal of Community Health, 24(5), 359–378.CrossRefPubMedGoogle Scholar
  11. 11.
    Cornell, C. E., Littleton, M. A., Greene, P. G., Pulley, L., Brownstein, J. N., Sanderson, B. K., et al. (2009). A community health advisor program to reduce cardiovascular risk among rural African-American women. Health Education Research, 24(4), 622–633.CrossRefPubMedGoogle Scholar
  12. 12.
    Hilfinger Messias, D. K., Parra-Medina, D., Sharpe, P. A., Treviño, L., Koskan, A. M., & Morales-Campos, D. (2013). Promotoras de Salud: Roles, responsibilities, and contributions in a multisite community-based randomized controlled trial. Hispanic Health Care International, 11(2), 62–71.CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Kim, S., Koniak-Griffin, D., Flaskerud, J. H., & Guarnero, P. A. (2004). The impact of lay health advisors on cardiovascular health promotion using a community-based participatory approach. Journal of Cardiovascular Nursing, 19(3), 192–199.CrossRefPubMedGoogle Scholar
  14. 14.
    Navarro, A. M., Rock, C. L., McNicholas, L. J., Senn, K. L., & Moreno, C. (2000). Community-based education in nutrition and cancer: The Por La Vida Cuidandome curriculum. Journal of Cancer Education, 15, 168–172.PubMedGoogle Scholar
  15. 15.
    Wilcox, S., Saunders, R. P., Kaczynski, A. T., Forthofer, M., Sharpe, P. A., Goodwin, C., et al. (2018). Faith, activity, and nutrition randomized D&I study: Countywide adoption, reach, and effectiveness. American Journal of Preventive Medicine (in press).Google Scholar
  16. 16.
    U.S. Department of Health and Human Services. Health resources and services administration data warehouse. Health professions shortage area find. Retrieved March 15, 2017, from
  17. 17.
    US Census Bureau. Quick facts, Fairfield County, South Carolina. People: Race and Hispanic origin, Black or African American alone, July 1, 2016. Retrieved November 21, 2017, from
  18. 18.
    US Census Bureau. Quick facts, Fairfield County, South Carolina. People: Income & poverty, people in poverty, 2011–2015. Retrieved November 21, 2017, from
  19. 19.
    Robert Wood Johnson Foundation. County health rankings and roadmaps, Fairfield County, adult obesity, 2013. Retrieved November 21, 2017, from
  20. 20.
    Cohen, D. A., Scribner, R. A., & Farley, T. A. (2000). A structural model of health behavior: A pragmatic approach to explain and influence health behaviors at the population level. Preventive Medicine, 30(2), 146–154.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Patricia A. Sharpe
    • 1
  • Sara Wilcox
    • 1
    • 2
  • Deborah Kinnard
    • 1
  • Margaret D. Condrasky
    • 3
  1. 1.Arnold School of Public Health, Prevention Research CenterUniversity of South CarolinaColumbiaUSA
  2. 2.Department of Exercise ScienceUniversity of South Carolina Arnold School of Public HealthColumbiaUSA
  3. 3.Department of Food, Nutrition, and Packing SciencesClemson UniversityClemsonUSA

Personalised recommendations