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Literature Review Abstracts

Buchanan TJO
Health Promotion Behaviors of Mexican-American Adults Participating in A Promotoras Project
Institution: TEXAS TECH UNIVERSITY; 0230
Source: MAI, 37, no. 06 (1999): p. 1815

The purpose of the descriptive study was to provide a comparison of the number of health promoting behaviors of the "Promotoras" project group with a group of prospective project members who have not had the educational intervention. The Health Promoting Lifestyle Profile (HPLP) instrument and a demographic information sheet were administered to a convenience sample of Promotoras project participants and prospective clients of the same program before intervention. The independent variables of culturally competent basic health care education, assistance with access to economic and social resource programs, and the personal social support of Promotoras personnel were assessed. The dependent variable of the two groups was the number and type of health promotion behaviors. The study results contributed to the knowledge about health promoting behaviors in Mexican-American adults in the southern Texas/New Mexico area and support the effectiveness of the Promotoras teaching project.

Burhansstipanov L. Dignan MB. Wound DB. Tenney M. Vigil G.
Native American Recruitment into Breast Cancer Screening: The NAWWA Project.
Journal of Cancer Education. 15(1):28-32, 2000 Spring.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Corkery E. Palmer C. Foley ME. Schechter CB. Frisher L. Roman SH.
Effect of A Bicultural Community Health Worker on Completion of Diabetes Education in A Hispanic Population.
Diabetes Care. 20(3):254-7, 1997 Mar.

Objective: To determine the effect of a bicultural community health worker (CHW) on completion of diabetes education in an inner-city Hispanic patient population and to evaluate the impact of completion of the education program on patient knowledge, self-care behaviors, and glycemic control.

Research Design and Methods: Patients were randomized into CHW intervention and non-CHW intervention groups. All patients received individualized, comprehensive diabetes education from a certified diabetes nurse educator after baseline demographic information, diabetes knowledge, diabetes self-care practices, and glycohemoglobin levels were assessed. Rates of education program completion were determined. Diabetes knowledge, self-care practices, and glycohemoglobin levels were reassessed at program completion and at a later postprogram follow-up medical appointment and compared to baseline. Logistic regression analysis and the Mantel-Haenszel chi 2 statistic were used to determine the effect of the CHW assignment on program completion. Analyses of covariance were performed with end-of-treatment behavior scores, knowledge scores, and glycohemoglobin levels as outcome variables, controlling for baseline values and testing for the effect of CHW assignment.

Results: Of 64 patients enrolled in the study, 40 (63%) completed and 24 (37%) dropped out before completing the diabetes education program. Of the patients having CHW intervention, 80% completed the education program, compared with 47% of patients without CHW intervention (P = 0.01). "Dropouts" were younger (age 47.5 +/- 12.5 years [mean +/- SD]) compared with patients who completed the program (55.9 +/- 9.9 years) (P = 0.004). Dropout status showed no significant relationship to educational level achieved or literacy level. For the program "completers," knowledge levels and selected self-care practices significantly improved, and glycohemoglobin levels improved from a baseline level of 11.7% to 9.9% at program completion (P = 0.004) and 9.5% at the postprogram follow-up (P < 0.001). The effect of the CHW assignment on program completion, controlling for financial status and language spoken, was extremely robust (P = 0.007). The effect of the CHW on knowledge, self-care behavior, or glycohemoglobin outcome variables was not statistically significant.

Conclusions: These findings suggest that intervention with a bicultural CHW improved rates of completion of a diabetes education program in an inner-city Hispanic patient population irrespective of literacy or educational levels attained. Our data further suggests that completion of individualized diabetes educational strategies leads to improved patient knowledge, self-care behaviors, and glycemic control.

Earp JA. Flax VL.
What Lay Health Advisors Do: An Evaluation of Advisors' Activities.
Cancer Practice. 7(1):16-21, 1999 Jan-Feb.

Purpose: Since the 1970s, health promotion and disease prevention programs that rely on lay health advisors have proliferated, making it important to ascertain the levels and types of activity that can reasonably be expected from such advisors. This report describes the activities of lay health advisors participating in a program to increase mammography screening by older African American women and shares lessons that the authors learned about evaluating advisors' activities.

Description of Study: Between September 1994 and January 1996, 144 lay health advisors, associated with the North Carolina Breast Cancer Screening Program, were asked to complete, on a periodic basis, a standardized, self-administered activity report that asked about group presentations in the past 3 months and one-on-one contacts in the past week. Eighty-five advisors submitted one or more reports. The authors tabulated responses for lay health advisors overall, for those turning in one or more reports, and for those reporting a specific type of activity.

Results: The responses showed that North Carolina Breast Cancer Screening Program lay health advisors made approximately one group presentation every 3 months and had one to three individual contacts per week. Group presentations were commonly in churches and homes, and focused on who needs a mammogram, how then, and where to get one. During one-on-one encounters, advisors primarily encouraged women to get mammograms or discussed fears about mammograms.

Clinical Implications: Information about lay health advisor activities serves several important purposes. Such information allows programs to identify the types of messages that lay health advisors transmit and the number of contacts they make, while also identifying the groups that are more and less difficult to reach, and the topics and locations favored by advisors and the women they contact. Activity data may indicate what resources or other support the advisors need, whether in-service training is necessary, and how to enhance the recruitment and training of additional lay health advisors.

Fernandez ME. DeBor M. Candreia MJ. Wagner AK. Stewart KR.

Evaluation of ENCOREplus. A Community-Based Breast and Cervical Cancer Screening Program.
American Journal of Preventive Medicine. 16(3 Suppl):35-49, 1999 Apr.

Background: Minority women and women with low income levels are significantly less likely to practice appropriate mammography and Pap test screening. ENCOREplus is a health promotion program that provides outreach, education, referral, and other service that facilitate breast and cervical cancer screening for medically underserved women. The program is delivered through a network of community-based nonprofit organizations (YWCA of the U.S.A). The purpose of this study was to assess the effectiveness of ENCOREplus in promoting mammography and Pap test screening among women who were nonadherent to screening guidelines.

Methods: Baseline data were collected from women participating in the program. Follow-up occurred within six months of baseline to assess whether or not enrollees received recommended screenings. Screening-completion rates were compared to rates from other published intervention studies.

Results: Data from the program's second implementation year show that 27,494 women participated in the ENCOREplus program. Over half the women were racial/ethnic minorities, over 75% reported annual incomes under $15,000, and 49% reported no insurance. Among women 40 and over, 69.7% were nonadherent to ACS mammography screening guidelines at baseline. Among participants 18 and older, 68.9% were nonadherent to Pap test screening guidelines. Of nonadherent participants, 57.8% received mammograms and 36.5% received Pap tests. Both mammography and Pap test screening-completion rates compared favorably with other programs. CONCLUSION: This study demonstrates that programs implemented through community-based organizations can be successful in increasing mammography and Pap test screening among low-income and minority women.

Giblin PT.
Effective Utilization and Evaluation of Indigenous Health Care Workers.
[Review] [35 refs]
Public Health Reports. 104(4):361-8, 1989 Jul-Aug.

The use of indigenous health care workers (IHCWs), who were key elements in community health care programs in the United States in the 1960s, has gone in and out of fashion in subsequent years. The author and his colleagues recently established a service program at Wayne State University's Institute of Maternal and Child Health that employs IHCWs. Characterizations of IHCWs in previous health care programs were reviewed in the process of developing criteria and guidelines for the recruitment, selection, training, employing, and evaluating these workers in the Institute's program. The unique applicability of indigenousness to the delivery of health care services is addressed in terms of the rationale for the use of IHCWs as well as criteria for their success, benefits and problems encountered in the use of these workers, and deficiencies in evaluations of IHCWs. A model of program evaluation, action research, is proposed that assesses the processes and outcomes of providing health services by indigenous paraprofessionals. [References: 35]

Rodney M. Clasen C. Goldman G. Markert R. Deane D.
Three Evaluation Methods of A Community Health Advocate Program.
Journal of Community Health. 23(5):371-81, 1998 Oct.

The title Community Health Advocate (CHA) is one of thirty or more titles used throughout the world for an indigenous outreach worker who is trusted and respected in his or her community and who serves as a bridge between peers and health professionals. In 1992, the Center for Healthy Communities in Dayton, Ohio developed a program to train as Advocates people indigenous to the communities in which they would be working. Since the first CHAs began work in January 1993, the effectiveness of the program has been evaluated from three perspectives: the Community Health Advocates, the managers/directors of the community sites at which the CHAs work, and the clients with whom the CHAs work. Advocates indicated that the training program adequately prepared them for their roles and functions. They also identified systematic frustrations and barriers that made it more difficult for them to perform their job. Community site directors and community leaders indicated that the CHAs were considered a positive force in meeting client needs and facilitating independence, and were very effective in outreach and coordination of resources. A survey of CHA clients revealed an overwhelmingly positive response to the Advocate's work, validating the belief that CHAs can fill an important niche in the health care community. The three evaluation processes described in this paper helped to document the need for and the effectiveness of this program and can serve as a model for similar programs.

Sharp PC. Dignan MB. Blinson k. Konen JC. McQuellon R. Michielutte R. Cummings L. Hinojosa L. Ledford V.
Working with Lay Health Educators in A Rural Cancer-Prevention Program.
American Journal of Health Behavior, 22(1):18-27, 1998 Jan-Feb. (15 ref)

Objective: To describe procedures for working with lay health educators in a rural cancer prevention program.

Methods: Process evaluation of traditional personnel methodology indicated problems during the early phases of the program. This necessitated modifications in procedures.

Results: Adopting methods more in concert with Native American modes of communication were more beneficial. Conclusion: Experience suggests that lay health educators can be valuable team members in health-education programs. Sensitivity to cultural differences and a high degree of flexibility maybe required in recruitment, training, and supervision. (15 ref)

Sherer JL.
Neighbor to Neighbor. Community Health Workers Educate Their Own.
Hospitals & Health Networks. 68(20):52-6, 1994 Oct 20.

Weber BE. Reilly BM.
Enhancing Mammography Use in The Inner City. A Randomized Trial of Intensive Case Management.
Archives of Internal Medicine. 157(20):2345-9, 1997 Nov 10.

Background: Breast cancer screening with mammography is an effective intervention for women aged 50 to 75 years but it is underused, especially by the urban poor.

Objective: To improve mammography completion rates for urban women aged 52 to 77 years who had not had a mammogram in at least 2 years.

Methods: We conducted a randomized controlled trial of a case management intervention by culturally sensitive community health educators vs usual care in 6 primary care practices supported by a computerized clinical information system.

Results: Women in the intervention group were nearly 3 times as likely to receive a mammogram (relative risk, 2.87; 95% confidence interval, 1.75-4.73). The benefit persisted when analyzed by age; race, and prior screening behavior. This intervention was practice based, not dependent on visits, and enhanced the efficacy of an already successful computerized preventive care information system.

Conclusions: Personalized education and case management are successful in enhancing compliance with breast cancer screening among historically noncompliant vulnerable urban women. This intervention, when combined with a preventive care information system, has the potential to achieve Healthy People 2000 objectives for breast cancer screening.

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