Health disparities researchers attempting to engage and effectively deliver interventions to underserved populations often encounter a number of challenges ranging from geographical considerations to more complex issues of medical mistrust. While there are a number of strategies researchers may employ to address these challenges, one of the most successful of these has been the use of community health workers (CHWs). Despite the documented success of CHWs, little information exists on the use of theory-driven intervention strategies with these community partners. Researchers who have partnered with CHWs tend to provide brief descriptions of training strategies and provide little discussion of the challenges and barriers to training a lay population in the delivery of technical interventions, including ensuring fidelity to the intervention protocol. The purpose of this article is to describe the feasibility of training CHWs to deliver a motivational interviewing intervention to promote cancer screening in underserved populations. With this article we present an innovative way to use motivational interviewing delivered by CHWs. Specifically, we will detail the development of the training protocol, the implementation of that training in a variety of research settings, and the development and implementation of fidelity protocols. We will use examples from two research studies where CHWs were successfully trained to use MI to promote cancer screening in underserved communities to highlight the challenges and barriers faced in developing and implementing the training and strategies used to overcome these challenges during the refinement of the intervention.
Objective: To provide a conceptual description of an Emergency Department (ED) placed randomized controlled trial designed to reduce the disproportionate burden of colorectal cancer (CRC) among rural Appalachian residents. Background: Residents of rural Appalachia have a higher incidence and mortality rate from CRC than residents of any other region of the country. The Centers for Disease estimate that as many as 60% of CRC deaths could be prevented if everyone aged 50 and up were screened regularly. One of the primary barriers to CRC screening for rural Appalachian residents is limited access to the health care system resulting in infrequent recommendations for screening and inadequate screening education. Given the propensity of rural Appalachians to accept health related information from trusted community members we designed an intervention to be delivered by local community health workers in the ED while individuals waited for non urgent care or waited with a family member. The ED provides services to a segment of the population that is traditionally hard to reach and at high risk for underutilization of preventive services. ED visits may be the sole point of contact with the health care system for these vulnerable individuals and provides a venue and opportunity for CRC screening promotion and education. Methods: This ED-placed RCT, designed and implemented in collaboration with community members and health care providers in rural Eastern Kentucky, is one of the first to use the ED as a site to promote colorectal cancer screening using a community health worker trained to deliver a motivational interviewing intervention to persons waiting for non urgent care or with a family member, in the ED of rural Appalachian hospitals. Results: We provide a conceptual overview to key elements of the intervention, including intervention development and refinement, theoretical foundations, intervention approach and implementation and evaluation procedures. Conclusion: This RCT has recruited more than 150 persons from rural Appalachian EDs who have not been screened for CRC in accordance with guidelines. It provides promise that CRC screening promotion activities are appropriately placed in rural EDs and provides a solid platform from which researchers and providers may launch efforts to develop targeted preventative health interventions in innovative public health settings. Citation Format: Jennifer Hatcher, Arica Brandford, Adaeze Aroh, Adebola Adegboyega, Brenda Combs, Nancy Schoenberg. Promoting colorectal cancer screening in rural Appalachian emergency department. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C65.
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