Community-based participatory design of a community health worker breast cancer training intervention for South Florida Latinx farmworkers

Abstract

Objective Community health worker (CHW)-led education is an important strategy to increase awareness and access to breast cancer screening in medically-underserved communities. This study aimed to develop a context-specific, culturally-appropriate training intervention for South Florida CHWs to educate Latinx immigrant farmworkers on breast cancer and early detection. Methods A community-based participatory research (CBPR) study, conducted 2017-2019, informed the design of a training curriculum for CHWs and educational dissemination materials. Twenty-two CHWs were trained and knowledge gains were measuring using a one-group pre-and post-test design. Triangulated evaluation consisted of field observations of CHW-client interactions, CHW self-reports, and rapid assessment surveys of community members. Results A community stakeholder-informed breast cancer training curriculum resulted in significant, sustained breast cancer knowledge gains among CHWs when comparing pre-, post-, and 4-6 month post-training follow-up test scores. Field observations of educational material dissemination, CHW self-reported evaluations, and community rapid assessment surveys at three health fairs demonstrated this was an effective strategy to engage female Latinx farmworkers in breast cancer education. Conclusions Community and key stakeholder participation in the development of a breast cancer educational intervention allowed for tailored design priorities around knowledge-based content,

Roles, Barriers, and Recommendations for Community Health Workers Providing Community-Based HIV Care in Sub-Saharan Africa: A Review

“…It has been shown that educational pamphlets not only improve the health literacy of community members but also the evidence-based health knowledge of CHWs. 72 Appropriate, sufficient, and understandable educational resources will therefore help ensure that CHWs offer better-quality HIV services. Significant effort should be made to address the lack of oversight, structured support for challenging cases, and incentives to promote a high quality of home-based HIV services.…”

Harvesting Health Knowledge: Breast Cancer Perceptions in the South Florida Latinx Farmworker Community

“…CHWs have historically worked in Africa, Asia, Latin America, and some areas of the United States in negotiating, engaging in participatory health discussions with the community, advocating and translating the community member’s (CM) needs to the health system (Lehmann & Sanders, 2007; Pérez & Martinez, 2008). CHW-led interventions have resulted in culturally appropriate health programs and education for underserved communities that account for lay health knowledge and increase the communities’ service access (Rodriguez et al, 2020). In Florida, Tucker and colleagues (2018) conducted a state-wide CHW survey and found that 212 CHWs worked in areas focused on prevention, 208 focused on occupational health, 187 specialized in women’s health, and 126 focused on cancer in low resource communities.…”

“…This study uses qualitative methods to examine breast cancer perceptions, knowledge gaps, needs, and barriers to breast cancer screening among South Florida Latinx farmworkers, and the role of CHWs in supporting the community’s access to early detection services (Donaldson et al, 2012; Oluwole et al, 2003; Rodriguez et al, 2020; Zambrana et al, 1999). Breast cancer data are typically disaggregated by racial-ethnic group categories; however, the Hispanic category is extremely diverse from national and ethnic perspectives, thus presenting limitations in understanding subgroup experiences and meaning-making in illness experiences.…”

Breast cancer screening outcomes among Mexican-origin Hispanic women participating in a breast cancer screening program

“…Cultural characteristics ( Yanez et al, 2016 , Austin et al, 2002 ). Hispanic sub-group ( Shoemaker and White, 2016 ); geography ( Coughlin et al, 2003 , Nuño et al, 2011 ); cost ( Abraído-Lanza et al, 2004 , Schueler et al, 2008 ); lack of access to healthcare ( American Cancer Society, 2019 , Laws and Mayo, 1998 , Rodriguez et al, 2020 , Valdez et al, 2001 , Palmer et al, 2005 , Selvin and Brett, 2003 ); time living in the United States ( Schueler et al, 2008 , Rodriguez et al, 2020 ). English language proficiency ( Austin et al, 2002 , Ramachandran et al, 2015 , Stein and Fox, 1990 ); and overall fear about safety, pain, or abnormal results ( Austin et al, 2002 , Schueler et al, 2008 , Ramachandran et al, 2015 , Fayanju et al, 2014 ) are factors associated with lower screening rates.…”

“…English language proficiency ( Austin et al, 2002 , Ramachandran et al, 2015 , Stein and Fox, 1990 ); and overall fear about safety, pain, or abnormal results ( Austin et al, 2002 , Schueler et al, 2008 , Ramachandran et al, 2015 , Fayanju et al, 2014 ) are factors associated with lower screening rates. The relative contribution of these factors is unclear; in one study among foreign born Hispanic women, controlling for socioeconomic factors ( Rodriguez et al, 2020 ) reversed the association with screening mammography. Furthermore, once an abnormal mammogram is detected, Hispanic women have been shown to have a longer time to diagnostic follow up ( Press et al, 2008 , Stuver, 2011 ) and are more likely to receive treatment below standard of care when compared to non-Hispanic white women ( Chen and Li, 2015 , Ooi et al, 2011 ).…”