Training Community Health Workers in Motivational Interviewing to Promote Cancer Screening

Abstract

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.

The global role, impact, and limitations of Community Health Workers (CHWs) in breast cancer screening: a scoping review and recommendations to promote health equity for all

“…Teaching methods utilized by CHWs in these settings include Motivational Interviewing (MI, n = 2), door-to-door conversations (n = 2), and Kin Keeper home visits (n = 3). Used by Brandford et al (2019), MI is a technique that emphasizes ‘communication skills like reflective listening’ to promote healthy behavior change [ 26 ]. In this study, CHWs were able to effectively implement MI strategies, and felt more confident talking to community members about breast cancer screening.…”

Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing

“…Confrontation and persuasion on the part of the interviewer may elicit resistance and soften change talk. 21,22…”

“…24 Research suggests MI adherence by CHWs improves over time and is achievable. 22 By using MI skills to resolve resistance, CHWs can support participants in committing to a diet and exercise plan and help them maintain behavior changes.…”

Promoting Hispanic Immigrant Health via Community Health Workers and Motivational Interviewing

“…Immigrant communities struggling with the unfamiliarity of the health-care system, limited transportation, and fear of deportation may benefit from MI as the conversations seek to address potential barriers in depth with the CHW. 19 For example, the depth of the MI conversation may lead a CHW to support a participant in identifying strategies to minimize deportation risk, such as by relying on a friend or family member to help with transportation.…”

“…Confrontation and persuasion are avoided, as they are usually met with resistance from the participant and can soften change talk. 19,22…”