Unpacking the ‘black box’ of lay health worker processes in a US-based intervention

Abstract

Prior studies have supported the effectiveness of the use of Lay Health Workers (LHWs) as an intervention model for managing chronic health conditions, yet few have documented the mechanisms that underlie the effectiveness of the interventions. This study provides a first look into how LHWs delivered a family-based intervention and the challenges encountered. We utilize observation data from LHW-led educational sessions delivered as part of a randomized controlled trial (RCT) designed to test a LHW outreach family-based intervention to promote smoking cessation among Vietnamese American smokers. The RCT included experimental (smoking cessation) and control (healthy living) arms. Vietnamese LHWs were trained to provide health information in Vietnamese to groups of family dyads (smoker and family member). Bilingual, bicultural research team members conducted unobtrusive observations in a subset of LHW educational sessions and described the setting, process and activities in structured fieldnotes. Two team members coded each fieldnote following a grounded theory approach. We utilized Atlas.ti qualitative software to organize coding and facilitate combined analysis. Findings offer a detailed look at the 'black box' of how LHWs work with their participants to deliver health messages. LHWs utilized multiple relational strategies, including preparing an environment that enables relationship building, using recognized teaching methods to engage learners and co-learners as well as using humor and employing culturally specific strategies such as hierarchical forms of address to create trust. Future research will assess the effectiveness of LHW techniques, thus enhancing the potential of LHW interventions to promote health among underserved populations.

Community of Practice of Promotoras de Salud to address health inequities during and beyond the COVID-19 pandemic

“…CHW/Ps have long been a critical workforce in the US for supporting communities disproportionately impacted by a wide range of health issues (6,25). CHW/Ps were especially critical during the COVID-19 pandemic.…”

Keeping Each Other Accountable

“…Including LHWs as third-party facilitators of educational sessions and discussions around smoking and healthy living may make conversations regarding smoking cessation easier. We have previously reported on LHW processes,42 including culturally specific strategies LHWs utilized to cultivate friendly and supportive environments and build trust among Vietnamese male smokers and family member participants. As previously noted, “[E]ducation from a caring member of one's own community, delivered in a personal manner, is not reproducible or replaceable by any form of technology.”30 (p108S) Smokers may have varying intentions and motivations to quit; thus, interventions that incorporate only one mechanism of social support may limit their reach to participants.…”

“…Lay health workers utilized intervention materials tailored for each arm of the study to support smoker and family member participants. 42,44 Materials included: (1) flip charts; (2) Healthy Family Action Plan; and (3) smoking cessation resource information (only used in the tobacco arm). LHWs used flip charts, made with self-standing laminated cardboard, to deliver the educational sessions.…”

“…[39][40][41] Preliminary evidence has also supported promising efficacy of the use of LHW outreach involving both smokers and their family members in promoting smoking cessation. 42 Lay health workers have also been used within community interventions for recruitment and social support. A qualitative study exploring the qualities of effective lay health workers found that being responsive, nonjudgmental, approachable, having experiential knowledge, and cultural understanding were essential in successfully connecting with the community of interest.…”

“…Furthermore, lay health worker interventions have shown to be effective in increasing breast, cervical, and colorectal cancer screening in Vietnamese Americans 39–41. Preliminary evidence has also supported promising efficacy of the use of LHW outreach involving both smokers and their family members in promoting smoking cessation 42. Lay health workers have also been used within community interventions for recruitment and social support.…”