Abstract A25: Evaluating the process of implementing and disseminating a lay health-delivered prevention program in faith-based settings to address health disparities
Authors: Gibson Andrea S. , Brandt Heather M. , Revels Asa , Davis Lisa , Peay Camille , Talley Jacqueline , Wineglass Cassandra , Drayton Ruby F. , Hebert James R. 
Published: May 2016

Background: Social and behavioral determinants contribute to health disparities among African-Americans (AAs). Cancer disparities among AAs in the Southeastern United States are some of the most extreme in the United States. Community-based participatory research (CBPR) is a useful approach to reduce health disparities by actively involving members of AA churches as equal partners with different expertise to establish and deliver prevention programs. Such programs often use lay health educators from the target population with varied levels of knowledge and skills to implement prevention programs. Lay health educations must be trained appropriately for high quality implementation to ensure successful dissemination as well as the sustainability of cancer prevention programs. The purpose was to evaluate the process of involving lay health educators to deliver prevention programs to address health disparities.

Methods: Using CBPR, the main goal of Dissemination and Implementation of a Diet and Activity Community Trial In Churches (DIDACTIC) is to implement an evidence-based diet and physical activity intervention called Healthy Eating and Active Living in the Spirit (HEALS), which consists of 12 weekly sessions and nine monthly booster sessions over a one-year period. The dissemination and implementation phase follows a randomized controlled trial (RCT)of HEALS from August 2008-December 2014. During the RCT phase, 54 lay health educators – church education team (CET) – were trained by the intervention coordinator to deliver HEALS in 21 AA churches in South Carolina to 438 participants. For DIDACTIC, based on lessons learned during the RCT phase, a mentoring approach to training CETs was implemented to increase capacity for future replication and to maximize sustainability. Mentors were identified from CETs during the RCT phase to assist in training and supporting implementation during DIDACTIC. In November 2014, a systematic training process began for 10 mentors who then trained 38 CETs from 11 AA churches to disseminate the HEALS program to 400 participants. Mentors and CETs complete pre- and post-test evaluations during training and two follow-up assessments 12 weeks following the weekly intervention sessions and at one year at the end of the intervention. In addition, mentors and CETs complete weekly reflection forms to assess the implementation process. Mentors observe CETs to evaluate implementation.

Results: An iterative process of reviewing training evaluation data is used to make improvements. Baseline evaluation data show that after training, mentors and CETs feel knowledgeable to oversee and facilitate the HEALS program. Mentors provide regular feedback on the effectiveness of CET facilitation through observations of intervention sessions. CETs provide weekly feedback on how the intervention is being received by participants based on how they have been trained to carry out the program. In combination, evaluation efforts are providing timely, important feedback on opportunities for real-time improvement for dissemination and implementation. Involving members of the target population as implementers has been important to the intervention delivery process as well as efforts to address health disparities.

Conclusion: The process of training lay health educators allows prevention programs to be culturally- and contextually-appropriate in the AA church. So far, we have seen much enthusiasm from CETs from our first three waves of DIDACTIC to be mentors for future waves, thus establishing a pipeline for sustainability by increasing individual capacity and agency to deliver prevention programs. We therefore anticipate high potential for replication among other churches in the state. It is our long term goal to use the results to improve the training of mentors and CETs in order to optimize outcomes of cancer prevention programs and their sustainability to address health disparities.

Citation Format: Andrea S. Gibson, Heather M. Brandt, Asa Revels, Lisa Davis, Camille Peay, Jacqueline Talley, Cassandra Wineglass, Ruby F. Drayton, James R. Hebert. Evaluating the process of implementing and disseminating a lay health-delivered prevention program in faith-based settings to address health disparities. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A25.