Health Promotion Practice recent issues

Health Promotion Practice: From Vision to Successful Journal

Schwartz, R. — Tue, 06 Oct 2009 10:58:02 PDT

Health Promotion Practice Begins a New Chapter

Auld, M. E., Meier, K. — Tue, 06 Oct 2009 10:58:02 PDT

Book and Media Review: A Practical Guide to Program Evaluation Planning: Holden, D. J., & Zimmerman, M. A. (Eds.). (2009). A Practical Guide to Program Evaluation Planning. Los Angeles: Sage. 170 pages. ISBN 978-1-4129-6775-4

Olson, S. J. — Tue, 06 Oct 2009 10:58:02 PDT

For practitioners of health education and managers of health promotion programs, evaluation is consistently described as a challenge. Staff members often express the need for more expertise and guidance in evaluation. The newly published A Practical Guide to Program Evaluation Planning, edited by Debra J. Holden and Marc A. Zimmerman, is a compact and easily understood resource that promises to be of great value, especially to health promotion practitioners and students.

50+ Ways to Leave 'em Learnin': Tried and True Training Techniques

Denard Goldman, K., Schmalz, K. J. — Tue, 06 Oct 2009 10:58:02 PDT

Advocacy Evaluation: What It Is and Where to Find Out More About It

Fagen, M. C., Reed, E., Kaye, J. W., Jack, L. — Tue, 06 Oct 2009 10:58:02 PDT

Advocacy and policy change have become increasingly important strategies in health promotion efforts. As a result, advocacy evaluation is emerging as a necessary competency for health promotion practitioners. This article introduces the growing field of advocacy evaluation by describing its typical features, which include using prospective evaluation designs, emphasizing real-time data collection and use, monitoring and responding to changing environmental conditions, and assessing both individual and organizational capacity building. A number of freely available resources for learning more about advocacy evaluation’s key concepts and methods are highlighted.

Beyond the Cathedral: Building Trust to Engage the African American Community in Health Promotion and Disease Prevention

Tue, 06 Oct 2009 10:58:02 PDT

Effective efforts to eliminate health disparities must be grounded in strong community partnerships and trusting relationships between academic institutions and minority communities. However, there are often barriers to such efforts, including the frequent need to rely on time-limited funding mechanisms that take categorical approaches. This article provides an overview of health promotion and disease prevention projects implemented through the Community Outreach and Information Dissemination Core (COID) of the Center for Minority Health, within the Graduate School of Public Health at the University of Pittsburgh. The COID is one of five Cores that comprised the University of Pittsburgh’s NIH Excellence in Partnerships for Community Outreach, and Research on Disparities in Health and Training (EXPORT Health) funded from 2002 to 2007 by the National Center on Minority Health and Health Disparities. Based in large part on the success of the community engagement activities, in 2007, the National Center on Minority Health and Health Disparities, National Institutes of Health, designated the CMH as a Research Center of Excellence on Minority Health Disparities. COID major initiatives included the Community Research Advisory Board, Health Disparity Working Groups, Health Advocates in Reach, Healthy Class of 2010, and the Healthy Black Family Project. Lessons learned may provide guidance to other academic institutions, community-based organizations, and health departments who seek to engage minority communities in changing social norms to support health promotion and disease prevention.

Associate Editor's Foreword

Lancaster, B., Roe, K. — Tue, 06 Oct 2009 10:58:02 PDT

Integrating Cell Phones and Mobile Technologies Into Public Health Practice: A Social Marketing Perspective

Lefebvre, C. — Tue, 06 Oct 2009 10:58:02 PDT

Mobile communications are being used for many purposes, from instant messaging (IM), mobile or microblogging (Twitter), social networking sites (Facebook, MySpace), e-mail to basic voicemail. A brief background on cell phone and mobile technology use in public health is reviewed. The focus of the article is framing the use of mobile technologies in public health from a social marketer’s perspective—using the 4 Ps marketing mix as a guide.

Marketing Health Educators to Employers: Survey Findings, Interpretations, and Considerations for the Profession

Tue, 06 Oct 2009 10:58:02 PDT

In July 2007, a market research report was produced by Hezel Associates on behalf of five sponsoring health education profession member organizations and the National Commission for Health Education Credentialing. The purpose of the survey was to learn about current or potential employers’ knowledge, attitudes, and behaviors toward health educators and the health education profession and their future hiring practices. This article presents the background leading up to the production of this report, the major findings of the survey of employers, recommendations from the market research group regarding core messages, and implications for the profession having discovered for the first time information about employers’ understanding of professionally prepared health educators. The article discusses the umbrella and key messages that may be incorporated into a marketing plan and other recommendations by the firm that should assist health educators in marketing the profession. Furthermore, this article presents reactions by leaders in this field to these messages and recommendations and concludes with next steps in this project and a call for the overall need to market the profession of health education.

Settings for Health Promotion: An Analytic Framework to Guide Intervention Design and Implementation

Poland, B., Krupa, G., McCall, D. — Tue, 06 Oct 2009 10:58:02 PDT

Taking a settings approach to health promotion means addressing the contexts within which people live, work, and play and making these the object of inquiry and intervention as well as the needs and capacities of people to be found in different settings. This approach can increase the likelihood of success because it offers opportunities to situate practice in its context. Members of the setting can optimize interventions for specific contextual contingencies, target crucial factors in the organizational context influencing behavior, and render settings themselves more health promoting. A number of attempts have been made to systematize evidence regarding the effectiveness of interventions in different types of settings (e.g., school-based health promotion, community development). Few, if any, attempts have been made to systematically develop a template or framework for analyzing those features of settings that should influence intervention design and delivery. This article lays out the core elements of such a framework in the form of a nested series of questions to guide analysis. Furthermore, it offers advice on additional considerations that should be taken into account when operationalizing a settings approach in the field.

Implementation of Universal Screening for Domestic Violence in an Urgent Care Community Health Center

Tue, 06 Oct 2009 10:58:02 PDT

Given the morbidity and mortality associated with domestic violence (DV), there is international recognition that the health sector has a responsibility to prevent violence. In North America, the health sector has commonly responded by developing protocols for identifying victims of abuse. This utilization-focused evaluation describes the process involved in the implementation of a universal DV screening protocol undertaken by nurses in the urgent care clinic of a community health center. Dealing with the challenges of the urgent care setting, the strong and supportive urgent care team approach helped integrate the screening procedure into routine nursing practice. Understanding the purpose of asking about DV, quickly recognizing problems, validating staff concerns, and adapting procedures resulted in a strong commitment to implementation. This research has implications for others looking to implement or evaluate screening protocols in other health care settings.

A Case Study in Teaching Tobacco Policy Advocacy at a Historically Black University

Jolly, D. H., Wigfall, P. M., Scott, S. A., Richardson, R. C., Ray, K. — Tue, 06 Oct 2009 10:58:02 PDT

Policy advocacy is increasingly recognized as a crucial component of the training provided to health educators but relatively few universities offer advocacy training as part of their professional preparation programs for health educators. Historically Black colleges and universities (HBCUs) represent a natural setting for creating strong Black leaders in tobacco policy advocacy. This case study focuses on experiential education at an HBCU to develop advocacy skills around tobacco issues among Black college students. The authors describe the structure and content of two tobacco policy courses, their efforts to evaluate these courses, and the lessons they learned planning and conducting them. They believe their experience can prove useful to others developing curricula for teaching policy advocacy skills to health education students.

Designing the Process Evaluation for the Collaborative Planning of a Local Turning Point Partnership

Tolma, E. L., Cheney, M. K., Troup, P., Hann, N. — Tue, 06 Oct 2009 10:58:02 PDT

This study describes the design of the process evaluation of a collaborative effort among community partners to address health issues in central Oklahoma. The design is an application of a sound process evaluation planning framework that integrates the components of context, reach, dose delivered, dose received, fidelity, implementation, recruitment, barriers, and maintenance. The planning framework also provides guidance regarding the steps of designing and implementing the process evaluation. This planning process was conducted by utilizing a participatory research approach. At the end of the planning phase, the evaluation team accomplished the following: (a) development of an evaluation plan, (b) development of evaluation instruments (i.e., surveys, interview guides, observation forms), and (c) development of evaluation questions and process objectives. The information derived from this study can be valuable to practitioners and researchers involved in the planning of community partnerships or coalitions and interested in process evaluation that takes place in community settings.

Targeting School Tobacco Policy: Lessons From the Acadiana Coalition of Teens Against Tobacco (ACTT)

Boris, N. W., Johnson, C. C., Huang, S., Myers, L., Andrew, K., Webber, L. S. — Tue, 06 Oct 2009 10:58:02 PDT

This case study examines the comparative effect of no-use school tobacco policies and restricted-use tobacco policies on teacher and student smoking behaviors and attitudes. Data from teachers (n = 1,041) and ninth-grade students (n = 4,763) at 20 schools in five districts in southern Louisiana were available. No significant difference was observed between teacher smoking (11% vs. 13%, p = .42) or student smoking (24.6% vs. 25.2%, p = .75) at no-use versus restricted-use policy schools. The proportion of teachers smoking on campus at no-use or restricted-use schools was not significantly different. Teachers at restricted-use schools were however less concerned about students seeing teachers smoke and less supportive of a no-use policy than teachers at no-use schools. Tobacco use policies are often not promoted, and enforcement of policies impacting teachers is complex. Changing social norms for smoking at high schools through policy promotion and enforcement is understudied.

Integrating Adult Learning Principles Into Training for Public Health Practice

Bryan, R. L., Kreuter, M. W., Brownson, R. C. — Tue, 06 Oct 2009 10:58:02 PDT

Providing training and planned learning experiences to practitioners and community partners is fundamental to effective public health. The extent to which principles of adult learning currently guide such training is unknown and likely varies widely. The purpose of this article is to introduce five principles of adult learning and discuss how each can be applied in assessing trainee needs, planning and delivering training, and evaluating training processes and outcomes. Training guided by these principles should facilitate adult learning, collaborative efforts, and mutual respect between agencies, practitioners, and community partners.

Design Elements for the Development of Cancer Education Print Materials for a Latina/o Audience

Buki, L. P., Salazar, S. I., Pitton, V. O. — Tue, 06 Oct 2009 10:58:02 PDT

Health educators can help reduce cancer disparities in Latino populations through the creation of effective print materials. In this effort, the National Cancer Institute conducted a comprehensive needs assessment to identify key design elements of cancer education programs and create a cost-effective process that would ensure consistency in the development of materials. This article introduces the Checklist of Design Elements for the Development of Cancer Education Print Materials for Latina/o Audiences (CEMLA), which includes a total of 10 design elements related to the process of developing materials and content. Using social learning theory as a theoretical framework, design elements are included that reflect cultural sensitivity at the surface and deep structure levels. This is the most comprehensive effort to date to integrate and synthesize theory and application in the design of materials for this audience.

Preparing for Pandemic Influenza: California Confronts the Legal Implications

Macario, E., Heyden, L., Nakahara, N., Macias-Reynolds, V. — Tue, 06 Oct 2009 10:58:02 PDT

California Department of Health Services and California Distance Learning Health Network collaborated with the California Conference of Local Health Officers to produce the Pandemic Influenza and Public Health Law: What Public Health Departments Need to Know satellite broadcast and tabletop exercise training. Local health officers, county counsels, school superintendents, hospital administrators, and senior decision makers in California planned for ways stakeholders would make legal use of public health law in case of pandemic emergency. The training provided an opportunity for decision makers to become familiar with statutes and regulations in anticipation of such an event. Finding a legal balance between the need to mandate legal orders for the protection of the common good and the degree of infringement on individual rights was the thematic thread for the training. Although California specific, the instructional modalities and lessons learned from this training program serve as a guide for state and local governments.

Assessment of Training Needs and Preferences for Geographic Information Systems (GIS) Mapping in State Comprehensive Cancer-Control Programs

Hopfer, S., Chadwick, A. E., Parrott, R. L., Ghetian, C. B., Lengerich, E. J. — Tue, 06 Oct 2009 10:58:02 PDT

Geographic information systems (GIS) mapping technologies have potential to advance public health promotion by mapping regional differences in attributes (e.g., disease burden, environmental exposures, access to health care services) to suggest priorities for public health interventions. Training in GIS for comprehensive cancer control (CCC) has been overlooked. State CCC programs’ GIS training needs were assessed by interviewing 49 state CCC directors. A majority perceived a need for GIS training, slightly more than half of state CCC programs had access to geocoded data, and the majority of programs did not require continuing education credits of their staff. CCC directors perceived judging maps and realizing their limitations as important skills and identified epidemiologists, CCC staff, public health officials, policy makers, and cancer coalition members as training audiences. They preferred in-class training sessions that last a few hours to a day. Lessons learned are shared to develop training programs with translatable GIS skills for CCC.

Partnering With Libraries to Promote Walking Among Community-Dwelling Adults: A Kingston Gets Active Pilot Pedometer-Lending Project

Ryder, H. H., Faloon, K. J., Levesque, L., McDonald, D. — Tue, 06 Oct 2009 10:58:02 PDT

Most adults do not walk enough to obtain health benefits. Pedometers have been successfully utilized to motivate and increase walking. Given that libraries are a place where community members seek health resources, they are a logical setting for increasing community accessibility to pedometers. The purpose was to examine the feasibility of lending pedometers to library patrons to increase walking. In five Canadian public libraries, 90 pedometers were made available for 6 months. A total of 41 library patrons (33 women, 8 men, age range 18 to 65 or older) completed a survey about their walking patterns and pedometer use. More than 330 loans were made. Chisquare analysis found significant associations between walking and motivation to walk more (p < .05), walking and goal setting (p < .05), and motivation to walk more and setting a walking goal (p < .001). Results provide preliminary evidence that lending pedometers through local libraries is an effective, low-cost approach to enhance walking in community members.

Comparing the Efficacy of Permanent Classroom Teachers to Temporary Health Educators for Pregnancy and HIV Prevention Instruction

Anderman, E. M., Lane, D. R., Zimmerman, R., Cupp, P. K., Phebus, V. — Tue, 06 Oct 2009 10:58:02 PDT

Ninth grade health education classrooms were randomly assigned to conditions in which a 14-lesson unit on HIV and pregnancy prevention was provided either by the permanent classroom teacher or by a temporary health educator. Student data were collected prior to the lessons and approximately 3 weeks after the completion of the unit. Results indicate that students who learned the unit from the classroom teacher reported that that the instructor was more likeable and credible and that the classrooms were more motivational. Sexually active adolescents with regular classroom teachers reported greater increases in frequency of class discussion.

Implementing Safe Routes to School: Application for the Socioecological Model and Issues to Consider

Levin Martin, S., Moeti, R., Pullen-Seufert, N. — Tue, 06 Oct 2009 10:58:02 PDT

The newly established national Safe Routes to School (SRTS) program has the potential to positively influence individuals, communities, and the environment regardless of race, ethnicity, or socioeconomic status. Many communities are applying their interest in physical activity promotion toward creating policies and programs to encourage active travel, though many barriers exist. SRTS legislation provides funds to address some of the barriers and improve the ability of students to safely walk and bicycle to school. SRTS requires that 70% to 90% of the funds be used for infrastructure projects (i.e., engineering treatments, such as sidewalk construction), and 10% to 30% for noninfrastructure activities, such as education, encouragement, and enforcement. The socioecological model (SEM) is widely used in public health and includes five levels of influence on behavior, from individual to public policy. Application of the SEM to SRTS provides a framework for a comprehensive approach to improve active travel to school.

Book and Media Review: Community-Based Participatory Research for Health: From Process to Outcomes: Minkler, M., & Wallerstein, N. (Eds.). (2008). Community-Based Participatory Research for Health: From Process to Outcomes (2nd ed.). San Francisco: Jossey-Bass. 508 pages. ISBN: 978-0-4702-6043-2

Spector, A. Y. — Thu, 02 Jul 2009 14:51:44 PDT

Ovation-Worthy Orations: Enlightened Lecturing Techniques

Drummond, T. — Thu, 02 Jul 2009 14:51:44 PDT

Guerilla Advocacy: Using Aggressive Marketing Techniques for Health Policy Change

Galer-Unti, R. A. — Thu, 02 Jul 2009 14:51:44 PDT

Ethics and Patient Education: Health Literacy and Cultural Dilemmas

Marks, R. — Thu, 02 Jul 2009 14:51:44 PDT

This article discusses health literacy and cultural factors that have implications for the ethical practice of health education. It specifically focuses on recent data that speaks to the challenges in carrying out patient education from the perspective of comprehension and equitable distribution of health-related information across diverse cultures and communities. It discusses strategies for reducing the negative impact of low health literacy among diverse groups and the importance of acknowledging this pervasive problem in the context of ensuring equity in the optimal delivery of health promotion messages.

Entrepreneurship in Health Education and Health Promotion: Five Cardinal Rules

Eddy, J. M., Stellefson, M. L. — Thu, 02 Jul 2009 14:51:44 PDT

The nature of health education and health promotion (HE/HP) offers a fertile ground for entrepreneurial activity. As primary prevention of chronic diseases becomes a more central component of the health and/ or medical care continuum, entrepreneurial opportunities for health educators will continue to expand. The process used to design, implement, and evaluate health promotion and disease prevention has clear articulation with entrepreneurial, marketing management, and other business processes. Thus, entrepreneurs in HE/HP must be able to utilize business process to facilitate creative, new HE/HP business ideas. The purpose of this article is to weave theory and practical application into a primer on entrepreneurial applications in HE/HP. More specifically, the authors meld their prospective experiences and expertise to provide background thoughts on entrepreneurship in HE/HP and develop a framework for establishing an entrepreneurial venture in HE/HP. Five Cardinal Rules for Entrepreneurs in HE/HP are proposed.

Associate Editors' Foreword

Thu, 02 Jul 2009 14:51:44 PDT

A career in health education or health promotion (HE/HP) can be developed in many ways. In past editions of this department, career development has been discussed in relation to distance (Balonna, 2001), consulting (Bookbinder, 2001), certifications (Hayden, 2005), graduate school (Cottrell & Hayden, 2007), and many other topics. This article looks at a less traditional means of career development—entrepreneurship. Health education is a field ripe with opportunities for consulting and for selling health-related products and services. Entrepreneurship can not only create financial rewards but can also provide high visibility and networking contacts that can advance one’s career. This article combines both theory and practical applications to assist readers in developing entrepreneurial activities. The authors are experienced in entrepreneurial development and use that expertise to provide relevant examples and develop a framework using "five cardinal rules" for establishing an entrepreneurial enterprise in HE/HP.

Examining the Role of Training in Evidence-Based Public Health: A Qualitative Study

Thu, 02 Jul 2009 14:51:44 PDT

The use of evidence-based public health (EBPH) approaches is generally recognized as essential to changing public health outcomes. However, using an EBPH decision-making process requires public health practitioners to have the skills to review the evidence and pick the most workable strategy to address the problem at hand for their population of interest and the local context. Although there has been a growing body of academic literature examining the skills needed to translate evidence-based programs in local settings, many public health practitioners have not had the opportunity to learn or develop these skills. This article reports on qualitative interviews conducted to evaluate the process and impact of an EBPH course. The course has been found to assist participants in integrating new and existing skills to make evidence-based decisions. However, participants emphasize that factors external to the course influence their ability to engage in the EBPH process they learned.

Using a Cultural Framework to Assess the Nutrition Influences in Relation to Birth Outcomes Among African American Women of Childbearing Age: Application of the PEN-3 Theoretical Model

Thu, 02 Jul 2009 14:51:44 PDT

The purpose is to present the process and results of focus groups conducted to access information for the design of a healthy eating curriculum to reduce maternal nutritional risks and enhance protective factors among African American women in relation to birth outcomes. Sixteen younger (19 to 25 years) and 20 older African American women (45 to 60 years), respectively, participated. The PEN-3 model, (Airhihenbuwa, 1995, 1999) guided the focus groups. Most women stated that culture and family relationships impacted their food choices. Younger women expressed creativity with recipes and presented a desire to be more involved with preparing foods. Older women expressed eagerness to teach family-centered culinary skill-building classes. Both groups of women acknowledged time and budget barriers, identified the prevalence of lactose intolerance, and recognized that large grocery stores that offered food variety were not located in their community. Health professionals are encouraged to consider these findings while designing interventions targeting young African American women's nutrition in relation to birth outcomes.

Conducting Effective Tailgate Trainings

Harrington, D., Materna, B., Vannoy, J., Scholz, P. — Thu, 02 Jul 2009 14:51:45 PDT

The California Department of Health Services' Occupational Health Branch and others have identified the construction industry as being at high risk for injuries, illnesses, and fatalities. Effective tailgate trainings (brief job site safety meetings) can be a powerful tool to promote hazard awareness and safe work practices. The authors found that many contractors and supervisors conducted ineffective tailgate trainings. They developed the BuildSafe California Project to assist contractors to have more effective programs by holding 25 training-of-trainers sessions reaching 1,525 participants. The needs assessment, intervention, and evaluation results from the first 18 trainings are presented. Eighty-six percent of the participants found the program "very helpful." Participants used the materials and made improvements in the quality and frequency of trainings. Supervisors must be skilled at conducting tailgate trainings as part of their responsibilities. There is a serious need to provide more culturally appropriate safety training in a workforce increasingly made up of Latino workers.

Lessons Learned From Evaluating Maryland's Anti-Drunk Driving Campaign: Assessing the Evidence for Cognitive, Behavioral, and Public Health Impact

Beck, K. H. — Thu, 02 Jul 2009 14:51:45 PDT

The evidence concerning Maryland's anti-drunk driving program, Checkpoint Strikeforce, is reviewed. To date, there is no evidence to indicate that this campaign, which involves a number of sobriety checkpoints and media activities to promote these efforts, has had any impact on public perceptions, driver behaviors, or alcohol-related motor vehicle crashes and injuries. This conclusion is drawn after examining statistics for alcohol-related crashes, police citations for impaired driving, and public perceptions of alcohol-impaired driving risk. Comparisons are also made with other states in the mid-Atlantic region, where similar campaign activities have occurred. Reasons for this failure in Maryland include insufficient levels of enforcement (e.g., too few sobriety checkpoints and vehicle contacts occurred to raise public perceptions of risk pertaining to impaired driving) and inadequate publicity surrounding this campaign. Suggestions for overcoming these problems are offered.

Process and Impact Evaluation of a Legal Assistance and Health Care Community Partnership

Teufel, J. A., Brown, S. L., Thorne, W., Goffinet, D. M., Clemons, L. — Thu, 02 Jul 2009 14:51:45 PDT

Community health partnerships have increased in popularity, but their effectiveness is often not evaluated. Through secondary data analysis, this study evaluates a program that offered access to legal services to address health-related issues, such as Medicaid reimbursement, Social Security benefits, medication coverage, and divorce. Based on the analysis reimbursements to expenditures, the health and law program appears to be cost-effective and thereby economically sustainable. The cost-effectiveness of this program increases the likelihood that it will be institutionalized and/or expanded. This program evaluation is used to exemplify how community stakeholders could partner to leverage resources to establish a sustainable community health and law program to address the needs of people living in medically underserved areas.

Assessing the Scientific Accuracy, Readability, and Cultural Appropriateness of a Culturally Targeted Smoking Cessation Program for American Indians

Makosky Daley, C., Cowan, P., Nollen, N. L., Greiner, K. A., Choi, W. S. — Thu, 02 Jul 2009 14:51:45 PDT

This study assesses educational materials developed for the All Nations Breath of Life smoking cessation program (targeted for American Indians and Alaska Natives) for scientific accuracy, readability and other literacy factors, and cultural appropriateness. The authors used a scientific review panel of experts in smoking cessation representing epidemiology, medicine, and psychology; the suitability assessment of materials (SAM) and the simplified measure of gobbledygook (SMOG) reading grade level formulas; and review by Native program facilitators and pilot participants. Materials were scientifically accurate and culturally appropriate. The mean SAM score was 80% (superior rating), and the average reading grade level was 7.1 using the Fry formula (part of the SAM) and 8.4 using the SMOG formula (difference was not statistically significant). Based on this project, the SAM can be used in combination with scientific review and input from community members during formative research to assess and modify educational materials for a targeted population.

Process Evaluation of a School-Based Intervention to Increase Physical Activity and Reduce Bullying

Bowes, D., Marquis, M., Young, W., Holowaty, P., Isaac, W. — Thu, 02 Jul 2009 14:51:45 PDT

Increases in schoolyard bullying and physical inactivity have become important issues to many stakeholders. Peers Running Organized Play Stations (PROPS) is a program designed to address these two issues in elementary schools. Using a "train the trainer" approach, PROPS was introduced to 41 schools. Results of a process evaluation indicate that the implementation rate was 39%. Resources were identified by some respondents as an implementation facilitator. A variety of barriers to implementation were identified: The PROPS program was not a component of anyone's job at the school level, teachers or parent volunteers are needed to run the program, and there is no funding to purchase equipment or storage bins for the equipment. In addition, support for PROPS is vulnerable to changing environments. This process evaluation points to some needed changes for long-term sustainability of the program while highlighting challenges associated with implementing a program in the elementary school setting.

Evaluation of the Walkable Neighborhoods for Seniors Project in Sacramento County

Hooker, S. P., Cirill, L. A., Geraghty, A. — Thu, 02 Jul 2009 14:51:45 PDT

The Walkable Neighborhoods for Seniors project was implemented to foster the creation and promotion of safe and accessible neighborhood walking routes for seniors. This article describes a case study of the efforts put forth by a local task force jointly managed by the Sacramento County Department of Health Services and WALK Sacramento. To facilitate environmental and policy changes that would enable and encourage walking by older adults, these local lead agencies implemented several strategies including organizing a community task force with broad professional and civic representation, conducting environmental audits of selected walking routes, creating walking groups, and advocating for environmental and policy change. Evaluation processes yield information on successes, challenges, and lessons learned that could be applied to similar efforts undertaken by community organizations to improve the walkability of neighborhoods for older adults.

Factors Influencing Booster Seat Use in a Multiethnic Community: Lessons for Program Implementation

Thu, 02 Jul 2009 14:51:45 PDT

Based on the local incidence and severity of motor vehicle occupant injuries, the authors' community and hospital injury prevention partnership identified child passenger safety for 4-to-8-year-old children as a priority. They designed a booster seat promotion campaign using an integrated social cognition model of health behavior. A series of focus groups were held with low-income African American, Somali, and Vietnamese parents to understand determinants of booster seat use in these communities. Deficits in understanding about the purpose of booster seats were seen in all groups, and concerns about cost and self-efficacy varied in important ways. Although legislation is an important tool in motivating child passenger restraint, most families saw safety as the prime reason to use booster seats with their children. These results illustrate the use of qualitative data to adapt a theory-based intervention to the needs of specific communities.

The Use of Photovoice as a Method of Facilitating Deliberation

Downey, L. H., Ireson, C. L., Scutchfield, F. D. — Thu, 02 Jul 2009 14:51:45 PDT

Efforts have been made in one rural Appalachian county to broaden local participation in a community health assessment. Through a series of community forums and a photovoice project, residents named community health needs and assets, framed potential solutions, and selected possible action steps to improve the local health status. Photographs and narratives from the photovoice project supplemented information from preliminary health forums to devise a framework of possible solutions to the identified health problems. Analysis of forum transcripts suggests that participants who used an issue guide that used photovoice images and stories were able to transition from broad approaches of change to specific action steps more than participants in other forums who used a more traditional forum issue guide. Community members are more easily able to identify solutions to local health issues when forum discussions are informed by local images and narratives.

Public Health Educators' Participation in Teams: Implications for Preparation and Practice

Thu, 02 Jul 2009 14:51:45 PDT

Collaboration among public health organizations is essential to ensuring the health of the public. Much of the day-to-day work of public health educators is done in groups or teams or in consultation with others. This study examined the extent of health educators' work in teams as a proxy for collaboration. Health educators participated in an average of four teams per individual; three of these were interorganizational teams. Moreover, 40% of the respondents participated in five or more teams. Health educators supervised by other health educators were more likely to work in interorganizational teams than were those supervised by other professionals. Certified Health Education Specialists were more likely to participate in intraorganizational teams. Curricula in academic programs should reflect the extensive teamwork in which health educators are involved. Employers need to provide health educators with grounding in organizational priorities and support to carry out their collaborative work.

Indigenous Knowledge Translation: Baseline Findings in a Qualitative Study of the Pathways of Health Knowledge in Three Indigenous Communities in Canada

Thu, 02 Jul 2009 14:51:45 PDT

To acquire an understanding of the pathways of health information dissemination and use by Indigenous community members, the researchers applied an Indigenous participatory action research approach in partnership with one urban Inuit, one urban Métis, and one semirural First Nations community in Ontario, Canada. A descriptive community case study was conducted in each community through the use of focus groups, key informant interviews, and document inquiry. Results were corroborated by the communities. Each of the three community consultations generated distinct and striking data about health information sources and dissemination strategies; decision-making processes; locally relevant concepts of health, local health services, and programs; community structures; and mechanisms of interface with noncommunity systems. In addition, several crosscutting themes were identified. The participatory research approach successfully engaged community partners. These findings support the hypothesis that understanding local Indigenous processes of knowledge creation, dissemination, and utilization is a necessary prerequisite to effective knowledge translation in Indigenous contexts.

Reducing Farmworker Residential Pesticide Exposure: Evaluation of a Lay Health Advisor Intervention

Arcury, T. A., Marin, A., Snively, B. M., Hernandez-Pelletier, M., Quandt, S. A. — Thu, 02 Jul 2009 14:51:45 PDT

The goal of this analysis is to evaluate the effectiveness of a promotora program for teaching women in Latino farmworker families about pesticide safety and increasing pesticide safety behaviors. Volunteer promotoras delivered a pesticide safety curriculum (intervention) and nutrition curriculum (control) to farmworker women residing in western North Carolina and Virginia. Pre-and postintervention interviews assessed differences in delivery of the intervention, recognition of the intervention, pesticide knowledge, pesticide exposures behaviors, and integrated pest management behaviors. Participants in the intervention group reported significantly more receipt of pesticide education and greater recognition of the key messages. However, their knowledge, pesticide exposure behaviors, and integrated pest management behaviors did not change. A more structured program is needed to be sure that the dose of interventions is large enough to overcome educational and cultural characteristics of immigrant communities. Policy changes are needed to address circumstances outside of farmworkers' control that affect pesticide exposure.

Erratum

Thu, 02 Jul 2009 14:51:45 PDT

Prevention Works

Butterfoss, F. D., Cohen, L. — Tue, 19 May 2009 14:55:54 PDT

Cultivating Healthy Communities: The CDC Perspective

Giles, W. H., Holmes-Chavez, A., Collins, J. L. — Tue, 19 May 2009 14:55:54 PDT

Communities Taking Charge of Their Health

Marks, J. S. — Tue, 19 May 2009 14:55:54 PDT

Steps to a Healthier Salinas: Targeting the Taqueria: Implementing Healthy Food Options at Mexican American Restaurants

Hanni, K. D., Garcia, E., Ellemberg, C., Winkleby, M. — Tue, 19 May 2009 14:55:54 PDT

As part of a 5-year community-based intervention in Salinas, California, the Steps to a Healthier Salinas team developed a taqueria intervention addressing obesity and diabetes among Mexican Americans. The authors present: (a) a comparison of service/entrée options for Salinas taquerias (n = 35) and fast-food restaurants ( n = 38) at baseline, (b) a case study of one taqueria, (c) a description of a healthy nutrition tool kit tailored to taquerias, and (d) an evaluation of the intervention at Year 3. It was found that traditional Mexican American—style menu offerings at taquerias tended to be healthier than American-style fast-food restaurant offerings. In addition, the initial response to the intervention has shown positive changes, which include the taqueria owners promoting available healthy menu items and modifying other menu offerings to reduce fats and increase fruit and vegetable availability. This, in turn, has led to a transition of the owners' perceptions of themselves as gatekeepers for a healthy community.

Steps to a Healthier New York: Rock on Cafe: Achieving Sustainable Systems Changes in School Lunch Programs

Johnston, Y., Denniston, R., Morgan, M., Bordeau, M. — Tue, 19 May 2009 14:55:54 PDT

The rising rate of overweight poses a significant threat to the health of children. Because roughly one third of a child's dietary intake occurs during school hours and because both health and academic outcomes have been linked to children's nutrition, school nutrition policies and programs have been identified as a key area for intervention. This article describes the components, processes, and initial successes of a grassroots effort and innovative project to improve the nutritional quality of the School Lunch Program through a sustainable systems intervention and policy change across a regional area of upstate New York. The Rock on Cafe intervention was partially funded by the Steps to a Healthier New York program and promises to be a model for creating a school environment that supports healthy dietary behaviors among children.

Steps to a Healthier Anishinaabe, Michigan: Strategies for Implementing Health Promotion Programs in Multiple American Indian Communities

Tue, 19 May 2009 14:55:54 PDT

American Indians experience significant health disparities compared to the general U.S. population. The Steps to a Healthier Anishinaabe program adopted a unique framework to implement health promotion intervention activities in multiple American Indian communities in Michigan. By enabling each community to tailor interventions to their specific culture and health priorities, the program is characterized by a culturally competent and community-driven approach to decrease the impact of chronic diseases on the health of Michigan's American Indians. This article describes the community-based framework and argues that multisite, community-tailored health promotion programs are a promising approach to reducing health disparities in minority populations.

REACH 2010: Kansas City, Missouri: Evaluating Mobilization Strategies With Neighborhood and Faith Organizations to Reduce Risk for Health Disparities

Collie-Akers, V., Schultz, J. A., Carson, V., Fawcett, S. B., Ronan, M. — Tue, 19 May 2009 14:55:54 PDT

Health disparities, differences in health status, and mortality among different groups have challenged the public health commitment to health for all. African Americans and Latinos have historically experienced greater prevalence and mortality from many chronic diseases than Whites. Community mobilization is a promising approach to addressing health disparities. The Kansas City—Chronic Disease Coalition (KC-CDC), a REACH 2010 initiative, aimed to engage neighborhoods and faith organization in changing conditions to reduce risk for cardiovascular disease and diabetes. Using a time series design replicated with each of these two sectors, we examined the effects of a microgrant strategy and a resource distribution strategy on the coalition's facilitation of community change. Results indicate that both strategies increased the implementation of community change by neighborhood and faith organizations, with higher rates of change for the microgrant strategy. This study holds important implications for public health practitioners working with neighborhood and faith-based organizations to address health disparities.

REACH 2010: New York City: Effective Strategies for Integrating Immunization Promotion Into Community Programs

Tue, 19 May 2009 14:55:54 PDT

Most immunization coalitions have originated with health care providers, potentially excluding families without medical homes. This study focused on a community-based approach to providing timely vaccinations. A coalition of 23 organizations developed an immunization program in a low-income community in New York City. Nearly 1,000 community health workers incorporated immunization promotion into social service and educational programs. Outcomes were coverage rates for the 4:3:1:3:3 series at 19 to 35 months, which were compared with national data by ethnicity, as reported in the National Immunization Survey 2002-2006. Parents (n = 10,251) of children <5 years received immunization education and reminders. The 2003-2007 rates of 80% equaled or exceeded the national rates for 19- to 35-month-olds, and the 2007 rate of 96.8% far surpassed the national average. Coalitions can effectively integrate immunization promotion activities into community programs. Immunization rate improvements maintained for a 5-year period, suggesting this approach to be sustainable.

Steps to a Healthier Washington: From Making Pamphlets to Making Policies: Results From a Collaborative Training to Increase Knowledge, Motivation, and Self-Efficacy for Achieving Public Health Policy and Systems Change

Dilley, J. A., Reuer, J. R., Colman, V., Norman, R. K. — Tue, 19 May 2009 14:55:54 PDT

Steps to a Healthier Washington , in collaboration with other programs in the Washington State Department of Health and external partners, has implemented training to improve public health practice and create greater organizational and staff capacity for promoting effective policy and systems changes, including reducing disparities. The training is grounded in behavior change and adult learning theories. A comprehensive post training evaluation found long-term improvements in self-efficacy, reported changes in work, and attribution of those changes to the training. Organizations working to refocus public health work on policy and systems change should consider providing skills-based policy training to their staff. This study suggests that an integrated training, using adult learning theory, has led to long-term improvements in capacity among public health staff and partners.

Pioneering Healthier Communities, West Michigan: A Community Response to the Food Environment

Cyzman, D., Wierenga, J., Sielawa, J. — Tue, 19 May 2009 14:55:54 PDT

In 2005, the Pioneering Healthier Communities initiative prompted the creation of the Activate West Michigan coalition. One of its earliest objectives was to increase fruit and vegetable consumption for people who lived in low-income, African American, and Latino communities in urban Grand Rapids. Because the existing food environment created barriers to this objective, the coalition created community and schoolyard gardens and farmers' markets. By 2008, the Activate West Michigan coalition had begun to improve the food environment by establishing nine community and schoolyard gardens and five farmers' markets.

Steps to a Healthier Arizona: A Pebble in the Pond: The Ripple Effect of an Obesity Prevention Intervention Targeting the Child Care Environment

Tue, 19 May 2009 14:55:54 PDT

Through Steps to a Healthier Arizona, a unique partnership was developed to reach the culturally diverse, rural communities of Southern Arizona. This partnership included local, regional, and state agencies and coalitions focused on reducing the burden of chronic disease and health disparities. This article describes the success of a program aimed at preventing childhood obesity and diabetes. Partners in Yuma County worked with child care providers to implement organizational best practices which promote positive nutrition and physical activity behaviors in young children. As a result of this project, the number of child care centers in Yuma County implementing best practices increased. Additionally a ripple effect has reached beyond the individual child care setting, into broader local and state early childhood development systems. Taking place against the backdrop of state-wide initiatives in early childhood development and health, the Steps to a Healthier Arizona's NAP SACC program positioned stakeholders to integrate with these advances.

Book and Media Review: Unnatural Causes: Is Inequality Making Us Sick?

Olson, S. J. — Thu, 16 Apr 2009 10:09:41 PDT

Unnatural Causes: Is Inequality Making Us Sick? is a 7-part, 4-hour series produced by California Newsreel, in association with the five National Minority Consortia of public television. It looks at evidence that supports the concepts of health as involving more than just health care. It examines the social determinants that affect people's health and quality of life—the social circumstances in which we are born, live, and work—that profoundly affect well-being and longevity. The series is part of a larger "health equity" movement to reframe the national debate about health, focus attention on the underlying social and economic conditions, and determine what we can do to address health equity.

Program "Miracle Grow": Program Staff and Evaluators Joining Forces to Power-Up Program Potential

Lieberman, L. D. — Thu, 16 Apr 2009 10:09:41 PDT

A Multidirectional Communication Model: Implications for Social Marketing Practice

Thackeray, R., Neiger, B. L. — Thu, 16 Apr 2009 10:09:41 PDT

The landscape of sending and receiving information has changed dramatically in the past 25 years. The communication process is changing from being unidirectional to multidirectional as consumers are becoming active participants by creating, seeking, and sharing information using a variety of channels and devices. The purpose of this article is to describe how this shift in the communication process— where gatekeepers control the creation and content of information and consumers are less active recipients to one that reflects a multidirectional and more dynamic process with participative consumers—will affect the social marketing process. This shift in communication does not represent an option for social marketers so much as a necessity. As professionals respond to this evolving communication model, the practice of social marketing can remain vibrant as a relevant consumer-oriented approach to behavior change.

The Environmental Assessment Instrument: Harnessing the Environment for Programmatic Success

Lavinghouze, S. R., Price, A. W., Parsons, B. — Thu, 16 Apr 2009 10:09:41 PDT

This article describes the Environmental Assessment Instrument (EAI), a tool designed to help public health professionals analyze and then engage the environment in which programs operate. The prevailing environment is an important force that must be considered in an integrated systems approach when implementing programs and policies. The Division of Oral Health of the Centers for Disease Control and Prevention developed the EAI to facilitate the ability of a state oral health program to understand their environment and the impact it has on the achievement of performance objectives. EAI results are plotted on a four-quadrant grid that depicts four types of change—stagnant, disruptive, continuous, and sporadic. General strategies are suggested based on these categories of change. By assessing environmental influences, program and policy planners can determine salient leverage points within their environment, identify strategies to address barriers to success, and build on supportive features in the environment.

Digital Storytelling: An Emergent Method for Health Promotion Research and Practice

Gubrium, A. — Thu, 16 Apr 2009 10:09:41 PDT

Strengthening Quality Assurance in Health Education: Recent Milestones and Future Directions

Taub, A., Birch, D. A., Auld, M. E., Lysoby, L., Rasar King, L. — Thu, 16 Apr 2009 10:09:41 PDT

The health education profession has a lengthy history of efforts to assure the quality of health education professional preparation and practice. These initiatives to improve the value and accountability of health education are not only beneficial to current practitioners and faculty but also to consumers, students, employers, other professional colleagues, and numerous other stakeholders. This article describes the movement during the last decade to further strengthen quality assurance in health education, including current credentialing mechanisms for individuals and academic programs, the efforts of three national accreditation task forces, and the 2006 Third National Congress for Institutions Preparing Health Educators (Dallas II). Post—Dallas II activities related to program accreditation and approval and individual certification are presented as well as future directions for the health education workforce.

Michigan Genetics Plan: A Report on the Needs Assessment Process

Beene-Harris, R., Bach, J. V. — Thu, 16 Apr 2009 10:09:41 PDT

During 2000-02, Michigan Department of Community Health—Hereditary Disorders and Newborn Screening Programs conducted a needs assessment to develop a comprehensive state genetics plan. The goal was to define the priorities of patients and their families, the general public, health and human service providers, and educators for all four stages of the life cycle (prenatal, newborn, childhood, and adult). The needs assessment process was used to identify available resources in addition to the strengths, weaknesses, and gaps in the current genetic services system. A five-step needs assessment process was designed to collect both quantitative and qualitative data. In preparing for the advancements in genetic technology and related services, the results from this assessment are being used to help refocus existing program functions, delineate goals and objectives for the strategic plan, and guide future genetic services delivery and infrastructure efforts. A 5-year state genetics plan for Michigan was created with input from nearly 1,000 residents.

Pap Smear Screening Among Asian Pacific Islander Women in a Multisite Community-Based Cancer Screening Program

Fernandez, M. E., Lin, J., Leong-Wu, C., Aday, L. — Thu, 16 Apr 2009 10:09:41 PDT

This study assessed screening completion rates (SCR) and sociodemographic factors associated with Pap test screening among previously nonadherent, foreign-born Asian Pacific Islander (API) women across four sites participating in a community-based cancer screening program called ENCOREplus. At intake, 926 out of 1,140 women were nonadherent to recommended Pap test screening guidelines. Most participants were age 51 and older, had a high school education or higher, had been in the U.S. less than a decade, had annual household incomes less than $10,000, and were uninsured. Women with limited resources were more likely to get a Pap test after participating in ENCOREplus. Women from the Glendale site were almost 18 times more likely to get a Pap test than API women in other sites. Over half of the women in Glendale reported that help getting low cost Pap tests and having translators available were instrumental in completing screening.

A Primer on Quality Indicators of Distance Education

Thu, 16 Apr 2009 10:09:41 PDT

In the past decade, there has been an enormous growth of distance education courses and programs in higher education. The growth of distance education is particularly evident in the field of health education. However, the enormous potential of distance education is tempered by one overriding question: How does one ensure that distance education coursework and degrees are of high quality? To this end, the purpose of this study is twofold: to identify quality indicators of distance education and to provide implications of the identified quality indicators for health education researchers and practitioners. The results of the study reveal common benchmarks and quality indicators that all parties deem important in designing, implementing, and evaluating distance education courses and programs.

Using an Analytic Framework to Identify Potential Targets and Strategies for Ecologically Based Physical Activity Interventions in Middle Schools

Robertson-Wilson, J., Levesque, L., Richard, L. — Thu, 16 Apr 2009 10:09:41 PDT

The objective was to demonstrate the value of applying an ecological analytic framework to formative data in conjunction with ecological planning frameworks (e.g., intervention mapping) to ensure a high degree of ecological program integration as illustrated through a physical activity program for students in middle school. Eight focus groups were conducted with 38 students in four schools to examine student perceptions of who or what in their school made it easy or difficult for students to be physically active. Qualitative data were used to identify potential intervention targets according to the analytic framework. Frequency analysis revealed that most identified physical activity barriers/facilitators were associated with organization (59.4%) targets. Five different intervention strategies were identified, with organizational modification being most popular. Applying the analytic framework to formative data enabled us to identify potential targets, strategies, and activities for an ecologically based physical-activity-promotion program relevant to the priority population.

A Descriptive Analysis of Patient Education Courses in Undergraduate and Graduate Health Education Programs

Gail-Hinckley Heitzer, J., McKenzie, J. F., Amschler, D. H., Bock, W. — Thu, 16 Apr 2009 10:09:41 PDT

Patient education is a necessary component of quality health care, yet little attention has been given to the preparation of health educators to work in that setting. This study seeks to determine the status of and content in patient education courses offered in professional preparation programs. Results show that 9% of respondents offered a patient education course in their academic unit, whereas 18% indicated that such a course was offered in another unit on campus. It appears there is not agreement between university faculty members and practicing patient educators on what should be taught in such a course. In addition, no significant relationship is found between (a) programs with accreditation or approval and offering a patient education course and (b) programs that prepared students for the Certified Health Education Specialist examination and offering a patient education course. Recommendations are offered for improving the preparation of health educators for the medical care setting.

Integrating Research, Policy, and Practice in School-Based Physical Activity Prevention Programming: The School Health Action, Planning, and Evaluation System (SHAPES) Physical Activity Module

Leatherdale, S. T., Manske, S., Wong, S. L., Cameron, R. — Thu, 16 Apr 2009 10:09:41 PDT

The School Health Action, Planning, and Evaluation System (SHAPES) is a data collection and feedback system designed to support population-based intervention planning, evaluation, and field research related to youth. The Physical Activity Module of SHAPES consists of: (a) a machine readable questionnaire to collect physical activity data from all students (grades 6 to 12) in a school, (b) a school administrator questionnaire to assess school policies, programs, and resources related to physical activity, and (c) a school-specific feedback report documenting student behavior and school programs and policies. This SHAPES module provides schools with feedback that enables them to take stock of patterns of activity and obesity within their school, recognize what is (and what is not) in place to support physical activity, and how to plan and evaluate their own prevention efforts. SHAPES enables researchers and stakeholders to identify what interventions work, in what contexts, with what students.

The 6-Step Model for Community Empowerment: Revisited in Public Housing Communities for Low-Income Senior Citizens

Yoo, S., Butler, J., Elias, T. I., Goodman, R. M. — Thu, 16 Apr 2009 10:09:41 PDT

The 6-step community empowerment model was replicated in communities with different geographical, racial, and age backgrounds from the original application. Resident groups of Blue Ribbon Health Panels (BRHPs) in federally funded senior housing in Pennsylvania followed the 6 steps to identify community health issues, to develop strategies to address priority issues, and to implement the strategies in collaboration with partner agencies. The 6-step model served as an operationalization strategy of community empowerment by facilitating quick accomplishments of communities' desired outcomes, legitimizing and motivating BRHP efforts. Community capacities to actively participate and collaborate influenced the model's progress in this replication study, as did partner agencies' capacities to adhere to the community-based participatory and collaborative orientation of the project. Community capacity development and partnership facilitation would be important for a community empowerment project, as well as consistent and clear communication among everyone involved in the process.

Surveillance Recommendations for Developing Effective Tobacco Prevention and Control Interventions for Low-SES Populations

Louis, G. — Thu, 16 Apr 2009 10:09:41 PDT

On October 6 and 7, 2005, a diverse panel of experts was invited to Atlanta, Georgia by the Centers for Disease Control and Prevention, Office of Smoking and Health to discuss, explore, and share their ideas on how to identify and subsequently plan effective interventions with low socioeconomic status populations in regard to tobacco prevention and control. The invited participants had expertise in three areas: surveillance and evaluation, program planning, and health communications. This article summarizes the methods, processes, discussions, and recommendations that emerged from the surveillance and evaluation group. Current surveillance systems have had success at identifying high-risk populations, but usually at the national or state level. Interventions occur at the local level, and current data are woefully inadequate in providing direction as far as programming planning. It is recommended that an eight-step approach be used for surveillance and monitoring that includes qualitative data collection and participatory planning models.

Integrating a School-Based Health Intervention in Times of High-Stakes Testing: Lessons Learned From Full Court Press

Eisenberg, M. — Thu, 16 Apr 2009 10:09:41 PDT

Because of the growing focus on the production of favorable academic standardized test scores, schools have become increasingly resistant to sponsoring nonacademic programming, such as tobacco cessation services for students. Nevertheless, the need for such programs has not diminished. The purpose of this article is to provide descriptive information about the logistics of establishing and delivering a health intervention in schools that are resistant to nonacademic programming. The data were collected as part of a qualitative retrospective process evaluation of Full Court Press, a 5-year youth tobacco demonstration project funded by the Robert Woods Johnson Foundation and implemented in Tucson, Arizona. Lessons learned about recruiting schools, integrating programs, and managing facilitators are presented.

Implementation, Outcomes, and Lessons Learned From a Collaborative Primary Health Care Program to Improve Diabetes Care Among Urban Latino Populations

Thu, 16 Apr 2009 10:09:41 PDT

A collaborative primary health care service demonstration program was conducted to improve diabetes care among limited English-proficient (LEP) Latino patients. The intervention provided a multilevel approach aimed at patients and health care providers: Community health workers (CHWs) were mobilized to offer diabetes education in Spanish to LEP Latino diabetes patients, and health professions students and providers were offered intensive Spanish language training and cultural competency workshops. Positive outcomes for patients included a significant decrease in HbA1c. Health care providers reported improved patient communication and greater appreciation for cultural influences on health. Collaborating institutions realized ongoing benefits from expansion of CHWs' role and incorporation of cultural and language classes into health professions students' and house officers' training programs. Lessons learned included the importance of working together at every stage to identify and provide for the CHWs' training and support needs and to link the program's intervention with evaluation of multilevel outcomes.

Acknowledgments

Thu, 16 Apr 2009 10:09:41 PDT