A Community Health Advisor Program to Reduce Cancer Screening Disparities in the Deep South and Appalachia: The American Cancer Society's CHA Collaborative.

INTRODUCTION: Cancer disparities continue to exist in the United States. Community health advisors (CHAs) can play a critical role in addressing cancer disparities. The American Cancer Society (ACS) implemented a 3-year pilot CHA program in the South based on an evidence-based program to increase breast cancer screening. STUDY DESIGN: Evaluation assessed the extent to which ACS successfully implemented the program. Quantitative data were tracked and reported by ACS staff, and qualitative data were collected through focus groups and interviews with volunteer participants. SETTING/PARTICIPANTS: The pilot was implemented in 28 communities in nine states. ACS staff recruited volunteer community network partners (CNPs) as local advisory groups, and volunteer CHAs to conduct outreach, education, and screening navigation. MEASURES: Outcome measures included number of individuals educated and screened, and number of communities reaching education and screening targets. Process measures included number of volunteers recruited, number of communities reaching recruitment targets, and implementation process, challenges, and successes. RESULTS: A total of 383 CHAs were recruited and recruitment goals were met in 68%; 31,439 individuals were educated, and 93% of communities reached education goals. In all, 5,056 individuals were screened, but screening goals were attained in only 36% of communities. CONCLUSION: This pilot demonstrates the ability of ACS to adapt and disseminate an evidence-based program to fit into its volunteer-based outreach model. ACS built community network partnerships, recruited a cadre of volunteers, and trained them to conduct education and screening navigation.

The effects of situational obstacles and social support on suicide- prevention gatekeeper behaviors.

BACKGROUND: Although the effectiveness of suicide-prevention gatekeeper-training programs in improving knowledge, attitudes, and referral practices has been documented, their effects do not seem to be lasting. AIMS: This study investigated situational obstacles at work that prevent suicide-prevention gatekeepers from engaging in suicide-prevention behavior and the role of social support in modifying the relationship between situational obstacles and suicide-prevention behaviors. METHODS: 193 gatekeepers completed an online survey to rate the obstacles they had experienced at work since completing a gatekeeper-training program and the support received from coworkers, supervisors, and the organization. Participants also reported the frequency of suicide-prevention behaviors performed. RESULTS: The results indicated that both situational obstacles and social support predicted the number of suicide-prevention behaviors performed, as expected. There was also a trend that support from supervisors and the organization may alleviate the adverse effect of situational obstacles on suicide-prevention behavior. LIMITATIONS: The cross-sectional nature of the study does not allow for directional, causal conclusions to be drawn. CONCLUSIONS: By understanding the roles of situational obstacles faced by trained gatekeepers at their work and the support they receive from supervisors and organizations, appropriate strategies can be identified and applied to facilitate gatekeeper performance.