Salubrízate, un proyecto de armonía con las personas y el entorno / Salubrízate: a project in harmony with the people and the environment

Introducción. Salubrízate es un grupo de procesos y activos comunitarios que realiza intervenciones de educación y promoción de la salud para el bienestar colectivo, en Ourense y alrededores desde el año 2018. Objetivo. El objetivo principal es conocer y responder a las inquietudes de salud de la ciudadanía. Métodos. Esta experiencia se basa en un modelo abierto a la participación, intersectorial y multidisciplinar, que tiene la capacidad de adaptarse a diversas circunstancias sanitarias o sociales, como la COVID. Se trabaja en cuatro áreas: hábitos saludables, bienestar emocional y social, entornos saludables y seguridad ciudadana. Tiene como recursos principales a las personas, los medios de comunicación colectiva como la radio y las redes sociales y diversas instituciones tanto sanitarias como sociales. Resultados. La repercusión de Salubrízate se está midiendo a través del alcance de cada uno de los proyectos llevados a cabo por el grupo, analizando también las debilidades que limitan el proyecto y sus fortalezas. (AU)

Introduction. Salubrízate is a group of community processes and assets that has been implementing health education and promotion interventions for collective well-being in Ourense and its surroundings since 2018.Aim. The main purpose is to be aware of the health concerns of citizens and respond to them.Methods. This experience is based on an intersectoral and multidisciplinary model open to participation, which can adapt to various health or social circumstances, such as COVID-19. The programme works on four areas: healthy habits, emotional and social well-being, healthy environments and citizen safety. Its key resources are people, mass media such as radio and social media and various health and social institutions.Results. The impact, strengths and limiting weaknesses of Salubrízate are being analysed by means of the scope of each project conducted by the group.

Association between a complex community intervention and quality of health extension workers' performance to correctly classify common childhood illnesses in four regions of Ethiopia.

BACKGROUND: Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and strengthening of district ownership and accountability of sick child services. We evaluated the association between the intervention and the health extension workers' ability to correctly classify common childhood illnesses in four regions of Ethiopia. METHODS: Baseline and endline assessments were done in 2016 and 2018 in intervention and comparison areas in four regions of Ethiopia. Ill children aged 2 to 59 months were mobilized to visit health posts for an assessment that was followed by re-examination. We analyzed sensitivity, specificity, and difference-in-difference of correct classification with multilevel mixed logistic regression in intervention and comparison areas at baseline and endline. RESULTS: Health extensions workers' consultations with ill children were observed in intervention (n = 710) and comparison areas (n = 615). At baseline, re-examination of the children showed that in intervention areas, health extension workers' sensitivity for fever or malaria was 54%, 68% for respiratory infections, 90% for diarrheal diseases, and 34% for malnutrition. At endline, it was 40% for fever or malaria, 49% for respiratory infections, 85% for diarrheal diseases, and 48% for malnutrition. Specificity was higher (89-100%) for all childhood illnesses. Difference-in-differences was 6% for correct classification of fever or malaria [aOR = 1.45 95% CI: 0.81-2.60], 4% for respiratory tract infection [aOR = 1.49 95% CI: 0.81-2.74], and 5% for diarrheal diseases [aOR = 1.74 95% CI: 0.77-3.92]. CONCLUSION: This study revealed that the Optimization of Health Extension Program intervention, which included training, supportive supervision, and performance reviews of health extension workers, was not associated with an improved classification of childhood illnesses by these Ethiopian primary health care workers. TRIAL REGISTRATION: ISRCTN12040912, http://www.isrctn.com/ISRCTN12040912.

Elaboration and validation of a booklet on diabetes for Community Health Workers.

OBJECTIVES: to develop and validate a diabetes booklet for Community Health Workers. METHODS: methodological study developed in seven steps: Bibliographic review; Development of the booklet; Calculation of readability and comprehensibility scores; Validation of the booklet by the committee of judges; Discussion between experts; Validation of the booklet by the target audience; and Final discussion between experts. Validation was performed by 10 judges via e-Surv and on a face-to-face test with 5 Community Health Workers, considering the minimum Content Validity Coefficient of 0.80. RESULTS: the booklet had a mean Content Validity Coefficient of 0.97 in the validation by the committee of judges, and the images had 96.67% approval. In the face-to-face test, the Community Health Workers considered the material clear and appropriate to the function. CONCLUSIONS: the booklet was developed and validated on its content and relevance, and it can be used by Community Health Workers for diabetes education.

[I promotori di salute come attori-protagonisti delle cure primarie nel controllo delle malattie comunicabili e non comunicabili e nell' empowerment delle comunità. Esperienza e risultati di lungo periodo in aree marginali in Ecuador dal 1980 al 2018.] / The community health promoters as protagonist actorsof primary health care and community empowerment:a long term field-report from 1980 to 2018.

. INTRODUCTION: Against the increasing recognition of the critical importance of a direct participation of community members to assure effective health care in peripheral areas of Middle and Low Income Countries (MLIC), representative field experiences of their essential role are only occasionally available. AIMS AND METHODS: We report a narrative, factual documentation of a spectrum of projects covering the basic and specific health needs of the disperse communities in Ecuador, a model MLIC, and discuss the broader implications of the role and performance of HPs over a long period, 1980-2018, in the project activation, implementation and monitoring. RESULTS: The role of 60 HPs, with the coordination of a small core group of professionals of the Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET) is documented through their main achievements which include: infectious diseases and in particular Neglected Tropical Diseases (eradication of onchocerciasis and yaws; virtual elimination of malaria and of strongyloidiasis; identification and control of a new focus of Chagas Disease; control of tuberculosis), mother and child health, reproductive health, hypertension (as model of the emergence of non-transmissible, chronic diseases). The most effective and sustainable strategies and methods are discussed also in terms of their more general transferability, already partially tested in programs in Bolivia, Burkina Faso, undeserved areas of Argentina. CONCLUSIONS: The systematic availability of non-professional, trained HPs should be recommended as a sustainable and reliable component of health care strategies and interventions targeted to marginalized settings, to assure a concrete accessibility to the fundamental human right to life.

Translating Workforce Development Policy Interventions for Community Health Workers: Application of a Policy Research Continuum.

CONTEXT: There is a need for knowledge translation to advance health equity in the prevention and control of cardiovascular disease and type 2 diabetes. One recommended strategy is engaging community health workers (CHWs) to have a central role in related interventions. Despite strong evidence of effectiveness for CHWs, there is limited information examining the impact of state CHW policy interventions. This article describes the application of a policy research continuum to enhance knowledge translation of CHW workforce development policy in the United States. METHODS: During 2016-2019, a team of public health researchers and practitioners applied the policy research continuum, a multiphased systematic assessment approach that incorporates legal epidemiology to enhance knowledge translation of CHW workforce development policy interventions in the United States. The continuum consists of 5 discrete, yet interconnected, phases including early evidence assessments, policy surveillance, implementation studies, policy ratings, and impact studies. RESULTS: Application of the first 3 phases of the continuum demonstrated (1) how CHW workforce development policy interventions are linked to strong evidence bases, (2) whether existing state CHW laws are evidence-informed, and (3) how different state approaches were implemented. DISCUSSION: As a knowledge translation tool, the continuum enhances dissemination of timely, useful information to inform decision making and supports the effective implementation and scale-up of science-based policy interventions. When fully implemented, it assists public health practitioners in examining the utility of different policy intervention approaches, the effects of adaptation, and the linkages between policy interventions and more distal public health outcomes.

Elaboration and validation of a booklet on diabetes for Community Health Workers / Elaboración y validación de una cartilla sobre diabetes para los Agentes Sanitarios / Elaboração e validação de cartilha sobre diabetes para Agentes Comunitários de Saúde

ABSTRACT Objectives: to develop and validate a diabetes booklet for Community Health Workers. Methods: methodological study developed in seven steps: Bibliographic review; Development of the booklet; Calculation of readability and comprehensibility scores; Validation of the booklet by the committee of judges; Discussion between experts; Validation of the booklet by the target audience; and Final discussion between experts. Validation was performed by 10 judges via e-Surv and on a face-to-face test with 5 Community Health Workers, considering the minimum Content Validity Coefficient of 0.80. Results: the booklet had a mean Content Validity Coefficient of 0.97 in the validation by the committee of judges, and the images had 96.67% approval. In the face-to-face test, the Community Health Workers considered the material clear and appropriate to the function. Conclusions: the booklet was developed and validated on its content and relevance, and it can be used by Community Health Workers for diabetes education.

RESUMEN Objetivos: desarrollar y validar una cartilla sobre diabetes para los Agentes Sanitarios. Métodos: se trata de un estudio metodológico desarrollado en siete etapas: Estudio bibliográfico; Preparación de la cartilla; Cálculo de las fórmulas de legibilidad y aprehensibilidad; Validación de la cartilla por el comité de jueces; Discusión entre expertos; Validación de la cartilla por el público objetivo; y Discusión final entre los expertos. Diez jueces realizaron la validación vía e-Surv; y la prueba cara a cara, cinco Agentes Sanitarios, considerando el Coeficiente de Validez de Contenido mínimo de 0,80. Resultados: la cartilla tuvo un Coeficiente de Validez de Contenido promedio de 0,97 en la validación del comité de jueces, y las imágenes obtuvieron el 96,67% de aprobación. En la prueba cara a cara, los Agentes Sanitarios consideraron que el material era claro y apropiado para la función. Conclusiones: la cartilla se diseñó y se validó en cuanto a su contenido y a su relevancia y los Agentes Sanitarios podrán usarla en acciones de educación sobre la diabetes.

RESUMO Objetivos: elaborar e validar uma cartilha sobre diabetes para os Agentes Comunitários de Saúde. Métodos: estudo metodológico desenvolvido em sete etapas: Levantamento bibliográfico; Elaboração da cartilha; Cálculo das fórmulas de legibilidade e apreensibilidade; Validação da cartilha por comitê de juízes; Discussão entre especialistas; Validação da cartilha pelo público-alvo; e Discussão final entre especialistas. A validação foi realizada por 10 juízes via e-Surv; e o teste face a face, por 5 Agentes Comunitários de Saúde, considerando o Coeficiente de Validade de Conteúdo mínimo de 0,80. Resultados: a cartilha teve um Coeficiente de Validade de Conteúdo médio de ٠,٩٧ na validação pelo comitê de juízes, e as imagens tiveram ٩٦,٦٧٪ de aprovação. No teste face a face, os Agentes Comunitários de Saúde consideraram o material claro e adequado à função. Conclusões: a cartilha foi elaborada e validada quanto ao conteúdo e relevância, podendo ser utilizada pelos Agentes Comunitários de Saúde nas ações de educação em diabetes.

Development of a Framework to Describe Functions and Practice of Community Health Workers.

There is evidence to support the effectiveness of community health workers (CHWs), as they practice in a wide range of health care settings; yet, the perceived value of CHWs suffers from a lack of uniform credentialing and from a dearth of billing and payment structures to recognize their individual work. In turn, credentialing and billing for the work of CHWs is hampered by widely variable regulation, conflicting job titles and position descriptions, and general confusion about CHW identity, sometimes complicated by service boundaries that overlap with those of other health care and social service occupations. This article presents evidence from a rapid review of the CHW literature from 2003 to 2018. It includes clinical trials, meta-analyses, and policy reports summarizing more than 200 CHW interventions intended to improve patient health status or care delivery. The evidence is used to identify CHW roles, responsibilities, behaviors, and competencies. Four categories of CHW practice are developed from the evidence: peer CHW, general CHW, clinical CHW, and health navigator. A framework is proposed to recognize unique CHW roles, promote and further integrate varied levels of CHW function into health care-related organizations, and to inform decisions regarding certification, education, and payment for CHW services in the United States.

Changing Narratives and Persisting Tensions: Conflicts between Chinese and Western Medicine and Professional Profiles in Chinese Films and Literature, 1949-2009.

This paper analyses the shifting images of Chinese medicine and rural doctors in the narratives of literature and film from 1949 to 2009 in order to explore the persisting tensions within rural medicine and health issues in China. Popular anxiety about health services and the government's concern that it be seen to be meeting the medical needs of China's most vulnerable citizens - its rural dwellers - has led to the production of a continuous body of literary and film works discussing these issues, such as Medical Practice Incident, Spring Comes to the Withered Tree, Chunmiao, and Barefoot Doctor Wan Quanhe. The article moves chronologically from the early years of the Chinese Communist Party's new rural health strategies through to the twenty-first century - over these decades, both health politics and arts policy underwent dramatic transformations. It argues that despite the huge political investment on the part of the Chinese Communist Party government in promoting the virtues of Chinese medicine and barefoot doctors, film and literature narratives reveal that this rustic nationalistic vision was a problematic ideological message. The article shows that two main tensions persisted prior to and during the Cultural Revolution, the economic reform era of the 1980s, and the medical marketisation era that began in the late 1990s. First, the tension between Chinese and Western medicine and, second, the tension between formally trained medical practitioners and paraprofessional practitioners like barefoot doctors. Each carried shifting ideological valences during the decades explored, and these shifts complicated their portrayal and shaped their specific styles in the creative works discussed. These reflected the main dilemmas around the solutions to rural medicine and health care, namely the integration of Chinese and Western medicines and blurring of boundaries between the work of medical paraprofessionals and professionals.

Discretion, power and the reproduction of inequality in health policy implementation: Practices, discursive styles and classifications of Brazil's community health workers.

This article explores the mobilization of power by health workers during policy implementation, showing how in a context of discretion and resource scarcity they can reproduce inequalities in access to health services. The argument innovates theoretically by supplementing the 'street-level bureaucracy' literature, which emphasizes frontline worker discretion, with a conceptualization of power as domination encompassing the shaping of behavior, the constitution of subjects and the reproduction of inequality. Empirically, the article focuses on Brazilian community health workers (agentes comunitários desaúde, CHWs). CHWs are a neglected but highly important segment of the health workforce that traditionally functions as a link between the health system and disadvantaged groups. The article examines how Brazilian CHWs act as street-level bureaucrats mobilizing power in their interactions with users. They operate within a severely under-resourced public health system, the Sistema Único de Saúde, which places constraints upon their action and forces them to make allocation decisions with little training and support. The article highlights the ways in which inequalities in access to health services are reproduced (inadvertently or not) through the practices, discursive styles and classifications of CHWs. Methodologically, the paper is based on ethnography with 24 CHWs and interviews with 77 other CHWs in Brazil.

After Prison, Healthy Lives Built On Access To Care And Community.

A North Carolina program helps recently released inmates connect to health care, social services, and support.

Community Health Workers in Hawai'i: A Scoping Review and Framework Analysis of Existing Evidence.

Introduction: Community health workers (CHWs) play a vital role in health across Hawai'i, but the scope of this work is not comprehensively collated. This scoping review describes the existing evidence of the roles and responsibilities of CHWs in Hawai'i. Methods: Between May and October 2018, researchers gathered documents (eg, reports, journal articles) relevant to Hawai'i CHWs from health organizations, government entities, colleges/universities, and CHWs. Documents were reviewed for overall focus and content, then analyzed using the Centers for Disease Control and Prevention's 10 Essential Public Health Services as well as the Community Health Worker Core Consensus Project roles to identify workplace roles and gaps. Results: Of 92 documents received, 68 were included for review. The oldest document dated to 1995. Document types included curricula outlines, unpublished reports, and peer-reviewed articles. Documents discussed trainings, certification programs, CHWs' roles in interventions, and community-, clinical-, and/or patient-level outcomes. Cultural concordance parity between CHWs and patients, cost savings, and barriers to CHW work were noted. Most roles named by the Community Health Worker Core Consensus Project were mentioned in documents, but few were related to the roles of "community/policy advocacy" and "participation in research and evaluation." Workplace roles, as determined using the 10 Essential Public Health Services, focused more on "assuring workforce competency" and "evaluation," and less on "policy development," and "enforcing laws." Discussion: CHWs are an important part of Hawaii's health system and engage in many public health functions. Although CHW roles in Hawai'i mirrored those identified by the CHW Core Consensus Project and 10 Essential Public Health Services frameworks, there is a noticeable gap in Hawai'i CHW professional participation in research, evaluation, and community advocacy.

Legislative Definitions of Community Health Workers: Examples from Other States to Inform Hawai'i.

Community health workers (CHWs) have been important contributors to the health and wellness of disenfranchised and minority communities for more than 50 years in the United States. Recently the Centers for Disease Control and Prevention (CDC) recommended several policy initiatives to support and advance the CHW workforce, including formalizing a state-level definition for CHWs. Such state-wide standards can lay the groundwork for health insurance reimbursement for CHW services, help establish a professional identity, and generate cohesion among CHWs. Some states have already adopted a formal definition of CHWs. Hawai'i has had grassroots and political movement in this direction, although no widespread, formal consensus has been reached. This paper reviews decisions in other states in formally defining CHWs in order to inform efforts in Hawai'i. As of February 2019, data has been collected on states which have formally defined CHWs. Two independent reviewers compared the definitions used in 15 states with formalized definitions using the American Public Health Association (APHA) CHW Section definition. We found that most states built upon the APHA definition to create working definitions that were codified into law, sometimes with minor modifications for relevance to their communities. Given the widespread use of the APHA definition, Hawai'i may also find benefit from using the APHA definition as a backbone for a state-level definition. Critically, following best practices, it will be important to take steps to ensure CHW self-determination in all aspects of the processes towards a state-level definition of and scope of care for CHWs.

Community Health Worker (CHW) Movement in Hawai'i: Moving Towards a CHW Association.

This editorial presents the perspectives of allies - a group of governmental, university and public health organizations that support the creation of a professional association for CHWs in Hawai'i. We support the efforts of CHWs as they organize and move towards establishing a professional association. Hawai'i CHWs have held monthly meetings starting in 2017 to discuss variety of issues around their work and share information and experiences. A group of CHWs and allies developed a strategic plan in 2018 in preparation to establish a professional association. They shared the results with colleagues from across the state. One desirable outcome for many was a professional CHW association. Such an association could be a forum of shared learning, information sharing, networking, and advocating for workforce and professional development issues, such as training, reimbursement for services, credentials, and certifications. Furthermore, allies support CHW-led efforts to develop an association, for instance, by securing diversified funding sources for CHW trainings, networking, and planning activities. Allies also help by informing supervisors, employers, and policymakers about the importance of trainings and other workforce and professional development for CHWs. A professional association for CHWs in Hawai'i could be useful to many. This editorial provides more insights into this topic.

Community Health Workers in Action: Community-Clinical Linkages for Diabetes Prevention and Hypertension Management at 3 Community Health Centers.

In 2014, the Hawai'i State Department of Health (HDOH) received funding from the Centers for Disease Control and Prevention (CDC), via the 1422 Cooperative Agreement, to conduct diabetes prevention and hypertension management. To implement one grant-required strategy-the engagement of community health workers (CHWs) to promote community-clinical linkages-the HDOH partnered with the Hawai'i Primary Care Association and 9 federally qualified health centers (FQHCs). This qualitative evaluation case study sought to understand how 3 of the funded FQHCs engaged CHWs, the types of community-clinical linkages the CHWs promoted, and the facilitators of and barriers to those linkages. Evaluators conducted 2 semi-structured group interviews with 6 administrators/clinicians and 7 CHWs in April 2018. The transcribed interviews were deductively and inductively analyzed to identify major themes. First, CHWs made multiple internal and external linkages using resources provided by the grant as well as other resources. Second, CHWs faced barriers in making community-clinical linkages due to individual patient, geographic, and economic constraints. Third, CHWs have unmet professional needs related to building community-clinical linkages including professional development, networking, and burnout. Reimbursement and payment mechanisms are an all-encompassing challenge to the sustainability of CHW positions, as disease-specific funding and a complete lack of reimbursement structures make CHW positions unstable. Thus, CHWs fulfill a number of grant-specific roles at FQHCs due to this patchwork of funding sources, and this relates to CHWs' experiences of burnout. Policy implications of this study include funding and reimbursement stabilization so FQHCs may consistently engage and support the CHW workforce to meet their patients' complex, diverse needs. More professional development opportunities for CHWs are necessary to build sustainable networks of resources.

Community health workers to improve uptake of maternal healthcare services: A cluster-randomized pragmatic trial in Dar es Salaam, Tanzania.

BACKGROUND: Home delivery and late and infrequent attendance at antenatal care (ANC) are responsible for substantial avoidable maternal and pediatric morbidity and mortality in sub-Saharan Africa. This cluster-randomized trial aimed to determine the impact of a community health worker (CHW) intervention on the proportion of women who (i) visit ANC fewer than 4 times during their pregnancy and (ii) deliver at home. METHODS AND FINDINGS: As part of a 2-by-2 factorial design, we conducted a cluster-randomized trial of a home-based CHW intervention in 2 of 3 districts of Dar es Salaam from 18 June 2012 to 15 January 2014. Thirty-six wards (geographical areas) in the 2 districts were randomized to the CHW intervention, and 24 wards to the standard of care. In the standard-of-care arm, CHWs visited women enrolled in prevention of mother-to-child HIV transmission (PMTCT) care and provided information and counseling. The intervention arm included additional CHW supervision and the following additional CHW tasks, which were targeted at all pregnant women regardless of HIV status: (i) conducting home visits to identify pregnant women and refer them to ANC, (ii) counseling pregnant women on maternal health, and (iii) providing home visits to women who missed an ANC or PMTCT appointment. The primary endpoints of this trial were the proportion of pregnant women (i) not making at least 4 ANC visits and (ii) delivering at home. The outcomes were assessed through a population-based household survey at the end of the trial period. We did not collect data on adverse events. A random sample of 2,329 pregnant women and new mothers living in the study area were interviewed during home visits. At the time of the survey, the mean age of participants was 27.3 years, and 34.5% (804/2,329) were pregnant. The proportion of women who reported having attended fewer than 4 ANC visits did not differ significantly between the intervention and standard-of-care arms (59.1% versus 60.7%, respectively; risk ratio [RR]: 0.97; 95% CI: 0.82-1.15; p = 0.754). Similarly, the proportion reporting that they had attended ANC in the first trimester did not differ significantly between study arms. However, women in intervention wards were significantly less likely to report having delivered at home (3.9% versus 7.3%; RR: 0.54; 95% CI: 0.30-0.95; p = 0.034). Mixed-methods analyses of additional data collected as part of this trial suggest that an important reason for the lack of effect on ANC outcomes was the perceived high economic burden and inconvenience of attending ANC. The main limitations of this trial were that (i) the outcomes were ascertained through self-report, (ii) the study was stopped 4 months early due to a change in the standard of care in the other trial that was part of the 2-by-2 factorial design, and (iii) the sample size of the household survey was not prespecified. CONCLUSIONS: A home-based CHW intervention in urban Tanzania significantly reduced the proportion of women who reported having delivered at home, in an area that already has very high uptake of facility-based delivery. The intervention did not affect self-reported ANC attendance. Policy makers should consider piloting, evaluating, and scaling interventions to lessen the economic burden and inconvenience of ANC. TRIAL REGISTRATION: ClinicalTrials.gov NCT01932138.

An Incentive-Based and Community Health Worker Package Intervention to Improve Early Utilization of Antenatal Care: Evidence from a Pilot Randomised Controlled Trial.

Objectives One of the factors linked to South Africa's relatively high maternal mortality ratio is late utilization of antenatal care (ANC). Early utilization is especially important in South Africa due to the high HIV prevalence amongst pregnant women. This study examined the impact of a package intervention, consisting of an incentive called the Thula Baba Box (TBB) and a community health worker (CHW) programme, on early utilization of ANC. Methods A pilot randomised controlled trial consisting of 72 women aged 18 and older was conducted in an urban area in South Africa to evaluate the impact of the package intervention. Women were recruited and randomised into either intervention (n = 39) or control group (n = 33). The intervention group received both the TBB and monthly CHW visits, while the control group followed standard clinical practice. Both groups were interviewed at recruitment and once again after giving birth. The outcomes measured are the timing of first ANC visit and whether they attended more than four times. It is anticipated that the box will also have a beneficial impact on infant health outcomes, but these fall out of the scope of this study. Results Women in the intervention groups sought care on average 1.35 months earlier than the control group. They were also significantly more likely to attend at least four antenatal clinic visits. Conclusions for practice Given the South African context and the importance of early care-seeking behaviour to improve health outcomes of HIV-positive pregnant women, the intervention can help to improve maternal and neonatal health outcomes. Further research is needed to investigate the impact of the two interventions separately, and to see if these findings hold in other communities.

Re-evaluating the assistant practitioner role in NHS England: Survey findings.

AIM AND BACKGROUND: In the absence of data providing an overview on the state of the assistant practitioner (AP) workforce, this study surveys trusts in NHS England with the aim of establishing how the role is viewed, used and managed. METHODS: Based on an earlier survey undertaken around a decade ago, an online questionnaire was sent to members of an assistant practitioner network, generating a response from over fifty different trusts, drawn from different regions and health care settings. RESULTS: The survey results highlight the increased use of assistant practitioners by trusts and in a more diverse range of clinical settings. This increase has been driven more by the apparent value of the APs in addressing issues of service design and quality, than by attempts to reduce costs through substitution and skill mix dilution. CONCLUSIONS: The AP role has retained value to nurse managers in developing and designing services, and indeed in establishing a career pathway for health care assistants. Most striking are future intentions to continue using APs, particularly within the context of the emerging nursing associate (NA) role. This suggests that the AP and NA are likely to be complementary rather than alternative roles. IMPLICATIONS FOR NURSING MANAGERS: Nurse managers might note the continuing use and value of the AP role, although as a means of improving design and quality as well as providing career opportunities for health care assistants, rather than as a way of saving labour costs. Clearly, the AP role has a future although there is scope to review its position in relation to the newly emerging nursing associate role.

Web-based versus in-person methods for training lay community health advisors to implement health promotion workshops: participant outcomes from a cluster-randomized trial.

Project HEAL (Health through Early Awareness and Learning) is an implementation trial that compared two methods of training lay peer community health advisors (CHAs)-in-person ("Traditional") versus web-based ("Technology")-to conduct a series of three evidence-based cancer educational workshops in African American churches. This analysis reports on participant outcomes from Project HEAL. Fifteen churches were randomized to the two CHA training methods and the intervention impact was examined over 24 months. This study was conducted in Prince George's County, MD, and enrolled 375 church members age 40-75. Participants reported on knowledge and screening behaviors for breast, prostate, and colorectal cancer. Overall, cancer knowledge in all areas increased during the study period (p < .001). There were significant increases in digital rectal exam (p < .05), fecal occult blood test (p < .001), and colonoscopy (p < .01) at 24 months; however, this did not differ by study group. Mammography maintenance (56% overall) was evidenced by women reporting multiple mammograms within the study period. Participants attending all three workshops were more likely to report a fecal occult blood test or colonoscopy at 24 months (p < .05) than those who attended only one. These findings suggest that lay individuals can receive web-based training to successfully implement an evidence-based health promotion intervention that results in participant-level outcomes comparable with (a) people trained using the traditional classroom method and (b) previous efficacy trials. Findings have implications for resources and use of technology to increase widespread dissemination of evidence-based health promotion interventions through training lay persons in community settings.