Shelton Rachel C, Charles Thana-Ashley, Dunston Sheba King, Jandorf Lina, Erwin Deborah O
Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, 722 168th Street, Room 941, New York, NY, 10032, USA.
Office of Research and Methodology, Question Design Research Laboratory, National Centers for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD, 20782, USA.
Transl Behav Med. 2017 Sep;7(3):415-426. doi: 10.1007/s13142-017-0491-3.
Lay health advisor (LHA) programs have made strong contributions towards the elimination of health disparities and are increasingly being implemented to promote health and prevent disease. Developed in collaboration with African-American survivors, the National Witness Project (NWP) is an evidence-based, community-led LHA program that improves cancer screening among African-American women. NWP has been successfully disseminated, replicated, and implemented nationally in over 40 sites in 22 states in diverse community settings, reaching over 15,000 women annually. We sought to advance understanding of barriers and facilitators to the long-term implementation and sustainability of LHA programs in community settings from the viewpoint of the LHAs, as well as the broader impact of the program on African-American communities and LHAs. In the context of a mixed-methods study, in-depth telephone interviews were conducted among 76 African-American LHAs at eight NWP sites at baseline and 12-18 months later, between 2010 and 2013. Qualitative data provides insight into inner and outer contextual factors (e.g., community partnerships, site leadership, funding), implementation processes (e.g., training), as well as characteristics of the intervention (e.g., perceived need and fit in African-American community) and LHAs (e.g., motivations, burnout) that are perceived to impact the continued implementation and sustainability of NWP. Factors at the contextual levels and related to motivations of LHAs are critical to the sustainability of LHA programs. We discuss how findings are used to inform (1) the development of the LHA Sustainability Framework and (2) strategies to support the continued implementation and sustainability of evidence-based LHA interventions in community settings.
非专业健康顾问（LHA）项目为消除健康差距做出了巨大贡献，并且越来越多地被用于促进健康和预防疾病。国家见证项目（NWP）是与非裔美国幸存者合作开发的一个基于证据、由社区主导的LHA项目，该项目提高了非裔美国女性的癌症筛查率。NWP已在全国22个州的40多个地点成功传播、复制并实施，涉及不同的社区环境，每年惠及超过15000名女性。我们试图从LHA的角度，以及该项目对非裔美国社区和LHA的更广泛影响，来深入了解社区环境中LHA项目长期实施和可持续性的障碍与促进因素。在一项混合方法研究的背景下，2010年至2013年期间，在基线和12 - 18个月后，对八个NWP地点的76名非裔美国LHA进行了深入电话访谈。定性数据提供了对内部和外部背景因素（如社区伙伴关系、站点领导、资金）、实施过程（如培训），以及被认为会影响NWP持续实施和可持续性的干预措施特征（如在非裔美国社区中的感知需求和适应性）和LHA特征（如动机、倦怠）的洞察。背景层面的因素以及与LHA动机相关的因素对LHA项目的可持续性至关重要。我们讨论了研究结果如何用于为以下两方面提供信息：（1）LHA可持续性框架的制定；（2）支持基于证据的LHA干预措施在社区环境中持续实施和可持续性的策略。
