Brandford Arica, Adegboyega Adebola, Combs Brenda, Hatcher Jennifer
University of Kentucky, Lexington, KY, USA.
Health Promot Pract. 2019 Mar;20(2):239-250. doi: 10.1177/1524839918761384. Epub 2018 Mar 24.
Health disparities researchers attempting to engage and effectively deliver interventions to underserved populations often encounter a number of challenges ranging from geographical considerations to more complex issues of medical mistrust. While there are a number of strategies researchers may employ to address these challenges, one of the most successful of these has been the use of community health workers (CHWs). Despite the documented success of CHWs, little information exists on the use of theory-driven intervention strategies with these community partners. Researchers who have partnered with CHWs tend to provide brief descriptions of training strategies and provide little discussion of the challenges and barriers to training a lay population in the delivery of technical interventions, including ensuring fidelity to the intervention protocol. The purpose of this article is to describe the feasibility of training CHWs to deliver a motivational interviewing intervention to promote cancer screening in underserved populations. With this article we present an innovative way to use motivational interviewing delivered by CHWs. Specifically, we will detail the development of the training protocol, the implementation of that training in a variety of research settings, and the development and implementation of fidelity protocols. We will use examples from two research studies where CHWs were successfully trained to use MI to promote cancer screening in underserved communities to highlight the challenges and barriers faced in developing and implementing the training and strategies used to overcome these challenges during the refinement of the intervention.
试图与服务不足人群接触并有效提供干预措施的健康差异研究人员，常常会遇到一系列挑战，从地理因素到更为复杂的医疗不信任问题。虽然研究人员可以采用多种策略来应对这些挑战，但其中最成功的策略之一就是利用社区卫生工作者（CHW）。尽管有文献记载CHW取得了成功，但关于与这些社区伙伴采用理论驱动的干预策略的信息却很少。与CHW合作的研究人员往往只是简要描述培训策略，很少讨论在对非专业人群进行技术干预培训时所面临的挑战和障碍，包括确保对干预方案的忠诚度。本文的目的是描述培训CHW以提供动机性访谈干预措施，从而在服务不足人群中促进癌症筛查的可行性。在本文中，我们提出了一种利用CHW进行动机性访谈的创新方法。具体而言，我们将详细介绍培训方案的制定、在各种研究环境中该培训的实施，以及忠诚度方案的制定和实施。我们将以两项研究为例，在这两项研究中，CHW成功接受培训，使用动机性访谈在服务不足的社区中促进癌症筛查，以突出在制定和实施培训过程中面临的挑战和障碍，以及在干预措施完善过程中用于克服这些挑战的策略。
