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

Abstract

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.

Trial registration: ClinicalTrials.gov NCT02076958.

Keywords: African Americans; Cancer early detection; Community health advisors; Implementation; Web-based learning.

Fig 1 |

Project Health through Early Awareness and Learning (HEAL) CONSORT flow diagram. Previously cited in Santos et al. [25]. ^aChurch dropped out before first workshop date; church not replaced due to late dropout. ^bParticipants completed baseline survey upon enrolment in workshops 1–3. ^cDropout = participant refused to continue on study; Lost to follow-up = study team was unable to contact participant for data collection. These events could occur at any of the follow-up intervals. Numbers at follow-ups are not cumulative.