title: Evaluation of breast cancer knowledge among health promoters in Mexico before and after focused training.
abstract: OBJECTIVE
  Breast cancer is a leading cause of morbidity and mortality in Mexico. We assessed the effectiveness of a train-the-trainer program in two Mexican states in improving knowledge among professional and nonprofessional community health workers.
  
  
  METHODS
  We worked with local organizations to develop and implement a train-the-trainer program to improve breast cancer knowledge among community health workers, including professional health promoters (PHPs) who were trained and then trained nonprofessional community health promoters (CHPs). We surveyed participants before and after training that included in-person and online classes and again approximately 3 months later. We used paired t tests and chi-square tests to compare survey responses at the different times. We also used logistic regression to assess whether promoter characteristics were associated with greater improvements in breast cancer knowledge after training.
  
  
  RESULTS
  Overall, 169 PHPs (mean age, 36 years) completed training and provided a 10-hour training course to 2,651 CHPs, who also completed the pre- and post-training survey. For both PHPs and CHPs, post-training surveys demonstrated increases in an understanding of breast cancer as a problem; an understanding of screening, treatment, and insurance coverage issues; and knowledge of breast cancer risk factors, symptoms, and what constitutes a family history of breast cancer (all p < .05). These improvements were maintained 3 to 6 months after training.
  
  
  CONCLUSIONS
  Train-the-trainer programs hold promise for leveraging community health workers, who far outnumber other health professionals in many low- and middle-income countries, to engage in health promotion activities for cancer and other noncommunicable diseases.
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Health Care Policy and Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts, USA; Fundación Mexicana para la Salud and Tómatelo a Pecho A.C., Mexico City, Mexico; National Institute of Public Health, Cuernavaca, Mexico.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Health Care Policy and Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts, USA; Fundación Mexicana para la Salud and Tómatelo a Pecho A.C., Mexico City, Mexico; National Institute of Public Health, Cuernavaca, Mexico.
authors.forename: Elena M
authors.initials: EM
authors.lastname: Kouri
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Health Care Policy and Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts, USA; Fundación Mexicana para la Salud and Tómatelo a Pecho A.C., Mexico City, Mexico; National Institute of Public Health, Cuernavaca, Mexico.
authors.forename: Héctor Arreola
authors.initials: HA
authors.lastname: Ornelas
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Health Care Policy and Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts, USA; Fundación Mexicana para la Salud and Tómatelo a Pecho A.C., Mexico City, Mexico; National Institute of Public Health, Cuernavaca, Mexico.
authors.forename: Oscar
authors.initials: O
authors.lastname: Méndez
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Health Care Policy and Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts, USA; Fundación Mexicana para la Salud and Tómatelo a Pecho A.C., Mexico City, Mexico; National Institute of Public Health, Cuernavaca, Mexico.
authors.forename: Laura Magaña
authors.initials: LM
authors.lastname: Valladares
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Health Care Policy and Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts, USA; Fundación Mexicana para la Salud and Tómatelo a Pecho A.C., Mexico City, Mexico; National Institute of Public Health, Cuernavaca, Mexico Felicia_knaul@harvard.edu.
authors.forename: Felicia Marie
authors.initials: FM
authors.lastname: Knaul
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology*; D005260:Female; D006282:Health Personnel / Q000193:education*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D013663:Teaching / Q000379:methods; D055815:Young Adult
keywords: Breast cancer; Education and training; Health workers; Mexico