Advancing understanding of the sustainability of lay health advisor (LHA) programs for African-American women in community settings.
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.
Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, 722 168th Street, Room 941, New York, NY, 10032, USA. rs3108@cumc.columbia.edu.
Rachel C
RC
Shelton
Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, 722 168th Street, Room 941, New York, NY, 10032, USA.
Thana-Ashley
TA
Charles
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.
Sheba King
SK
Dunston
Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1130, New York, NY, 10029, USA.
Lina
L
Jandorf
Office of Cancer Health Disparities Research, Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
Deborah O
DO
Erwin
D000328:Adult; D001741:Black or African American; D000368:Aged; D057191:Capacity Building; D003150:Community Health Workers / Q000191:economics / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000191:economics / Q000379:methods / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D008137:Longitudinal Studies; D008875:Middle Aged; D036301:Qualitative Research; D035862:Vulnerable Populations; D055815:Young Adult
Cancer screening; Evidence-based programs; Implementation; Lay health advisors; Qualitative research; Sustainability