Design, implementation, and evaluation of community health worker training programs in Latinx communities: A scoping review.

This review examines the current reporting trends of program design, implementation, and evaluation of training programs for Latinx community health workers. Five scholarly databases were searched using a scoping review methodology to identify articles describing training programs for Latinx community health workers. The timeframe was 2009 to 2021. We identified 273 articles, with 59 meeting inclusion criteria. Researchers thematically coded the articles to identify reporting strategies related to program design, implementation, and evaluation. Findings suggest a lack of consensus in reporting elements critical to program resources, instructor qualifications, frequency and length of training implementation, theoretical background, and pedagogical tools associated with the training program. We offer detailed reporting recommendations of community health worker training programs to support the consistent dissemination of promising practices and facilitate the initiation of new programs for Latinx community health workers.

Promotoras Voice Their Challenges in Fulfilling Their Role as Community Health Workers.

Promotoras de salud (Spanish for female community health workers) are integral to efforts to enhance the health and well-being of Latinx individuals, families, and communities. The purpose of this study was to describe the challenges that promotoras face and the proposed solutions from the perspective of the promotoras themselves. Five promotoras who worked for a year as volunteers in a community-based participatory research study, Lazos Hispanos, participated in two group interviews. Eight challenges emerged-balancing their new work with their family commitments, handling their perceived imbalance of power with men, managing the emotional impact of hearing participants' problems, facing and handling the barriers imposed by having limited English language skills, feeling discouraged by the perception of ethnocentric beliefs and discrimination from some providers, feeling disheartened by the cultural beliefs of some Latinx participants, handling the lack of transportation for themselves and for the participants, and managing the burden of data collection for the research aspect of the program. The explanation of these challenges and the practical solutions they proposed are embedded in their intersecting identities. The solutions are a valuable addition to the practice of health promotion and community-based participatory research, particularly within Latinx communities.

Lazos Hispanos: Promising Strategies and Lessons Learned in the Development of a Multisystem, Community-Based Promotoras Program.

U.S. Latinos face multiple inter-related barriers to access health and social services. Researchers and practitioners have called upon community-based participatory research (CBPR) to address such challenges and health disparities, with the community health worker-or promotoras-model evidencing positive outcomes. What is less clear, however, are the promising strategies to support the development of a multisystem, community-based promotoras program. In response, the current study applied a CBPR conceptual model as an organizing framework to develop a promotora program. Lazos Hispanos (Hispanic Links) was developed to enhance the health and well-being of Latinx residing in low-income communities in the Southeastern United States. This study highlights 16 lessons learned, anchored in the first two dimensions of the CBPR conceptual model: community context and partnership development. First, the community assessment and activities leading to Lazos Hispanos took nearly 2 years but were crucial to develop a strong basis for the program. Second, the development of a multicultural and interdisciplinary research team enriched every aspect of the program and enhanced culturally responsive community engagement. Selection, training, and ongoing support of the promotoras were fundamental to program success. Particularly important were the following: receiving mentorship from a successful promotora organization; delineating mutually agreed upon roles and responsibilities; following national training standards for community health workers; and, holding monthly meetings for training, support, and data collection. The engagement of community service providers as partners was facilitated by building upon existing community relationships, signing a memorandum of understanding that specified roles and responsibilities, conducting tours of provider facilities with the promotoras, and keeping providers abreast of the program via bi-annual community gatherings. The development process showed fidelity to the conceptual model. Lazos Hispanos has proven an asset to participants, the promotoras, and service providers as the program continues to develop a community-based, health supportive infrastructure.

A multistakeholder evaluation of Lazos Hispanos: An application of a community-based participatory research conceptual model.

The goal of Lazos Hispanos is to enhance the health and well-being of the Latinx community through promotoras, who connect community members with service providers for multiple health and social needs. A community-based participatory research conceptual model framed the multimethod evaluation of promotoras, service providers, and community participants at baseline and at the 1-year follow up. The promotoras increased their self-efficacy and knowledge, felt a strong sense of commitment to the community, viewed themselves as a bridge between participants and providers, and felt empowered by their new role. Service providers valued the promotoras as their ambassadors in the community and Lazos Hispanos as central to connecting service providers, promotoras, and community members; they noted that this collaboration increased their accountability with the Latinx community. This multistakeholder evaluation highlights the depth of positive changes achieved during the first year and the challenges of a community-embedded project and the benefits and possibilities of calling upon theoretically informed evaluation models.

Overcoming Barriers: Practical Strategies to Assess Latinos Living in Low-Income Communities.

The value of community assessments depends on the researchers' ability to reach a diverse and representative sample of participants. This process is particularly challenging when assessing the health and well-being of vulnerable populations that are reticent to participate in research because of demographic and sociopolitical factors. One such group is Latinxs (the gender-neutral version of Latinos or Latinas) of mixed immigration status who live in low-income, socially and geographically isolated enclaves in the Southeast. Framed by community-based participatory research and social marketing theories, this study describes practical strategies for health researchers, practitioners, and advocates seeking to engage and build trusting relationship within U.S. Latinx communities. First, identify and leverage points of entry to different segments of the communities of interest by engaging meaningful gatekeepers from different sections of the population and searching for places where potential participants gather. Second, reduce the burden of assessments by using incentives and creating intentional reciprocity. Third, establish critical, long-lasting trust with community members, leaders, and allies by adapting data collection procedures, ensuring confidentiality, engaging bilingual facilitators, and most important, being present with and for the community. Finally, presenting the findings back to the community can increase the ownership of the process.

Methods used to streamline the CAHPS Hospital Survey.

OBJECTIVE: To identify a parsimonious subset of reliable, valid, and consumer-salient items from 33 questions asking for patient reports about hospital care quality. DATA SOURCE: CAHPS Hospital Survey pilot data were collected during the summer of 2003 using mail and telephone from 19,720 patients who had been treated in 132 hospitals in three states and discharged from November 2002 to January 2003. METHODS: Standard psychometric methods were used to assess the reliability (internal consistency reliability and hospital-level reliability) and construct validity (exploratory and confirmatory factor analyses, strength of relationship to overall rating of hospital) of the 33 report items. The best subset of items from among the 33 was selected based on their statistical properties in conjunction with the importance assigned to each item by participants in 14 focus groups. PRINCIPAL FINDINGS: Confirmatory factor analysis (CFA) indicated that a subset of 16 questions proposed to measure seven aspects of hospital care (communication with nurses, communication with doctors, responsiveness to patient needs, physical environment, pain control, communication about medication, and discharge information) demonstrated excellent fit to the data. Scales in each of these areas had acceptable levels of reliability to discriminate among hospitals and internal consistency reliability estimates comparable with previously developed CAHPS instruments. CONCLUSION: Although half the length of the original, the shorter CAHPS hospital survey demonstrates promising measurement properties, identifies variations in care among hospitals, and deals with aspects of the hospital stay that are important to patients' evaluations of care quality.