Lessons Learned From a Community–Academic Initiative: The Development of a Core Competency–Based Training for Community–Academic Initiative Community Health Workers

摘要

Objectives. Despite the importance of community health workers (CHWs) in strategies to reduce health disparities and the call to enhance their roles in research, little information exists on how to prepare CHWs involved in community–academic initiatives (CAIs). Therefore, the New York University Prevention Research Center piloted a CAI–CHW training program. Methods. We applied a core competency framework to an existing CHW curriculum and bolstered the curriculum to include research-specific sessions. We employed diverse training methods, guided by adult learning principles and popular education philosophy. Evaluation instruments assessed changes related to confidence, intention to use learned skills, usefulness of sessions, and satisfaction with the training. Results. Results demonstrated that a core competency–based training can successfully affect CHWs’ perceived confidence and intentions to apply learned content, and can provide a larger social justice context of their role and work. Conclusions. This program demonstrates that a core competency–based framework coupled with CAI-research–specific skill sessions (1) provides skills that CAI–CHWs intend to use, (2) builds confidence, and (3) provides participants with a more contextualized view of client needs and CHW roles. Community health workers (CHWs) are frontline public health professionals who are trusted members of the communities in which they work. These trusting relationships enable them to “bridge cultural and social gaps between providers of health and social services and the community members they seek to serve.” 1 (p435) Therefore, CHWs are extremely valuable given the growth of minority and underserved populations whom health care providers often have difficulty reaching 2,3 and are increasingly recognized as effective resources for improving community health. However, little published information exists on CHW training programs and curricula that prepare CHWs involved in community–academic initiatives (CAIs) in which community members and organizations partner and collaborate with academic institutions on research studies, health interventions, and other programs. We outline the development and implementation of the New York University Prevention Research Center’s (NYU PRC’s) core competency–based CAI–CHW Training Program and report quantitative and qualitative evaluation results from the pilot training. The impetus for developing this competency-based CAI–CHW training program includes (1) national recognition of the CHW workforce, (2) efforts to identify CHW roles, and (3) a body of literature that stresses diverse training needs for CAI–CHWs. National organizations, such as the American Public Health Association and the Institute of Medicine, have recognized CHWs as effective and low-cost “community-based resources” that can be utilized to improve community health and well-being, reduce health disparities, and bridge the cultural and social barriers between underserved communities and the health care system. 2 (p195), 4 CHW leaders and supporters submitted a petition that was granted in 2009 by the Bureau of Labor Statistics to identify “community health worker” as a distinct Standard Occupational Classification, reflecting a desire to develop a nationally recognized definition for the work performed by CHWs. As recognition of the value of the CHW workforce continues to expand, CHW training programs will become increasingly significant and relevant. In 1998, the National Community Health Advisor Study established benchmarks on CHW workforce development and defined a set of key functional areas for CHW activity that were later fused into 7 essential CHW roles: bridging and providing cultural mediation between communities and health and social service systems; providing culturally appropriate health education and information; ensuring people get services they need; providing informal counseling and social support; advocating for individual and community needs; providing direct service, such as basic first aid and administering health screening tests; and building individual and community capacity. 5–7 Recent studies have identified additional roles for CHWs, including research. 8,9 Community–academic initiatives that seek to better understand and eliminate health disparities have integrated CHWs into their work because of CHWs’ unique “insider” status and access to accurate information in traditionally hard-to-reach communities. 10,11 The capacity of CHWs to become integral members of CAIs can be further enhanced by cultivating core competencies and skills that strengthen their understanding of the research process and the context in which health issues emerge. The movement toward developing a shared understanding of the essential roles of CHWs yields powerful information about the training needs of this workforce. Indeed, CHWs themselves express a desire for core competency–based training rather than just problem-spe