Few studies have reported on LHA curriculum development, training, and evaluation for addressing cancer health disparities. This article fills a clear gap identified in a recent systematic review suggesting that few studies have documented use of CBPR approach in the development of LHA curriculum and selection of LHAs (O’Brien et al., 2009
). In addition, this article details content of general LHA training and the time needed to complete initial training. Given the complexity of cancer and health disparities as topics, we used a two-stage approach—separated the general skills training from the disease (cancer type) targeted training— consistent with observations reported by O’Brien et al. (2009)
. As such, this article may assist other cancer health disparities researchers who may wish to replicate or adapt our experiences. Furthermore, we discuss lessons learned: development of a LHA training curriculum, use of CBPR and equitable participation of community in decision making and resource sharing, stepped approach to general and disease specific training, importance of paid LHA positions versus volunteers, and future directions.
The value of the CBPR approach and community partner participation in decision making at all steps of the training process is apparent in the selection of curriculum modules, improvements to the curriculum and the pragmatic feedback that was received. Community partner feedback and evaluation of LHAs training infused nuances of culture and literacy components that improved the salience and usability of the curriculum. Moreover, with feedback of community partners, community members and LHAs, we adopted a stepped approach which called for implementing the general curriculum first and later conduct training on the cancer site specific modules (which had already been developed by a local organization). This improved feasibility and comfort level of LHAs, and reduced feelings of being overwhelmed about learning all these skills at once.
Despite the small number of LHAs trained, our experiences with the development of cancer health disparities training for LHAs in CEH are both unique and complementary to the few programs documented in the literature (O’Brien et al., 2009
; Reinschmidt & Chong, 2007
; Yu et al., 2007
). Although most LHAs employed for cancer-specific initiatives have been used in the setting of specific research projects (Wells et al., 2011
; typically focusing on one cancer site), our LHAs were primarily intended for general cancer health disparities outreach, education, and facilitation of screening access where indicated. In this regard, our LHAs had to muster a broad set of skills as well as disease specific knowledge in the different cancer sites. However, our results do compare to and parallel the lessons and challenges in the literature. These include the common challenges of role delineation, determining which role (volunteer, part time, or full time) is best suited for the project, and effectively recruiting and hiring individuals who are vested in working in their communities (HRSA, 2007
; O’Brien et al., 2009
). Despite the obvious positive benefits, there remain many challenges to the “standardization and professionalization” of LHA training curricular and their work. For example, a standardized (one size fits all) curriculum may not be practical for all communities; some adaptation or tailoring is often needed for specific communities. Second, with the increased professionalization of a workforce comes the challenges of ensuring employment opportunities, need for centralized resources for developing and implementing certification and monitoring standards. Another local challenge faced by programs is how to define the scope of activity with regards to both the geographic scope to be covered and racial/ethnic-matching of LHAs to the population demographics. In the case of CEH, with three counties to be covered and diverse communities (race, ethnicity, language, and rural/urban, etc.) within and between counties, these issues remain ongoing challenges for our program. As a future direction for sustainability, in addition to the need for sufficient financial resources, there is need to explore the utility of career ladder and use of the “train-the-trainer” model to help disseminate effective programs. To achieve the latter, the current pilot LHA curriculum will be adapted by the CEH LHAs to offer training for volunteer LHAs or other LHAs employed at community-based organizations. The Florida CHW state-wide initiative is likely to aid with standardization and sustainability (Collins Center for Public Policy, 2011