Recruitment, Training Outcomes, Retention, and Performance of Community Health Advisors in Two Tobacco Control Interventions for Latinos

Due to barriers associated with healthcare access and culturally appropriate smoking cessation treatment, Latinos may experience an increased disease burden related to smoking and environmental tobacco smoke (ETS) exposure. Innovative efforts to reduce tobacco use and ETS exposure in the Latino community must be considered an important health priority. Community Health Advisors (CHAs) are trusted, indigenous lay health advisors who are members of existing social networks within communities. With training, these individuals can create health awareness, disseminate health information and support behavior change in their communities. The CHA approach is important to special populations such as monolingual Spanish-speaking Latinos who are generally less acculturated and may not benefit from mainstream health promotion efforts. Although CHAs have been used to deliver health care and health promotion in the U.S. for several decades, few studies have documented the characteristics, recruitment, training effectiveness, and performance of CHAs. The present study reports such data for 36 southern California CHAs (i.e., promotores) recruited and trained to deliver either a home-based smoking cessation program for Spanish-speaking adult smokers, or a home-based behavioral problem-solving intervention to reduce ETS exposure among low-income Latino children.

In addition to sociodemographic characteristics, Spanish-language measures collected from CHAs before and after training included general self-esteem, general self-efficacy, smoking cessation/ETS knowledge, and 7 psychosocial constructs related to behavior/attitude change including (a) anticipated outcomes with regard to ETS reduction and smoking cessation, (b) emotional reactions toward working with people to reduce ETS and to quit smoking, (c) intentions to help others reduce ETS and to quit smoking, (d) the belief that environmental constraints with regard to ETS reduction and smoking cessation can be overcome, (e) perceived norms about helping others reduce ETS and quit smoking, (f) self standards with regard to helping others reduce ETS and quit smoking, and (g) perceived self-efficacy with regard to helping others reduce ETS and quit smoking. All CHAs completed all measures (i.e., smoking cessation CHAs completed ETS-related items, and vice-versa). These comparison measures allowed the researchers to better evaluate the effectiveness of the training in the specific area of training.

Results demonstrated that the two groups of CHAs were similar in terms of sociodemographic characteristics. Of the 35 women and 2 men recruited, 65% had some high school education, 65% reported a monthly household income of less than $1,500, and 88% were originally from Mexico. The average CHA age was 44 years. There were pre-to-post training changes in knowledge and psychosocial constructs in a direction generally consistent with training—that is, smoking cessation CHAs showed positive changes on cessation measures but not on ETS measures, and vice-versa for ETS CHAs. Other measures showed differential change: ETS CHAs showed changes in general self-esteem and self-efficacy, while the smoking cessation CHAs did not.

Additional qualitative and quantitative data will be presented regarding CHA retention, expert-rated performance of CHAs, and changes in actual research participants' ETS and cessation behavior. Overall, this information may aid in planning for recruitment and evaluation of CHAs for future social welfare and health programs.