A Lay Health Advisor Program to Promote Community Capacity and Change Among Change Agents

Abstract

The Charlotte REACH 2010 project focuses on cardiovascular disease and diabetes among African Americans in a geographically defined community. The goal of the project is to create changes in individual behaviors, community capacity, change agents, and systemic policies and actions that will result in the reduction of health disparities related to cardiovascular disease and diabetes. The project consists of three main components: lay health advisors as change agents, targeted interventions (exercise, nutrition, smoking cessation, primary care), and environmental and systemic interventions. The purpose of this article is to describe the lay health advisor intervention using qualitative methodologies that were developed to document changes in community capacity and change among change agents. Lay health advisors report that they have internalized their role as a community advocate and have made positive changes in their own personal health behavior. Their understanding of the underlying causes of poor health has expanded to include social and institutional factors and they have begun to shift their emphasis toward advocacy for social and institutional change.

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…The Charlotte, NC, REACH 2010 program developed individual-and community-level interventions for 20 000 blacks residing in its recruitment communities. 336 Individual interventions targeted CVD health behaviors such as physical activity, diet, and smoking cessation. Community-level interventions included the following: launching of culturally specific mass media campaigns to raise awareness on healthy behavior, healthful food labeling in schools and restaurants, and introduction of local farmer's markets to increase healthy food access.…”

The Role of Peer Support in Diabetes Care and Self-Management

“…[60,65,67,85] In a program to support weight loss goals among older adults with type 2 diabetes, peer support facilitators met with groups of patients who had just completed an educational session with the dietitian. The peers were trained in group dynamics and facilitated interaction and discussion among the participants.…”

“…In North Carolina, the Charlotte REACH 2010 project is developing peer lay heath advisors (LHAs) as community change agents. [85] This model addresses the societal factors that influence individuals' ability to make healthy choices. While the LHAs provided support to individuals though support groups and community events, they also worked at the level of environmental and system change, e.g.…”

“…Yet, only a few of these studies have explored the mechanisms for the effectiveness of peer support interventions. [85,95] Those that have gathered qualitative information from participants in peer support interventions, [49,95,96] highlight the importance to participants of the role that peers play in providing sustained, non-judgmental support and encouragement. Because they have similar cultural backgrounds -and perhaps also share the experience of living with diabetes -peers can often bridge social barriers and distrust to a far greater extent than healthcare professionals.…”

Oral Health Disparities of Children among Southeast Asian Immigrant Women in Arranged Transnational Marriages in Taiwan

“…The 5-year Lay Health Advisor Approach to Promote Oral Health Program (LHA-POHP), aimed at promoting the oral health of new immigrant children, was first implemented in the Kaohsiung area in 2011. The LHA's strategies are feasible and effective for promoting health care, especially among disparate immigrant and children populations [Kim et al, 2004;Plescia et al, 2008]. Prior to this study, no oral health promotion programs for mixed marriage preschool children and their mothers were conducted.…”