The Role of Lay Health Advisors in Cardiovascular Risk Reduction: A Review

Abstract

Interventions are needed to reduce the negative impact of cardiovascular disease. The combination of health risks for disease, disability, and mortality, particularly among underserved populations, might be best addressed with programs designed to enhance awareness and development of resources within a context of community support. The objectives of this review were to: (1) provide a comprehensive review and evaluation of the roles, evaluation, and effectiveness of LHA in community-based programs with an emphasis on cardiovascular risk reduction; and (2) provide recommendations for future research involving LHA in such programs. Computer and manual searches were conducted of articles in the English-language literature from 1980 to 2007. Twenty articles were evaluated, which emphasized the role of the LHA in cardiovascular risk reduction. A review of research literature provides a starting point for determining salient approaches for intervention and evaluation, issues related to program implementation and sustainability, and strengths and limitations of existing approaches.

Increasing Knowledge of Cardiovascular Risk Factors Among African Americans by Use of Community Health Workers: The ABCD Community Intervention Pilot Project

“…In a longitudinal, multicenter trial involving 32 churches and CHWs to deliver educational sessions and biweekly counseling on CVD risk (obesity, physical activity) to African American women over a 4-month study period, there were significant changes in knowledge of signs, symptoms, and CVD risk factors within the intervention group. 21 Similarly, a randomized, controlled trial of an intensive diabetes mellitus self-management intervention (individual counseling, 12 group sessions, monthly telephone calls, and postcard contact) showed a significant decrease in HbA 1c within the intervention group, although there was no significant difference in HbA 1c change between the intervention and the control group (which received pamphlets in a setting of an African American church). 22 The fact that measures of global health literacy (s-TOFHLA) did not change significantly in a short-term, low-intensity intervention is not unexpected, since such knowledge and literacy are acquired over a lifetime.…”

A systematic review of the effectiveness and cost-effectiveness of peer-based interventions to maintain and improve offender health in prison settings

“…The range of outcomes identified, including increased knowledge and awareness, the uptake of preventative and treatment services, health behaviour change and psychosocial outcomes, mirror those found in other reviews of peer educators/lay health advisors. 34,[247][248][249] There remains scope for more robust quantitative research studies on the effects of peer support, which is well justified CONCLUSIONS NIHR Journals Library www.journalslibrary.nihr.ac.uk theoretically. 94 In terms of contributing to the evidence base for lay-led NHS models, although there was some limited evidence on prison health trainers, there were no studies in the review on lay-led self-care interventions to complement research on the English Expert Patient Programme.…”

The role and influence of ‘Champions’ in a community-based lifestyle risk modification programme

“…There is growing recognition of the importance of enabling and utilising community resources and support systems and building partnerships with community stakeholders (Eng, Rhodes, & Parker, 2009;Foster, et al, 2008). Interventions led by Lay Health Advisors (LHA) have gathered increasing recognition as an effective strategy for health promotion, disease prevention and chronic disease self-management at the community level (Fleury, Keller, Perez, & Lee, 2009;Lorig, Hurwicz, Sobel, Hobbs, & Ritter, 2005;Quinn & McNabb, 2001;Rhodes, Foley, Zometa, & Bloom, 2007).…”

“…Without formal qualifications as health care professionals, they are trained to provide information and support and to motivate their community partners or peers. These interventions offer a powerful means of addressing health-related attitudes, beliefs, and social norms within a social network, particularly for hard-to-reach population groups (Fleury, et al, 2009). The role of LHAs can be multi-faceted: they serve as a liaison between community members and providers; promote community advocacy and capacity building; provide cultural mediation, counselling, social support and culturally appropriate health education; promote attendance at appointments and adherence to medication and other medical regimens and promote delivery of direct health care services (Andrews, Felton, Wewers, & Heath, 2004;Fleury, et al, 2009).…”