Cardiovascular disease training for community health workers serving native Hawaiians and pacific people

Abstract

It has been well documented that Native Hawaiians and other Pacific Peoples (NHPP) are disproportionately affected by cardiovascular disease (CVD) in the United States, and particularly in Hawaiʻi. Nationally, community health workers (CHW) have been shown to be effective in delivering CVD self-management education. They are utilized by clinics and health agencies for individual and group education, as well as in case management and outreach; however, they are often hired with no formal health education and with limited clinical experience. In Hawaiʻi, CHW are used extensively in community health centers (CHC) and throughout the Native Hawaiian Healthcare System (NHHS). A 2008 needs assessment of 19 CHC and the NHHS identified the training of CHW in CVD as a top priority. The focus of this thesis was to further develop and evaluate a CVD training program tailored specifically for CHW serving NHPP. A community-based participatory research (CBPR) framework was utilized to both identify this priority and guide the development of a training program. Our efforts were motivated by the hypothesis that CHW knowledge in CVD could be increased, and subsequently retained, through training that is both culturally competent and interactive. Specific aspects of culture-based education (CBE) were systematically incorporated throughout the development of the training. The resulting product, "Heart 101," is a 5-hour long training seminar that is taught by a multidisciplinary team and balances a PowerPoint guided lecture with interactive class games, group discussions, and role-play scenarios. To date, Heart 101 has been delivered nine times, reaching 162 individuals, primarily CHW. For our evaluations we examined participants from three training seminars held during 2010. Identical pre-, post-, and 6-month post-training CVD knowledge tests were administered to seminar participants to assess gain and retention of CVD knowledge. Additionally, participants were also asked to complete a satisfaction survey. The results of our analyses of changes in mean test scores revealed both significant gains in CVD knowledge from pre-to post-seminar, as well as retention of that knowledge measured at 6-months post-training. Participant feedback about their experience in Heart 101 was overwhelmingly positive. A subsequent analysis to investigate knowledge change by CVD subtopics compared the frequency of correct answers by question from pre-to post-seminar. Although there were clear increases in knowledge for all subtopics reviewed, we also found baseline understanding among participants to be stronger in clinical knowledge as opposed to that of the basic sciences. This finding provides us with a basis to strengthen the Heart 101 curriculum and may serve as a guide for the development of future CHW training programs. The demonstrated success of Heart 101 has positive implications for the standardization of CHW education and their professional development. Our findings show that a CHW training program like Heart 101 can be effective in providing the necessary tools for the further development of this important and growing segment of the healthcare workforce. As the utilization of CHW in efforts to ameliorate health disparities increases, so will the importance of their ability to assist in the delivery of chronic disease management directives.