Serving as a Lay Health Advisor: The Impact on Self and Community

DESCRIPTION (provided by applicant): Addressing cancer-related disparities is a national priority. Racial/ethnic and socioeconomic disparities in cancer morbidity and mortality are striking, with African American and low-income populations carrying a disproportionate burden of disease. Eliminating cancer disparities will require dissemination of community- based programs that increase screening adherence among racial/ethnic minority and low-income populations. Community-based Lay Health Advisor (LHA) programs hold tremendous promise for improving the health of underserved populations. The Witness Project is one example of a LHA program that effectively increases breast cancer screening and early detection among lower-income African American women, and continues to be disseminated nationally. Although LHA programs may be effective in meeting the health needs of medically underserved communities, evaluations of these programs have been singularly focused on individual changes among program participants who receive LHA services. We have much to learn from the experiences of LHAs, who are influential community insiders that contribute to the education and empowerment of their communities. However, very little research has been conducted to understand the impact of these programs on LHAs themselves, including the benefits and challenges that stem from their new role, and whether the new skills and competencies they develop extend to other areas of their lives. To address these gaps in understanding, we propose to conduct an exploratory study among up to 80 African American LHAs from the National Witness Project over a two-year period. The sample will be composed of LHAs who are currently active in their role, as well as newly hired LHAs and those who choose not to continue in that role. This study will provide opportunities to: 1) understand the experiences, benefits and challenges faced by LHAs;2) investigate skills and competencies that make LHAs effective and factors that support their retention in the program;and 3) explore how LHAs apply new skills and competencies outside of the program, with potential benefits to program recipients as well as LHAs and their broader communities. The longitudinal study design and combination of qualitative and quantitative methods (in-depth interviews, surveys, and program-level data) is ideally suited to achieve our research aims. This research is timely given that in our current economic context, use of LHAs and other volunteers to facilitate cancer screening and improve health behaviors is becoming increasingly common. The proposed pilot study is a crucial first step towards improving the recruitment, training, evaluation and retention of LHAs in future programs, with the goal of maximizing program reach and impact. This study would serve as the foundation for a larger research initiative to improve LHA programs, with the goal of eliminating health disparities by building the leadership and capacity of traditionally underserved and low-income communities.