Trust and Mistrust in Shaping Adaptation and De-Implementation in the Context of Changing Screening Guidelines

Objective: To understand barriers and facilitators to the adaptation of programs reflecting changing scientific guidelines for breast/cervical cancer screening, including factors influencing the de-implementation of messaging, program components, or screen­ing practices no longer recommended due to new scientific evidence.Design and Methods: We conducted a con­vergent mixed-methods design in partnership with The National Witness Project (NWP), a nationally implemented evidence-based lay health advisor (LHA) program for breast/cer­vical cancer screening among African Ameri­can (AA) women. Surveys were conducted among 201 project directors (PDs) and LHAs representing 14 NWP sites; in-depth interviews were conducted among 14 PDs to provide context to findings. Survey data and qualitative interviews were collected concur­rently from January 2019-January 2020.Setting: National sample of NWP sites from across the United States.Results: Trust and mistrust were important themes that arose in quantitative and qualita­tive data. Common concerns about adapting to new guidelines included: 1) percep­tions that new guidelines misalign with the personal values and beliefs of AA women; 2) mistrust of guidelines, providers, medical organizations; 3) confusion about inconsis­tent guidelines and concern they are based on studies that don’t reflect the experience of AA women (who experience more aggressive tumors at younger ages); and 4) belief that breast self-exam (BSE) is an empowerment tool for AA women and should be included to promote awareness, given many women discovered lumps/cancer through BSE.Conclusion: Findings highlight that trust and mistrust are important but understudied social determinants of health among AAs that should be considered in implementation science as they: 1) have critical implications for shaping health inequities; and 2) help ex­plain and contextualize why new screening guidelines may not be fully embraced in the AA community.Ethn Dis. 2021;31(1):119- 132; doi:10.18865/ed.31.1.119

Peer Leaders Increase Organ Donor Designation Among Members of Historically African American Fraternities and Sororities

Introduction: Health education programs can positively impact organ donor designation among African Americans, a disproportionately represented group on the transplant waiting list. Alumni chapters of historically African American sororities and fraternities are a novel setting for organ donation education and research. Research Questions: This study tested the effectiveness of a lay health advisor model to increase donor designation registrations on the Michigan Organ Donor Registry among members of Midwest alumni chapters. The secondary outcome was change in attitudes toward donation assessed by pre–post questionnaire. Design: Sorority/fraternity members were trained to deliver educational presentations during a 12-month period. Follow-up messaging consisted of tailored newsletters and e-mails. A cluster randomized design was utilized with 25 chapters (16 sororities and 9 fraternities) assigned to intervention (organ donation) or comparison (chronic disease). Results: Odds of signing up for the donor registry were 1.45 times higher for the intervention group than the comparison group. Among those identified as nondonors at baseline, the odds of signing up were 1.58 times higher for intervention than comparison. Discussion: Using lay health advisors in African American sororities and fraternities can increase enrollment in a donor registry. Alumni chapters offer a unique and viable setting for organ donation education and research; relationship building with chapter officials is key to success.

Evaluating the Effect of a Community-Based Lay Health Advisor Training Curriculum to Address Immigrant Children's Caries Disparities

Previous programs had not designed the culturally adequate Lay Health Advisor (LHA) oral health training curriculum for medically underserved population. We evaluated the effects of LHA training curriculum for addressing immigrant children's caries disparities in their access to dental care. We used a pre/post-test study design. Immigrant women were recruited from churches, schools, and immigrant centers in an urban area. Four training classes were held. Each training cycle lasted 15 consecutive weeks, consisting of 1 weekly 2-h training session for 12 weeks followed by a 3-week practicum. The curriculum included training in caries-related knowledge, oral hygiene demonstrations, teaching techniques, communication skills, and hands-on practice sessions. Thirty-seven LHA trainees completed the course and passed the post-training exam. The data were collected using self-report questionnaires. The level of oral health knowledge, self-efficacy and attitudes toward oral hygiene were significantly increased after LHA training. There was a significant and over twofold increase in trainees' oral hygiene behaviors. An increase of >20% in LHA and their children's dental checkup was observed following training. After training, LHAs were more likely to have 3+ times of brushing teeth [Odds Ratio (OR) = 13.14], brushing teeth 3+ minutes (OR = 3.47), modified bass method use (OR = 30.60), dental flossing (OR = 4.56), fluoride toothpaste use (OR = 5.63) and child's dental visit (OR = 3.57). The cross-cultural training curriculum designed for immigrant women serving as LHAs was effective in improvement of oral hygiene behaviors and access to dental care.