Culturally-Relevant Strategies to Build Capacity Among Community Health Workers: Lessons From Alaska

Abstract

Context: Culturally-relevant health promotion with community health workers (CHWs) is an opportunity to reduce health inequities. This dissertation explores the development, implementation, and evaluation of CHW interventions in Alaska tailored to vulnerable populations to promote health behavior change that contributes to chronic disease. Methods: This work was guided by the principles of Community-Based Participatory Action Research, honored Indigenous Ways of Knowing, and was grounded in Empowerment Theory. To explore a framework for culturally-relevant online education, the project team conducted: a focus group of Alaska Native education experts, key informant interviews of culturally and geographically diverse Alaska CHWs and their instructors/supervisors, a key stakeholder survey, and a literature review on distance-delivered education with Alaska Native or American Indian people. Findings informed the development of ten culturally-relevant online cancer education modules. A total of 428 end-of-module evaluation surveys were completed by 89 unique Alaska CHWs between January and December 2016. To study the implementation of a CHW intervention to support breastfeeding among Alaska WIC clients, 33 Women, Infants, and Children (WIC) staff/CHWs were interviewed, 25 WIC clients participated in five focus groups, and 129 clients completed surveys. Qualitative data was recorded, transcribed, and coded and analyzed in Atlas.ti. Quantitative data was summarized in Microsoft Excel. Conclusions: Findings describe a framework for culturally-relevant online education that includes: collaborating with learners; delivering content in relevant ways, such as through personal stories, interactivity, and visuals; contextualizing information as relevant to learners’ unique realities; and connecting learners to build relationships. As a result of completing the developed culturally-relevant online modules, learners reported they were empowered to share cancer information with their patients, families, friends, and communities, and to engage in personal cancer risk reduction behaviors such as eating healthier, getting cancer screenings, exercising more, and quitting tobacco. The implementation of a CHW-supported breastfeeding program reveals novel documentation and outreach strategies, including texting and online support groups. Findings provide opportunities for further research to test the proposed culturally-relevant online education framework and investigate health behavior change with CHW patients. Findings are potentially translatable to other culturally-relevant interventions with CHWs to promote health.