Teaching health advocacy to medical students: a comparison study.

CONTEXT: Many encourage service learning and health advocacy training in medical student education, but related evaluation is limited. OBJECTIVES: To assess (1) impact of a required community health advocacy training for medical students on student attitudes, knowledge, and skills; (2) student characteristics associated with higher advocacy knowledge and skills; and (3) perspectives of community-based organizations (CBOs). DESIGN: Cross-sectional surveys. SETTING: University of Miami Miller School of Medicine (UMMSM) Regional Medical Campus and main campus. PARTICIPANTS: Medical students at both UMMSM campuses. INTERVENTION: Required community health advocacy training for first- and second-year students including classroom experiences and hands-on project in partnership with a CBO. MAIN OUTCOME MEASURES: Student characteristics, health advocacy-related attitudes, self-reported and objective knowledge, and skills. Scores were compared between campuses, with multivariable modeling adjusting for individual student characteristics. Community-based organization perspectives were assessed via separate surveys. RESULTS: Ninety-eight (77%) regional campus students (intervention group) and 139 (30%) main campus students (comparison group) completed surveys. Versus the comparison group, the intervention group reported greater: mean knowledge of community health needs: 34.6 versus 31.1 (range: 11-44, P \u3c .01), knowledge about CBOs: 3.0 versus 2.7 (range 1-4, P \u3c .01) and knowledge of community resources: 5.4 versus 2.3 (range, 0-11, P \u3c .01), and mean skill scores: 12.7 versus 10.5 (score range: 4-16, P \u3c .01), following the intervention. Using adjusted analysis across both groups, female gender was associated with higher attitudes score. High level of previous community involvement was associated with higher attitude and skill scores. Higher self-reported educational debt was associated with higher skill scores. Community-based organization perspectives included high satisfaction and a desire to influence the training of future physicians. CONCLUSIONS: Medical student advocacy training in partnership with community-based organizations could be beneficial in improving student advocacy knowledge and skills in addressing community health issues and in developing sustainable community partnerships

Aligning systems science and community-based participatory research: A case example of the Community Health Advocacy and Research Alliance (CHARA).

Partnered research may help bridge the gap between research and practice. Community-based participatory research (CBPR) supports collaboration between scientific researchers and community members that is designed to improve capacity, enhance trust, and address health disparities. Systems science aims to understand the complex ways human-ecological coupled systems interact and apply knowledge to management practices. Although CBPR and systems science display complementary principles, only a few articles describe synergies between these 2 approaches. In this article, we explore opportunities to utilize concepts from systems science to understand the development, evolution, and sustainability of 1 CBPR partnership: The Community Health Advocacy and Research Alliance (CHARA). Systems science tools may help CHARA and other CBPR partnerships sustain their core identities while co-evolving in conjunction with individual members, community priorities, and a changing healthcare landscape. Our goal is to highlight CHARA as a case for applying the complementary approaches of CBPR and systems science to (1) improve academic/community partnership functioning and sustainability, (2) ensure that research addresses the priorities and needs of end users, and (3) support more timely application of scientific discoveries into routine practice

Creating and Managing Change Through Comprehensive School Health Programs

In 1994, Public Education Network (PEN) entered into a cooperative agreement with the Centers for Disease Control and Prevention, Division of Adolescent and School Health (CDC/DASH) to integrate comprehensive school health programs (CSHP) into a larger, systemic school reform effort at the local and national levels. Under this agreement, PEN worked with and provided funds ($20,000 each year over a three-year period) to five local education funds (LEFs) to conduct local projects that would establish, enhance, and/or institutionalize school health programs within their districts -- and in the case of one LEF, throughout the state.This report documents the process by which the LEFs were able to create and manage changes in the community brought about by their local school health programs

Developing an Action Learning Community Advocacy/Leadership Training Program for Community Health Workers and Their Agencies to Reduce Health Disparities in Arizona Border Communities

Community health workers (CHWs) make unique and important contributions to society. They serve as patient advocates, educators, and navigators in our health care system and a growing body of research indicates that they play an important role in the effective delivery of prevention and treatment services in underserved communities. CHWs also serve as informal community leaders and advocates for organizational and community change, providing valuable insiders\u27 insights about health promotion and the interrelatedness of individuals, their community, its institutions, and the surrounding environment. Accion Para La Salud or Action for Health (Accion) is a CDC-funded community based participatory research (CBPR) project addressing the social determinants of health affecting health-related behaviors with the ultimate goal of creating a mode in which community advocacy to address the systems and environmental factors influencing health is integrated into the role of CHWs working in chronic disease prevention. Kingdon\u27s three streams theory and the social ecological model provide an overarching conceptual framework for Accion. The curriculum and training are also grounded in the theory and principles of action learning, which emphasizes learning by doing, teamwork, real-world projects, and reflection. The curriculum was delivered in four workshops over thirteen months and included longitudinal team projects, peer support conference calls, and technical assistance visits. It is now being delivered to new groups of CHWs in Arizona using a condensed two-day workshop format

Barbers Against Prostate Cancer: A Feasibility Study for Prostate Cancer Education in an Urban African American Community

The goal of this pilot study was to assess the feasibility of training barbers to deliver a brief culturally and literacy appropriate prostate cancer educational intervention to urban African American men. Eight barbers received training to deliver a 2-month educational intervention in the barbershop and completed pre- and posttest training assessments. The training workshops led to a significant increase in mean prostate cancer knowledge scores among the barbers (60% before vs. 79% after; P \u3c 0.05). The barbers also reported positively on the intervention in terms of satisfaction and relative ease of engaging clients. Training barbers to deliver a prostate cancer educational intervention is a feasible strategy for raising prostate cancer awareness of the disease among a priority population

Legal Paraprofessionalism and Its Implications: A Bibliography

If access to legal services is thus essential for the attainment of democratic values, then the efficacy of the legal delivery system is of supreme importance. Much has been written examining the inefficiency of present methods of law practice as a means of conveying services to the consumer,\u27 and still more written decrying the shortage of basic legal services for the poor and for the middle class.\u27 In response to this criticism and as a way of meeting other needs, the profession is trying such new delivery systems as group legal services, prepaid legal insurance, and specialized practice. Additionally, there has been a virtual explosion of interest in using legal paraprofessionals to assist the lawyer in supplying legal services. The conceptual foundations of this bibliography thus proceed from these theses: that there are grave concerns for the efficacy of the legal services delivery system and for its ability to meet greatly increasing demands for legal services; and that, in response to these concerns, an attempt is being made to reform the delivery system by incorporating legal paraprofessionals into the delivery mechanism