Lay educators fill gaps in health care delivery
Here’s how to find, train, and use lay educators
Innovative disease management and prevention programs nationwide are using lay educators to provide health information to hard-to-reach populations, which not only reduces medical costs, but also improves patients’ overall health.
"Lay educators are a wonderful vehicle for managed care companies to improve the health of whole communities," says Georgia Robins Sadler, BSN, MBA, PhD, associate professor of surgery and associate director of outreach at the University of California at San Diego Cancer Center (UCSDCC) in La Hoya. Sadler oversees a breast cancer prevention and screening program that pays African American cosmetologists a small stipend to provide health information to their clients.
"We wanted to partner with trusted members of the community who had access to women on a regular and intimate level," Sadler explains. "The beauty of our approach is that women go back every few weeks to see their cosmetologist. The health messages can be reinforced."
An atmosphere of trust
Finding the appropriate lay educators to partner with is an essential first step in setting up a community health education effort. "We went to the natural leaders of the community. We talked to the ministers of the churches, politicians, nurses, any and all respected members of the community. We asked for their advice in selecting lay educators who were trusted members of the community," Sadler says.
"Local churches are an excellent source for finding lay educators," agrees Maryjane Henning, BSN, MPA, director of MotherNet America in Sterling, VA, a maternal and child health company that trains lay educators to deliver prenatal information in communities nationwide. "Basically, you want to look for people that are trusted by the members of the community and are natural communicators. You must find someone with credibility. It helps if you find individuals who have been through similar experiences and faced similar challenges as your target population."
It is important that lay educators come from the community they will serve, says Georgia E. Perez, field coordinator for the Native American Diabetes Project of the University of New Mexico in Albuquerque. "We are working closely with tribal leaders to identify members to come for the diabetes team training. We’ve had tribal leaders and tribal council members come for training. We’ve also had people working with the tribal Head Start programs or tribal health services programs."
"Human beings are simply more likely to listen to someone they identify closely with," says Larry Ouellet, PhD, research director for community outreach intervention projects at the School of Public Health at the University of Illinois in Chicago, which operates a street outreach project to educate IV drug users about HIV prevention. "People are more open to an individual with similar life experiences making recommendations or trying to assist them with behavior change. This is even more true for individuals who have been societal outcasts and think everything is hopeless."
As you screen potential lay educators, there are several characteristics to look for in a candidate, Sadler adds. "Look for a civic mindedness and passion for helping others. You want to see a spiritual side that says we can do more for our community if we try harder to make the world a better place."
Lay educators serve as valuable role models who tell members of a community that they too can succeed with behavior modification efforts, say program directors. "There’s that feeling that if they can do it, then I can do it," Ouellet says. "Using peers to deliver health education messages adds credibility and offers hope for success."
To succeed, lay educators also need a message that appeals to the target population. "We worked very hard to develop a diabetes curriculum that was very sensitive to Native American culture, traditions, and values," Perez explains. The Native American Diabetes Program developed a program called "Strong in Body and Spirit," which relies heavily on Native American storytelling traditions to deliver its health messages.
"We start the program with a story titled, Through the Eyes of the Eagle,’ which depicts life as it was many years ago in a traditional hunting society. The story relates how diabetes was unknown in that time because Native Americans had an active lifestyle and ate traditional foods."
The UCSDCC program also relies on storytelling traditions to deliver health messages. "We asked an African American nurse and storyteller to observe our cosmetologists as they worked and talked with their clients to see how we could train the cosmetologists to introduce breast cancer prevention information into their conversations with clients," Sadler says. "She worked out little gimmicks the cosmetologists could use in their normal pattern of conversation."
Some of those gimmicks include:
• "I’ve got some good news and some bad news and some good news for you. The good news is that breast cancer is very treatable in the early stages. The bad news is that our sisters don’t often find their breast cancer in its early stages. The good news is that we can do something about the bad news."
• "I believe that, for whatever reason, I’ve been asked to pass this information on to you because someone else may need it. I think if I pass this information on to you it doesn’t mean that you’re going to get breast cancer, but you may know someone who has a problem and really be able to help them."
Cosmetologists in the UCSDCC program are given brochures to distribute to their clients. They also have breast models available for practicing self-exam and a bead necklace that represents the various size lumps commonly found in the human breast. "We used to keep the beads in a small box, but we had trouble with them falling on the floor until we strung them on a necklace," Sadler says.
UCSDCC also developed an in-depth notebook that uses graphics to introduce health information messages. "The pages are encased in plastic sleeves. It’s designed so that the client can lay the book open on her lap while the cosmetologist works on her hair, and they can look at the pages together and discuss them.
The buddy system
MotherNet lay educators receive a five-day training course and then keep a resource handbook to bring with them on home visits. The handbook covers well baby care, prenatal care, and child growth and development, Henning says. In addition to the five-day training, lay educators go out on several "buddy visits" with experienced lay educators, social workers, or nurses who mentor the lay educators. "Our training emphasizes that the lay educator is not a nurse or social worker. They are guests in the woman’s home and must not overstep their boundaries. Yet they are an important link in the chain of health care delivery," she explains. "We find that families use the lay educator visits as an entry into the health care system. They may start by talking about their prenatal care, but they also ask questions about their grandmother who has diabetes."
MotherNet’s prenatal lay educator program has been prodigiously successful. Henning says outcomes data from the Los Angeles program include the following:
• 100% of infants were immunized.
• Women in program experienced no repeat pregnancies.
• 60% of fathers were involved in prenatal and child care.
• 50% of new mothers returned to school.
• 20% of new mothers found employment.
• 95% of new mothers breast-fed initially.
This year, MotherNet is expanding its efforts to include other health issues for women. Mother-Net received a grant from Bristol Meyers Squibb in New York City to develop a women’s health initiative. Lay educators will be trained to expand their health education efforts to include:
• heart disease prevention and treatment;
• diabetes prevention and treatment;
• general health and wellness;
• living healthy lifestyles.
"I can’t stress enough how valuable this lay home educator movement is," Henning says. "We must embrace this movement. Lay educators fill the gaps between the health care delivery system and underserved communities. Too many communities are isolated either because they are rural or just overburdened. If we can get basic information about health care and community resources to these populations, the overall health of these communities will improve."
Finally, although some lay educator programs use volunteers, Sadler says it’s important to pay lay educators even if it’s only a token amount. "Our lay educators are women supporting children. We can’t ask them to do one more job without letting them know that we think what they’re doing is vital.
"We believe these lay educators are important advocates for health promotion and early detection," she adds. "They encourage their clients to come into the medical institutions for care before their disease is so aggressive that it’s too late. If they succeed, their whole community is going to be healthier. Paying them is our way of telling them that we think what they do is an important function."
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