Product Details

Author Information

Corresponding Author
Erin Kobetz
Universtiy of Miami Miller School of Medicine
1120 NW 14th Street
Suite 1033
Miami, FL 33136
United States
p: 3052431360
ekobetz@med.miami.edu

Authors (listed in order of authorship):
Erin Kobetz

Julia Seay

Janelle Menard

Hannah Lipshultz

Sarah Marsh

Jenny Blanco

Larry Pierre
Center for Haitian Studies, Patne en Aksyon

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Biological Sciences, Medicine, Public Health, Social Work

What specific topics does your product address?

Access to health care, Cancer, Communicable diseases, Community engagement, Community-based education, Cultural competency , Curriculum development, Education, Employment, Epidemiology, Health disparities, Health education , Health equity, Immigrant/refugee health, Women's health , Community-based participatory research

Does your product focus on a specific population(s)?

Immigrant, Women

What methodological approaches were used in the development of your product, or are discussed in your product?

Community needs assessment, Community-academic partnership, Community-based participatory research , Participatory evaluation, Participant observation

What resource type(s) best describe(s) your product?

Manual/how to guide, Training material

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

Public health strategies to attenuate health disparities are most effective when developed, and implemented, with the guidance of community members. One such strategy includes building community capacity through training indigenous community members, such as Community Health Workers (CHWs), to make meaningful contributions to health disparities research in their own communities. As part of a campus-community collaboration known as Partners in Action (Patnè en Aksyon, in Haitian Kreyol), formed in 2004 to address cancer disparities in Little Haiti, Miami, we developed a set of iterative, detailed instructional modules, contained within one training manual, to guide instruction in basic health research methods for lay CHWs. These modules facilitate the training of lay CHWs to deliver a cervical cancer intervention via an educational flipchart. In addition, this manual is intended to prepare these workers to contribute to research through consenting participants and gathering data. Grounded in the principles of Community-Based Participatory Research (CBPR), the modules were developed with substantial community contributions ensuring they appropriately met CHW needs and preferences, as well as, enhanced CHW and community capacity to support research. Though first used to train CHWs by the academic members of Partners in Action, the modules are intended for use in a train-the-trainer format, in which CHWs, who have received the training and implemented the skills, may then use the modules to train other CHWs. The purpose of the training is to augment the skill set of CHWs so that they may meaningfully take part in, and help to shape, public health research and discourse in their community. Our training format is adaptable to other populations and research questions, and for use among academic and community-based organizations alike.

2. What are the goals of the product?

This product includes both long- and short-term goals, which reflect a mutual commitment among Partners in Action members to reduce the excess burden of cancer in Little Haiti as well as improve the overall health and lives of neighborhood residents. As such, specific long-term goals include the following: 1) To build community capacity for conducting research that will result in direct measurable benefits to the community; 2) To cultivate new skills among indigenous CHWs that may translate into educational capital that may help secure future employment; 3) To continue to lay the foundation for future collaborations to effect positive health and social change in Little Haiti, and 4) To aid in interventions to reduce cervical cancer disparities in Haitian women More proximal, immediate goals of the training modules include: 1) To enhance the skill set of Haitian CHWs through instruction in basic public health research and data collection methods related to cervical cancer screening and prevention ; and, 2) To improve the quality of research data collected. Collectively, these goals are intended to ultimately help attenuate health disparities in Little Haiti as well as other Diaspora communities in the United States and abroad. Beyond these goals, the product serves as a strategy for effectively integrating CHWs into research design and delivery. CHWs have not historically contributed to research, though having them do so may improve the relevance of study findings. CHWs’ intimate familiarity with community norms and practices surrounding health should ensure that research implementation is community competent, and appropriately reflects the historical, cultural, linguistic, and social determinants that shape community health and the distribution of disease. Integrating CHWs into study design is also an effective strategy for circumventing barriers to research, prevalent in Little Haiti and other communities, where researcher interests have not consistently met resident needs. Perhaps most importantly, involving CHWs in study implementation achieves an important aim of CBPR to have community members actively contribute at all phases of the research process from study conceptualization to dissemination of findings. Many CBPR initiatives struggle to effectively integrate community partners into data collection. Training CHWs to participate in research provides on strategy to accomplish this end and, in so doing, helps build necessary capacity to support future research and social change.

3. Who are the intended audiences or expected users of the product?

Training modules are primarily for use with lay CHWs indigenous to the Little Haiti community, although the modules’ format is adaptable for use with other, similar CHWs or community members. A lead trainer delivers the educational content of each workshop. A trainer is someone who is knowledgeable about the activities and flow of each module, as well as, has experience with the research methods presented in the module. Trainers may be academic or community partners. Various moderators can be used to lead module exercises and group learning activities. For each session, learning objectives are stated at the beginning of the session and re-visited at the session’s end to remind participants of the session’s intent. This provides opportunity to revisit any content not appropriately covered.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

Training content/delivery should be developed with meaningful input from community members, to ensure that important concepts will resonate with session participants. Generally, due to the content of the training and conservative Haitian cultural norms, female trainers should be used to train the AF. Training sessions can be easily modified to reflect such input and/or to accommodate a different health topic. Though the training shared here is oriented around cervical cancer, the modules can be easily adapted to address a new health focus, integrate more visual aids, and/or participatory activities based on participant and community learning preferences. Training should be conducted in a venue that is both comfortable and familiar to participants. Following sessions, participants are given the chance to reflect on the positive/negative aspects of the session and to offer necessary feedback for enhancing future sessions.

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

Our CHW training strategy is based on principles of emancipatory education as articulated by Paolo Freire (1), through which participatory learning methods build skills and research capacities within CHWs and promote a reciprocal exchange of community experiential and academic knowledge. Our educational approach is coupled with CBPR methods, in which the community is entrenched in the research process from the beginning, through to project evaluation, in efforts to address cancer disparities (2, 3). The integration of these paradigms has been successful in developing strategies to attenuate health disparities and foster community empowerment (4, 5, 6). Our product reflects the intersection of these two paradigms that guide our larger goals of achieving health equity in Little Haiti.Our work also adds to the existing literature on the various roles of CHWs in health disparities research/outreach. In medically underserved communities, CHWs historically have filled key roles in locally promoting health to effect sustainable change in community members’ health knowledge and behaviors. In such roles, CHWs have served as health educators and promoted awareness for disease prevention and early detection. They have also traditionally served as health advocates, who help to facilitate access to social and health care services (7, 8). CHWs address a broad range of issues, from reducing infectious diseases and promoting family planning in developing countries (9,10), to assisting domestically with chronic disease management (11, 12, 13), to increasing immunization uptake (14), to fostering increased community participation in secondary prevention for early disease detection (15, 16, 17). As “natural helpers” who reside in the communities they serve, CHWs are trusted and respected by peers for offering support (18, 19). In these traditional outreach roles, increases in health knowledge, awareness and participation in health screenings have been demonstrated among immigrant and ethnic minority women through the inclusion of CHWs as educators and advocates for health (20-23). More recently, CHW roles have been expanded to include aspects of conducting public health research, notably as key figures in intervention development and implementation (24). Published examples of using CBPR to train and integrate CHWs into community health researcher roles are few (cf. 25-27); yet, such integration has long been advocated in nursing and public health fields for the benefits CHWs can bring to the research process (28). Our manual helps fill this gap.

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

1. Freire, P. (1970). Pedagogy of the Oppressed. New York: Continuum.
2. Minkler, M., and Wallerstein, N. (2008). Community-Based Participatory Research for Health: From Process to Outcomes. San Francisco: Jossey-Bass.
3. Minkler, M. (2005). Community-based research partnerships: Challenges and opportunities. Journal of Urban Health 82(2): ii3-ii12.
4. Wallerstein, N., and Duran, B. (2006). Using community-based participatory research to address health disparities. Health Promotion and Practice 7(3):312-323.
5. Wallerstein, N. (1996). Powerlessness, empowerment, and health: implications for health promotion programs. American Journal of Health Promotion 6(3):197-205.
6. Wallerstein, N., and Bernstein, E. (1988). Empowerment education: Freire's ideas adapted to health education. Health Education Quarterly 15(4):379-94.
7. Brownstein, J.N., Bone, L.R., Dennison, C.R., Hill, M.N., Kim, M.T., Levine, D.M. (2005). Community health workers as interventionists in the prevention and control of heart disease and stroke. American Journal of Preventive Medicine 29(5, Suppl 1):128-33.
8. Ingram, M., Sabo, S., Rothers, J., Wennerstrom, A., & de Zapien, J.G. (2008). Community Health Workers and Community Advocacy: Addressing Health Disparities. Journal of Community Health 33(6):417-24.
9. Harvey, S.A., Jennings, L., Chinyama, M., Masaninga, F., Mulholland, K., Bell, D.R. (2008). Improving Community Health Worker use of malaria rapid diagnostic tests in Zambia: package instructions, job aid and job-aid-plus-training?10. Stanback, J., Mbonye, A.K., Bekita, M. (2007). Contraceptive injections by community health workers in Uganda: A nonrandomized community trial. Bulletin of the World Health Organization 85(10):768-73.
11. Cherrington, A., Ayala, G., Amick, H., Allison, J., Corbie-Smith, G., Scarinci, I. (2008). Implementing the Community Health Worker Model Within Diabetes Management: Challenges and Lessons Learned From Programs Across the United States. The Diabetes Educator 34: 824-833.
12. Friedman, A.R., Butterfoss, F.D., Krieger, J.W., Peterson, J.W., Dwyer, M. wicklund, K. Rosenthal, M.P., Smith, L. (2006). Allies community health workers: Bridging the gap. Health Promption and Practice 7(2 Suppl):96S-107S.
13. Thompson, J.R., Horton, C., Flores, C. (2007). Advancing diabetes self-management in the Mexican American population: a community health worker model in a primary care setting. Diabetes Education 33(Suppl 6):159S-165S.
14. Perez, M., Findley, S.E., Mejia, M., Martinez, J. (2006). The impact of community health worker training and programs in NYC. Journal of Health Care for the Poor and Underserved 17(1 Suppl):26-43.
15. Mayo, R.M., Sherrill, W.W., Crew, L., Mayo, W.W. (2004). Connecting rural African American and Hispanic women to cancer education and screening: the Avon Health Connector project. Journal of Cancer Education 19(2):123-6.
16. Mock, J., McPhee, S.J., Nguyen, T., Wong, C. Doan, H., Lai, K.Q., Nguyen, K.H., Nguyen, T.T., Bui-Tong, N. (2007). Effective lay health worker outreach and media-based education for promoting cervical cancer screening among Vietnamese American women. American Journal of Public Health 97(9): 1693-1700.
17. Reath, J., Carey, M. (2008). Breast and cervical cancer in indigenous women-overcoming barriers to early detection. Aust Fam Physician 37(3):178-82.
18. Kobetz, E., Vatalaro, K., Moore, A., & Earp, J.A. (2005). Taking the transtheoretical model into the field: a curriculum for lay health advisors. Health Promotion and Practice 6(3):329-37.
19. Tessaro, I. (1997). The natural helping role of nurses in promoting healthy behaviors in communities. Advanced Practice Nursing Quarterly 2(4):73-8.
20. Andrews, J.O., Felton, G., Wewers, M.E., Heath, J. (2004). Use of community health workers in research with ethnic minority women. Journal of Nursing Scholarship 36(4):358-65.
21. Brownstein, J.N. (2008). Charting the Course for Community Health Worker Research. Progress in Community Health Partnerships: Research, Education, and Action 2(3):177-78.
22. Brownstein, J.N., Chowdhury, F.M., Norris, S.L., Horsley, T., Jack, L. Zhang, X., Satterfield, D. (2007). Effectiveness of Community Health Workers in the Care of People with Hypertension. American Journal of Preventive Medicine 32(5):435-447.
23. Han, H.R., Lee, H., Kim, M.T., Kim, K.B. (2008). Tailored lay health worker intervention improves breast cancer screening outcomes in non-adherent Korean-American women. Health Educatin Research 24(2):318-29.
24. Flaskerud, J.H., Nyamathi, A.M. (2000). Attaining gender and ethnic diversity in health care research: Cultural responsiveness vs resource provision. Advances in Nursing Science 22(4):1-15.
25. McQuiston, C., Parrado, E.A., Olmos-Muniz, J.C., Bustillo Martinez, A.M. (2005). “Community-Based Participatory Research and Ethnography: The Perfect Union.” IN: Methods in Community-Based Participatory Research for Health, pp. 210-229. Jossey-Bass: San Francisco.
26. Hill, M.N., Bone, L.R., Butz, A.M. (1996). Enhancing the Role of Community-Health Workers in Research. Image: Journal of nursing scholarship 28(3):221-6.
27. Crowe, J.L., Keifer, M.C., Salazar, M.K. (2008). Striving to provide opportunities for farm worker community participation in research. Journal of Agricultural Safety in Health 14(2):205-19.
28. Israel, B.A., Schurman, S.J., House, J.S. (1989). Action Research on Occupational Stress: Involving Workers as Researchers. International Journal of Health Services 19(1):135-55.

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

Initial Development of the Manual
The training manual was developed based on community leaders’ historical insight regarding previous failed research attempts and a shared desire to build local capacity to support future research and intervention in the Little Haiti community. This manual was developed as part of four ongoing research projects designed to increase breast and cervical cancer knowledge and participation in screenings among women in Little Haiti. The manual was developed with substantial input from Partners in Action, a campus-community organization, whose primary goal is to attenuate cervical cancer disparities among Haitian women in Florida using culturally and linguistically appropriate intervention strategies. In keeping with the principles of CBPR, Partners in Action members worked together to identify potential candidates to hire and train as CHWs. An announcement for CHW positions was disseminated through local, Kreyol-language radio, and by word-of-mouth through key contacts in partner community-based organizations located in Little Haiti. Ultimately, four women were hired and trained as integral figures in each of our ensuing projects. Their efforts are essential to the larger community’s acceptability of, and participation in, all Partners in Action endeavors.

For these research projects, the training modules were organized into four workshop sessions. For our CHW training, each session lasted approximately four hours, including food and breaks. At the beginning of each session, the trainer reviews the content from the previous session and clarifies any questions/concerns that the CHWs may have about what they previously learned.

At the end of each session the trainer broadly reviews the key points of training, addresses any questions/comments that were raised during the session, and then asks participants to reflect on the positive and negative aspects of the session. Such feedback serves as important process evaluation data, and is used to inform future sessions and the manual, more generally. Training format was largely informed by community partners who offered key insight on how to best organize sessions to meet learning preferences. The first session described the epidemiology of cervical cancer and its relevance to women in Little Haiti, and introduced the CHWs to study aims and their roles in the research projects. This session also oriented CHWs to the larger purpose and goals of Partners in Action, which are to meaningfully impact cancer disparities in Little Haiti through campus-community collaboration. The second session introduced CHWs to basic principles of conducting ethical research with human populations. In this module, CHWs learned about past ethical breaches in public health research, such as the Tuskeegee syphilis experiment, which led to the creation of strict research protections for human participants. CHWs then completed the University’s certification course (CITI) for conducting research with human participants. The third and fourth sessions provided rigorous instruction on research methods, including how to recruit study participants and collect study data. During these sessions, the CHWs formally practiced and received feedback on interviewing skills, community observation and recording field notes. These interactive learning methods developed CHWs’ capacities for conducting community-based health research and helped to standardize the process by which the CHWs collected and managed study data.

Manual-Facilitated Research Projects
After the manual was drafted, piloted, and modified in collaboration with Haitian women and community organizations, a research initiative was developed aiming to train CHWs to utilize flipchart to increase cervical cancer knowledge and self-screening via self-sampling in Thomonde, Haiti. The primary aims of the first research project was to 1) To determine the acceptability of the cervical self-sampler device among Haitian women, 2) To estimate the crude prevalence of HPV infection among women living in Thomonde, Haiti, 3) To estimate the crude prevalence of cervical dysplasia and cervical carcinoma among women living in Thomonde, Haiti. The study sample consisted of Haitian women recruited in culturally-appropriate social venues and educated by the AF within the comfort of their own homes. The main measures collected in the study were the number of participants, the number of cervical self-samples collected, and the feedback elicited from the study participants regarding multiple aspects of the study.

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

The theoretical underpinnings of our training modules derive from Freire’s critical pedagogy (1). In application, our product was developed to actualize Freire’s concept of empowerment through participatory education. Our training manual exemplifies this concept in its design, which is consistent with a “train-the-trainer” approach to CHW education.

Community leaders advocated for the use of CHWs throughout the research process, including collecting study data and helping to identify women of Haitian descent who spoke both English and Haitian Kreyol fluently to hire for these positions.The content development for our CHW training modules originated with the academic Principle Investigator (PI), who has extensive experience in creating such programs; however, the PI continuously sought input and feedback from community partner members of Partners in Action in order to inform the training development. Community leaders strongly recommended that women from Little Haiti conduct the outreach activities and collect the data for research projects, in order to allay any potential apprehension among Haitian women about taking part in cancer education and screening programs.

With input from Partners in Action community members, the academic PI developed a draft of the CHW training modules. Community members, with whom we had worked closely in other Partners in Action projects, reviewed the training module content and objectives and offered suggestions to the PI. The PI incorporated the suggestions into the modules. The final modules were comprised of didactic and participatory components and included guest speakers from the community and academia with expertise in areas relevant to learning objectives.

Training took place in Little Haiti at the office of a community partner organization, which served as the employment “home” for each CHW. This community-based organization is well-known and trusted in Little Haiti, providing assistance with health and social services to Little Haiti’s residents. Academic partners of Partners in Health sought to incorporate CHWs into research roles in recognition of the invaluable insight CHWs bring to community-based public health work. Such efforts to increase community involvement in the research process constitute a means of building community capacity for effecting positive health and social change. Furthermore, by actively involving community members from project inception, opportunities were created for them to meaningfully contribute the research process. This approach effectively demystifies research, strengthens trust between community members and researchers, and fosters community ownership of data for use in effecting positive community health change.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

Our training modules, designed to cultivate research skills within CHWs, constitute an effort to advance the roles of CHWs from more traditional health promotion to active participation in the research process. Traditional roles of CHWs typically use a peer-to-peer teaching model in community-based contexts for health promotion and education. This model has a demonstrated history of success in multiple areas of community health, most often focusing on outreach practices that foster behavior change. More recently, public health practitioners have been incorporating CHWs into research-related roles, particularly in projects guided by CBPR. Such roles frequently include collecting study data, as well as, giving critical insight into the design of data collection instruments and protocols. Our CHW training modules add to this developing area in public health that encourages co-equal participation in the research process for community members.

We did not carry out a formal evaluation of the CHW training modules or increased community involvement, more generally. The intent of our program was focused more broadly on building community capacity and laying a foundation for future collaborations to effect positive health and social change in Little Haiti. While a formal evaluation of participant learning was not conducted, feedback from the participating CHWs and trainers/moderators indicates that such a program has helped to cultivate new skills within indigenous CHWs that may translate into health benefits within the community. The interactive instructional modules provided CHWs with intensive training in participant recruitment, interviewing techniques, and data management, further strengthening the skill set required to engage in basic public health research. Feedback from CHWs indicates that the training modules resonated strongly with their learning preferences. Consistent with the tenets of CBPR, our manual reflects the shared input and expertise of academic and community partners, and provides an opportunity for co-learning. Apart from the informal observation of our partners, we have used this tool to train upwards of 50 CHWs to meaningfully participate in ongoing research efforts in diverse communities.

Apart from the informal observations of our partners, the high percentage of cervical samples collected in our manual-facilitated cervical cancer study that were acceptable for laboratory HPV testing may serve as a measure of feedback, given that women performed the self-sampling by themselves in private after being educated by manual-trained Ajan Fanm. Preliminary data indicate that 243 Haitian women have self-sampled. To date, 107 samples have been processed in the lab, 100 samples have yielded results, and 7 samples had an insufficient cell quantity to yield results (6.5%). Of the 100 samples with results, 17 were HPV positive (17%), and 83 were HPV negative (83%). Currently, 119 samples are in the lab for testing, and cervical samples are being collected daily in Haiti.

10. Please describe why you chose the presentation format you did.

In order to provide the training necessary to the CHWs for conducting research, we divided the instruction into a series of iterative educational modules delivered in four group-level, workshop sessions. The workshops were then held at a community venue familiar to the CHWs, located in the heart of Little Haiti. For this project, a community partner hosted the training workshop sessions and served as the employment home for the CHWs. This venue was convenient for CHWs, and provided a familiar space in which to discuss sensitive women’s health topics related to cervical cancer and general gynecological health. With the guidance and suggestions of community members, we chose a training manual as a practical, portable format for trainers to use in the delivery of the modules’ educational content through workshops held in community settings. Each module follows a similar protocol for delivery of educational information and explaining group activities to foster learning of the material. Information was presented in a style consistent from one learning module to the next. Women in Little Haiti have fewer learning opportunities and, consequently, lower literacy levels. CHWs nominated more interactive and participatory session for the learning modules. As such, the training sessions emphasize didactic learning and exercises.

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

While we did not conduct a formal evaluation, we developed the training modules with ongoing input and suggestions from community and academic members of Partners in Action. This feedback was used to improve clarity of modules’ content pertaining to research design and methods as presented to non-researchers. As an iterative process, gaps in CHW knowledge and research methods were filed with constructive feedback from academic partners. To maintain the integrity of the project, most feedback focused on strategizing data collection, regular review of data, and identifying challenges to recruitment.

Strengths of the Training Manual

The purpose of the training was to augment the skills set of CHWs so that they could contribute to public health research and discourse in their community. This is the training modules’ greatest strength as it serves as a mode for effectively integrating CHWs into research design and delivery. Historically, CHWs have focused on disease prevention and health promotion in community settings. Utilizing CHWs in public health and biomedical research may improve the relevance of study findings due to intimate familiarity with community norms and practices surrounding health. Furthermore, integrating CHWs ensures that research implementation is community competent and appropriately reflects the cultural, social, and historical determinants that shape community health. As previously mentioned, we have used this tool to train upwards of 50 CHWs to meaningfully participate in ongoing research efforts in diverse communities. This has resulted in measurable benefits for community capacity building, through the hiring and training of indigenous CHWs. Further, CHWs promote and connect other community members throughout Little Haiti with preventive health services. Integrating CHWs into study design is also an effective strategy for circumventing barriers to research, prevalent in Little Haiti and other communities, where researcher interests have not consistently met resident needs.

Another strength of our training modules’ is reflected in its development process, and its potential for transferability into other community-based research contexts that rely on community members as active partners in the research process. The core tenants of CBPR methods were used to guides it development, implementation, and ongoing evaluation. This process helped ensure the product’s content and presentation validity among lay CHWs in Little Haiti. Furthermore, a strength of the training manual is its portability as a learning tool, allowing for versatile delivery in numerous community based venues. For example, training sessions can be held in homes, churches, and community-based clinical settings.

Limitations of the Training Manual

The manual addresses training lay workers in intervention techniques which are generally limited to use in small group settings. While fewer women are reached at any one given point in time, a smaller group creates the intimacy and comfort level necessary to encourage open dialogue about female anatomy, gynecological health and cervical cancer.

We are also modifying the training modules based on feedback from the Ajan Fanm, who indicated that women expressed the need to have more time for questions and discussion about early detection of cervical cancer, even among women who are not age-eligible for screening. In addition, the Ajan Fanm have indicated that the intervention delivery should be modified, such that the health education message is focused on self-care and cancer-prevention and avoids evocations of possible stigma associated with HPV. We are currently working with the Ajan Famn to improve the delivery of intervention information to in this respect.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

The final set of training modules reflects substantial input and collaboration from community and academic members of Partners in Action. While the academic PI was responsible for the concept and content of the training, community partner input was sought continuously throughout the training development. Community input was essential to specific aspects of this product, particularly for enhancing communication of research concepts for CHWs otherwise unfamiliar with research. Community “indigenous knowledge” holds equal importance as academic factual knowledge and experience needed to develop this set of educational modules for CHW research training. Such shared input, the fusion of academic expertise and local knowledge, is essential to ensure that the final product presents training information in culturally and linguistically relevant and clear ways. The collaborative nature of Partners in Action, and the guiding principles of CBPR, serve to ensure that equal voice is given to all contributors to our project. All community and academic partner members who participated in the training modules’ development agreed that it is important to share our experience with developing this training with other community and academic audiences who may be considering similar roles for CHWs. As such, Partners in Action members felt that CES4Health.Info is the ideal channel in which to present and disseminate our information. All members who took part in the CHW training development are co-authors on this submission.