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Title: Nutrition and Physical Activity Curriculum to Educate Promotores de Salud on Obesity Prevention and Healthy Lifestyles


Abstract: In San Bernardino County (SBC), California, 42 percent of all deaths in the County are attributed to obesity-related causes (1). Equally alarming, 76 percent of Hispanic residents are overweight or obese (2). In order to address this public health concern, El Sol Neighborhood Educational Center (El Sol) and Loma Linda University School of Public Health (LLU SPH) graduate students collaborated to develop and implement a 24-hour nutrition and physical activity curriculum to promote healthy lifestyles, using Community Campus Partnerships for Health principles (3). The curriculum was designed as a resource for organizations that can train promotores de salud (community health workers) and other local leaders optimally positioned to be involved in obesity prevention efforts. Promotores are local leaders who utilize their understanding of their own community's culture and values to provide health education in various settings, including homes, community groups, schools, and churches. A participatory process was used to incorporate the shared knowledge and expertise of El Sol promotores, staff, LLU SPH graduate students, and faculty. The curriculum uses engaging and active approaches to adult learning to provide instruction about healthy lifestyles and advocacy, progressively building on previous modules. It addresses an existing gap in publicly available obesity prevention curricula targeting organizations working with the Hispanic community, which is essential to reducing the prevalence of obesity nationwide.


Type of Product: PDF document


Year Created: 2012


Date Published: 3/6/2013

Author Information

Corresponding Author
Mercy Muigai
Loma Linda University
950 W. Sierra Madre Avenue #816
Azusa, CA 91702
United States
p: 6262247848
Mercymuigai@gmail.com

Authors (listed in order of authorship):
Biblia Kim
Loma Linda University


Mercy Muigai
Loma Linda University


Kristen Gunther
Loma Linda University


Mayra Barcenas
Loma Linda University 91702


David Busolo
Loma Linda University 91702


Angelica Alvarez
El Sol Neighborhood Educational Center


Lupita Mendez
El Sol Neighborhood Educational Center


Alexander Fajardo
El Sol Neighborhood Educational Center


Juan Carlos Belliard
Loma Linda University


Eddy Jara
Loma Linda University


Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health


What specific topics does your product address?

Advocacy, Chronic disease, Community engagement, Community health , Community-based education, Curriculum development, Diabetes, Diversity , Education, Health behavior, Health education , Minority health, Overweight/obesity, Partnership building , Physical activity/exercise, Prevention, Community-based participatory research


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

Latino/Hispanic


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 , Focus group , Participatory evaluation, Photovoice, Qualitative research, Quantitative research


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

Curriculum


Application Narrative

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

In San Bernardino County (SBC), California, 42 percent of all deaths in the County are attributed to obesity-related causes (1). Equally alarming, 76 percent of Hispanic residents are overweight or obese (2). In order to address this public health concern, El Sol Neighborhood Educational Center (El Sol) and Loma Linda University School of Public Health (LLU SPH) graduate students collaborated to develop and implement a 24-hour nutrition and physical activity curriculum to promote healthy lifestyles, using Community Campus Partnerships for Health principles (3). The curriculum was designed as a resource for organizations that can train promotores de salud (community health workers) and other local leaders optimally positioned to be involved in obesity prevention efforts. Promotores are local leaders who utilize their understanding of their own community's culture and values to provide health education in various settings, including homes, community groups, schools, and churches. A participatory process was used to incorporate the shared knowledge and expertise of El Sol promotores, staff, LLU SPH graduate students, and faculty. The curriculum uses engaging and active approaches to adult learning to provide instruction about healthy lifestyles and advocacy, progressively building on previous modules. It addresses an existing gap in publicly available obesity prevention curricula targeting organizations working with the Hispanic community, which is essential to reducing the prevalence of obesity nationwide.


2. What are the goals of the product?

The purpose of the curriculum is to provide staff from community-based organizations (CBOs) like El Sol with a resource to train promotores de salud in Hispanic community about obesity prevention and healthy lifestyle interventions. Ideally, trained promotores can then engage, teach, and motivate community members to make healthy choices through community health outreach and education.

The goals of this curriculum are:
•Long-term: To reduce the prevalence of obesity among Hispanic residents of San Bernardino County
•Short-term: To equip promotor trainers with the necessary knowledge, skills, and capacities about nutrition and physical activity for healthy lifestyles, obesity prevention, and related advocacy using culturally appropriate approaches

The objectives of this curriculum are to:
•To increase knowledge among promotor trainers on the various causes of obesity and related chronic diseases
•To cultivate practical nutrition and physical activity-related skills to navigate daily health-related decisions
•To integrate cultural considerations and scientific evidence to promote healthy lifestyle choices
•To empower promotor trainers to promote advocacy to initiate change at the individual, household, and community levels.


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

The primary audience of this curriculum is CBO staff members who would train local promotores de salud. Promotores are trained community-level experts who provide unique public health education and linkage to services at the community level. They address the cultural, language, service access, and stigma barriers that often exist for low-income Hispanics by working in various settings, such as schools, CBOs, health departments, and clinics (4). The curriculum is intended to provide staff and trainers with a flexible method of instructing promotores. The secondary audience is trained promotores who can utilize it as a resource for appropriate outreach in local contexts. While 20 promotores were involved for the first training, we recommend keeping trainings to 12 to 15 participants.


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.

We recommend the curriculum be implemented by CBOs that provide health education and outreach to primarily Hispanic communities. Agencies that have existing expertise in obesity prevention or those seeking to provide such services are prime candidates. It is also essential that the CBO has the capacity to recruit and train motivated promotores who have a demonstrated commitment to their community’s well-being. Such promotores may be chosen based on their predicted success in community outreach, which is often reflected in reputation, passion for health, and community leadership experience. In addition, it is important for trainers themselves to reflect ‘buy-in’ to the product by making healthy lifestyle choices as they train promotores.


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.

This curriculum builds on the existing community-based work of promotores de salud. The promotores model is based on Paulo Freire’s popular education theories that adults can be empowered by their life experiences to solve their own problems (5). It is a culturally viable solution proven to increase knowledge, promote positive behavior change, and decrease disparities related to the access and use of affordable preventative health care services among the Hispanic population (6, 7, 8). El Sol seeks to educate Hispanic adults in San Bernardino County about obesity with culturally and linguistically appropriate nutrition and physical activity information.

Currently, community-based organizations use promotor curricula and manuals to increase knowledge on various health topics, promote lifestyle and dietary changes for specific diseases, and disease management strategies. Various organizations, such as the Centers for Disease Control and Prevention (9), the National Heart, Lung, and Blood Institute (10), and California’s Project LEAN (11), have developed curricula on health topics including mental health, breast and cervical cancer, environmental health, heart disease, and diabetes (12, 13, 14, 15, 16, 17). With regard to obesity, several organizations have developed childhood obesity prevention curricula, which address school nutrition, dietary behaviors, healthy snacks for children, and methods to increase physical activity. However, most of these existing promotor programs and curricula are limited in scope, targeting children or specific conditions, such as diabetes and cardiovascular disease.

Thus, El Sol identified the need for a promotor curriculum with practical information for broad adult obesity prevention in the Hispanic population through community assessments. Building on a mutual partnership between El Sol and LLU SPH, a curriculum was tailored to the specific needs of the primarily Spanish-speaking low-income population in SBC. This curriculum builds on CCPH principles, and has been piloted and modified based on feedback from established promotores. The final product is an obesity prevention curriculum that addresses this community-identified health education 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. U.S. Census Bureau. (2010). State & County Quickfacts. Retrieved from http://quickfacts.census.gov
2. Healthy San Bernardino: Better Health Through Community. (2010). Community Snapshop. Retrieved from www.healthysanbernardinocounty.org
3. Community-Campus Partnerships for Health. Principles of Good Community-Campus Partnerships; 2010. Retrieved from http://depts.washington.edu/ccph/principles.html
4. Rosenthal, EL, Brownstein, JN, Rush, CH, Hirsch, GR, Willaert, AM, Scott, JR, et al. Community Health Workers: Part of the Solution. Health Affairs 2010; 29(7):1338-1342.
5. Freire, P. Pedagogy of the oppressed. New York: The Seabury Press; 1970.
6. Ander, RL, Balcazar, H, Paez, L. Hispanic community-based participatory research using a Promotores de Salud model. Hispanic Health Care International 2006; 4(2): 71-78
7. Giblin, PT. Effective utilization and evaluation of indigenous health care workers. Public Health Reports 1989; 104(4): 361-368.
8. Swider, SM. Outcome effectiveness of community health workers: an integrative literature review. Public Health Nursing 2002; 19(1): 11-20.
9. Centers for Disease Control and Prevention. The Road to Health Toolkit; 2008. Retrieved from http://ndep.nih.gov/media/road-to-health-toolkit-flipchart.pdf
10. National Institutes of Health. Your heart Your Life: A lay health educator’s program; 2010. Retrieved from http://hp2010.nhlbihin.net/salud/pa/index.htm
11. California Project LEAN. Parents in Action: A guide to engaging parents in local school wellness policy; 2008. Retrieved from http://www.californiaprojectlean.org/docuserfiles//ParentsInAction_web(1).pdf
12. Aguilar-Gaxiola, SA, Zelezny, L, Garcia, B, Edmondson, C, Alejo-Garcia, C, & Vega, WA. Translating research into action: reducing disparities in mental health care for Mexican Americans. Psychiatr Services 2002; 53(12): 1563-1568.
13. Hansen, LK, Feigl, P, Modiano, M, Lopez, J, Escobedo Sluder, S, Moinpour, C, et al. An educational program to increase cervical and breast cancer screening in Hispanic women: A Southwest Oncology Study. Cancer Nursing 2005; 28: 47-53.
14. Ramos, IN, May, M, Ramos, KS. Environmental health training of promotoras in colonias along the Texas-Mexico border. American Journal of Public Health 2001; 91: 568-570.
15. Boutin-Foster, C, George, KS, Samuel, T, Fraser-White, M, & Brown, H. Training community health workers to be advoicates for health promotion: Efforts taken by a community-based organization to reduce health disparities in cardiovascular disease. Journal of Community Health 2008; 33: 61-68.
16. Heisler, M, Spencer, M, Forman, J, Robinson, C, Shultz, C, Palmisano, G, et al. Participants’ assessments of the effects of a community health worker intervention on their diabetes self-management and interactions with healthcare providers. American Journal of Preventative Medicine 2009; 37(681): 270-279.
17. Corkery, E, Palmer, C, Foley, M. E., Schechter, CB, Frisher, L, & Roman, SH. Effect of a bicultural community health worker on completion of diabetes education in a Hispanic population. Diabetes Care 1997; 20(3): 254-257.
18. Centers for Disease Control and Prevention. Differences in prevalence of obesity among Black, White, and Hispanic adults --- United States, 2006—2008. Morbidity and Mortality Weekly Report 2009; 58(27): 740-744.
19. Yancey, AK, Cole, BL, Brown, R, Williams, JD, Hillier, A, Kline, RS, et al. A Cross-sectional prevalence study of ethnically targeted and general audience outdoor obesity-related advertising. The Milbank Quarterly 2009; 87(1): 155-184.
20. Balcazar, H., Alvarado, M., Hollen, M. L., Gonzalez-Cruz, Y., & Pedregon, V. Evaluation of Salud Para Su Corazon (Health for your Heart) -- National Council of La Raza Promotora Outreach Program Prev Chronic Dis 2005: 2: A09). United States.


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.

Development of the product began as a community engagement project designed for MPH students to address community health issues in San Bernardino County. The project developed from a mutually trusting partnership between El Sol and LLU into an on-going collaboration to develop a 24-hour training curriculum for promotores de salud. Using the principles of CCPH as an educational framework, MPH students collaborated with the promotores to first identify obesity specific health information to be included in the curriculum. The following indicates how CCPH principles were used in combination with community and academic expertise to develop a nutrition and physical activity curriculum for promotor trainers with the intent of promoting healthy lifestyle changes among Hispanic residents in San Bernardino County.

An assets and needs assessment consisting of focus groups, interviews, and observations was conducted prior to development of the curriculum. The first focus group conducted identified promotores’ existing knowledge in nutrition and physical activity and was used to select a user-friendly format specific for promotor training. The format of the curriculum follows that of the Parents in Action curriculum (3) and provides a clear layout of the entire lesson plan. The content was then developed from a literature review of basic nutrition and physical activity material and existing curricula. The promotores used their experiences and expertise in the local community to make the curriculum content relevant to their community and provided feedback to LLU students through post-module focus groups. Open communication between LLU students, promotores, and El Sol led to ensuring promotores’ suggestions in content and teaching methodologies were incorporated in subsequent modules. As a result, all eight modules of the final product are highly interactive and build on promotores’ existing knowledge while maintaining a flexible structure to allow for future additions and adaptation of material.

The main objectives of this curriculum are to:
•Increase knowledge among promotor trainers on the various causes of obesity and related chronic diseases;
•Cultivate practical nutrition and physical activity-related skills to navigate daily health-related decisions;
•Integrate cultural considerations and scientific evidence to promote healthy lifestyle choices; and
•Empower promotor trainers to promote advocacy to initiate change at the individual, household, and community levels.

Evaluation of the curriculum is currently in process. During curriculum development, process evaluation was used by incorporating promotor feedback obtained in focus groups and post-module discussions. Pre- and post-tests administered during the pilot sessions showed preliminary findings indicating that knowledge was gained. Preliminary results after curriculum implementation showed that 100 percent of participants felt that they had a better understanding of the material after taking the training, and that they would use the content to teach others. Long-term outcome evaluation is currently being conducted by El Sol and will include community intervention assessments and empowerment evaluations.

The quality of the final product greatly reflects both academic and community expertise. Using the El Sol leaders and promotores understanding of their training techniques and of their local community greatly impacted the interactive approach of the curriculum. By encouraging promotor contribution to the development of the curriculum a relationship of trust and respect was established between community and University partners that has already set the foundation for future projects.


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.

After determining the community’s needs for culturally appropriate nutrition and physical activity topics, MPH students began to research existing curricula and initiated development of a culturally appropriate curriculum for promotor trainers. Development of the curriculum spanned over six months, beginning in January and ending in June 2010. Several meetings were conducted involving MPH students and El Sol’s administration to identify appropriate topics in nutrition, physical activity, and advocacy. Regular meetings with staff provided students with feedback on the modules and guidance for subsequent modules. Five distinct strategies were used to develop the curriculum: literature searches for existing curricula; obtaining relevant information from public access sources; compilation of material; collaboration with faculty; and collaboration with El Sol promotores.

Literature review for existing curricula
The development process began by searching for existing curricula for nutrition and physical activity through literature searches in academic databases and Internet searches of organizations working with Hispanic communities. Materials were used to determine their relevance to this curriculum. The search did not reveal a fully developed curriculum for the specific needs of the population served by El Sol. While some materials demonstrated effective training strategies complete curricula were often unattainable. This was in part due to proprietary reasons and the lack of publicly accessible curricula. As mentioned in Question 5, we found existing curricula on various health topics that mentioned obesity, but they were usually disjointed or too narrow in scope. Most of the existing curricula we found were designed to target child obesity prevention or addressed how to manage specific health conditions, such as diabetes and cardiovascular disease. Furthermore, the majority of curricula were content heavy but had limited numbers of demonstrations and activities. Thus, this product meets the existing gap for a training that includes practical information for broader adult obesity prevention in low-income Hispanic communities through participatory and empowering methods.

Obtaining information from public access sources
Public access websites were used to find general information on nutrition topics and ideas for the incorporating physical activity. This included searching websites of the Centers for Disease Control and Prevention, American Heart Association, American Diabetic Association, California Project LEAN, and Community, Adolescents, Nutrition and Fitness. General informative materials were also obtained through a review of other CBO websites, such as Latino Health Access and Champions for Change. These were useful for specific nutrition information that could be incorporated in the curriculum.

Compilation of material to develop curriculum
Information gathered from public access websites and existing curricula were then compiled and organized to develop the curriculum. Information used was based on cultural appropriateness and relevance to community needs. Students used this information to write a new curriculum while incorporating topics on obesity, its relationship to various health conditions, nutrition facts, healthy food substitutions for Hispanic foods, physical activities, and community advocacy.

The training was designed to be given over 24 hours after consulting with our CBO partner, which has provided trainings to local residents and promotores for over 20 years. They found it was difficult for participants to consistently attend trainings on a weekly basis, resulting in high rates of drop-out. In their experience, participants have preferred intense trainings over a few days due to childcare or other scheduling conflicts. The curriculum consists of five nutrition and physical activity modules, totaling 18 hours, and three advocacy modules, totaling 6 hours. Decisions regarding module content were finalized after discussing with the CBO director, and instruction for basic nutrition and physical activity was condensed to 18 hours in order to keep the material at a basic level. In addition, we dedicated six hours advocacy specifically because the CBO anticipated that the majority of attendees would have little to no experience with the various advocacy techniques.

Collaboration with faculty advisors
Students submitted modules to faculty advisors at LLU SPH after development, and the group discussed the strengths, weaknesses, and potential improvements for the module. This served to create a more interactive curriculum for the promotores and foster increased learning. The collaboration allowed students to understand more effective methods of curriculum development and community engagement.

Collaboration with El Sol promotores
Lastly, the curriculum module topics were presented to El Sol promotores through a focus group, where they could provide feedback. Promotores assisted group members in deciding which topics would be covered and how they could be presented effectively. After completing research, faculty collaboration and community collaboration, students finalized the product to create a culturally appropriate curriculum and based on participatory approaches. Please refer to Table 1 for a list of the final module topics in the curriculum.


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.

Obesity is a rising public health concern in the United States that disproportionately affects minority populations such as Hispanics living in San Bernardino County (18). Factors contributing to the rise in obesity include genetic predisposition, environmental factors, and inaccessibility to preventative services. Increased advertising among low-income Hispanics for unhealthy foods coupled with a lack of community recreational facilities negatively impacts the community’s health, leading to a rise in overweight and obesity (19). This serious public health need is more challenging to address given Hispanic communities often lack culturally and linguistically competent information on obesity, its related chronic diseases and how to access preventive and control services. In addition, training curricula addressing adult obesity prevention are not readily available to the public. This curriculum seeks to address these concerns by providing relevant education to promotores de salud who build the capacity of other community members to positively impact community health. The curriculum seeks to close the inaccessibility gap by providing public access and use of educational materials for promotores and other CBOs.

Several short-term impacts that have been seen since the development and initial implementation of this curriculum include increasing the organizational capacity of El Sol to provide nutrition and physical activity health education. As a result of this, El Sol has secured funding for current and future promotor trainings. The curriculum was utilized to train twenty promotores in October 2010 with funding from Kaiser Permanente Fontana Medical Center. These training sessions have increased the promotores’ knowledge on obesity prevention, basic nutrition concepts, and methods to increase physical activity. In addition, promotores are empowered to make personal health changes and adopt healthier lifestyle habits that impact their family members. Promotores are currently conducting community education and outreach to inform their peers on healthy lifestyle habits and methods to advocate for improved health-related policies. The advocacy skills encourage community members to seek improved health-related policies within their community and be able to combat the rising obesity epidemic in San Bernardino County.

The participatory development process also strengthened an on-going collaboration between El Sol staff, promotores, and LLU faculty and students. This partnership allows MPH students the opportunity to network and gain practical skills working with a community-based organization while engaging community members in addressing public health concerns. This curriculum will be part of the Promotores de Salud Academy, established to train and certify promotores to award qualifications transferable to other promotor programs. As promotores are often challenged needing to prove the value of their work, certification through the curriculum enhances the value of their public health workforce development (20).

This curriculum has the potential to impact other communities in the United States. Since the curriculum was developed specifically for a low-income Hispanic population, it can most easily be adapted to serve other Hispanic communities. The integration of educational and practical information on promoting healthier lifestyles, and applicable advocacy skills can be used in many communities. Community-based organizations or collaborative partnerships between organizations and universities could utilize this curriculum to impact the communities they serve and reduce the overall obesity epidemic. Upon publication, the curriculum will be open to duplication at no cost and can be used by other organizations to train new promotor cohorts, provide refresher trainings, or start completely new programs.


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

The curriculum was presented to the promotores at El Sol in a class setting while incorporating discussion, games and outside activities. This presentation format met El Sol’s agency goals and utilized existing resources and promotores’ skills efficiently. The promotores involved in this project were already accustomed to meeting on a weekly basis for trainings and agency support since they had previously trained using a mental health curriculum. Therefore, it was a logical choice to continue with trainings in this format. Although there was some hesitation regarding PowerPoint presentations and a lecture format, the promotores later concluded that this method would be an effective training approach. There were many interactive activities and encouragement of audience participation included in the curriculum, as well as frequent breaks in the schedule. As mentioned above, basing the curriculum on the Parents in Action format provided an expected approach and consistency with each training. The presentation of this pilot curriculum demonstrated that this format was quite conducive to the health promotores’ learning, given continual guidance and feedback.


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.

The primary strength of the curriculum is that it fills the existing gap of promotor curricula to address adult obesity prevention, specifically in Hispanic communities. The long-term benefits that can be reaped through duplication and adaptation of the curriculum is not only empowering for the CBO that helped develop it, but also for other communities that identify obesity, nutrition, and physical activity as community concerns. The intent of the curriculum is to provide comprehensive but basic information that can be modified by topic of interest or audience; this is a unique strength because it places control in the hands of the trainer and allows room for adaptation for local promotor trainings, rather than dictating exactly what they should or should not say. The curriculum utilizes reference boxes that include more in-depth information about the module topics, should promotores want additional knowledge from their trainer.

In addition, the curriculum was developed based on the community’s self-identification of health issue, desired topics, and presentation or activity formats. In addition, input from LLUSPH partners strengthened the integration of promotor feedback to increase curriculum relevance and effectiveness. The mutually respectful and collaborative process between El Sol’s promotores and LLUSPH strengthens the still-novel process of giving partners equally weighted importance when combining community-based education and related practice, instead of leaving the process in the hands of academics. The product incorporates promotores’ synthesis of the most relevant training topics and methods, further strengthening the community-based educational practice model from which the curriculum was developed. By only including information and formats that promotores have indicated are useful, familiar, or easy to learn, it is presumed that the resource will also be community-friendly.

The curriculum also is an easily accessible material for promotor trainers within the Hispanic community because it can be provided at no cost in both English and Spanish. The fact sheets, handouts, and visuals that reinforce the content, as well as recipes, food substitutions, and tips for changing eating habits, also make the topics relevant, the format user-friendly, and content easily incorporable. The highly interactive components also increase the probability of actively motivating trainers, promotores, and community members to make healthy changes in their behavior and environment. These activities, such as icebreakers, testimonials, and games, were incorporated through promotores’ suggestions as a way to make the product attractive to members of their community. Finally, the advocacy components of the curriculum integrate individual and family priorities with the larger community, and equip communities as empowered agents of change.

While the curriculum seeks to be comprehensive, the length of training sessions may be problematic for individuals who either are limited in time or feel there is too much information. As the level of engagement depends on the trainer, content-heavy sessions may deter individuals from completing or learning all of the modules. In the case of this product, the minimum 2-hour long sessions were preferred by local promotores.

In addition, the product does not take the various knowledge levels of promotores into account, which means the content may be repetitive for some promotores. The curriculum also does not have a synthesized version that can be used in refresher trainings which are likely to be necessary in the future to ensure promotores continually disseminate scientifically correct information in conjunction with their inherent knowledge and experiences. Finally, the curriculum is currently specific to the Hispanic community in San Bernardino County, and statistics would need to be modified to be made relevant to other areas.


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 project involved collaboration between MPH students, LLU faculty, and members from El Sol. Format, topics, and teaching methodologies to be used in the curriculum were discussed and agreed upon by all partners before finalizing the final product. Each MPH student then researched, wrote curriculum material, and developed activities for specific topics within each module. Meeting times and meeting locations were agreed upon by the students and El Sol members. Although only one student facilitated the training sessions due to Spanish fluency, the other students played integral roles in curriculum development, general assistance during each session, observation, note-taking, and facilitating the discussions. The students also shared credit for the project in their class.

The faculty supported the students by providing guidance, helpful resources, and innovative ideas to improve the curriculum. They also answered questions when the students raised concerns and initiated communication between El Sol and MPH students. The El Sol staff members were very flexible in accommodating the students’ schedules and provided the students with templates of a previous El Sol curriculum to be used as a reference. Additionally, El Sol leaders facilitated trainings and meetings between students and participating promotores. With the guidance and input from the faculty and El Sol representatives, the students successfully developed and trained promotores using the curriculum.

All collaborators from the University have been notified of the plan for submission to CES4Health. El Sol has agreed to have this curriculum published and be used by other communities that seek to target similar audiences and have similar goals and objectives.

Since this product was initiated by faculty members and students as course credit for a required course, it was not submitted to the Institutional Review Board for approval.