A sustainable community health worker model for training at-risk, disadvantaged populations in cancer prevention, treatment, and survivorship

The EPICO (Education to Promote Improved Cancer Outcomes) cancer education intervention aims to increase delivery of cancer education through a replicable, sustainable training program for community health workers (CHWs) living and working among at-risk populations in Texas. Bicultural, bilingual CHW instructors used tailored strategies in English and Spanish to increase cancer prevention, treatment, and healthy survivorship behaviors among residents in two ways: 1) by delivering education modules directly to the residents; and 2) strengthening capacity of CHWs by delivering cancer education CEUs to certified community health workers. EPICO advocates a train-the-trainer methodology to strengthen the sustainability and scalability of the breast, cervical, and colorrectal cancer education program. Best practices included in the EPICO intervention were: utilization of CHWs; tailored messaging; and community based participatory research (CBPR) strategies. Challenges included: balancing the amount and level of cancer education for both promotores and residents and encouraging CHWs to incorporate the information within their daily outreach activities. Achievements included the delivery of 3,400 CEUs to CHWs between May 2012 and April 2013—who, in turn, then educated over 5000 residents. The EPICO intervention represents an effective model for disseminating health education and behavior change in culturally diverse settings. EPICO instructors integrate cancer expertise and community knowledge to develop culturally appropriate cancer education for CHWs they train. This training, using message tailoring and CBPR strategies, allows CHWs to adapt their training to characteristics of he individual residents they serve, ensuring the social acceptability of the outreach across the state.