PO.PS01.11 · 人群科学
评估C.H.A.N.G.E.培训的有效性：一项面向社区卫生工作者的社区烟草戒断项目
Evaluating the effectiveness of the C.H.A.N.G.E. training: A community-based tobacco cessation program for community health workers
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摘要 Abstract
中文摘要
背景：商业烟草使用导致约30%的癌症相关死亡，并且在低社会经济地位（SES）人群中居高不下，比例失衡。社区卫生工作者（CHWs）在此类社区内推动烟草戒断方面具有独特优势。C.H.A.N.G.E.（Community Health Allies Nicotine Guidance Education，社区卫生盟友尼古丁指导教育）培训旨在提升CHWs开展文化适应性戒断咨询的能力。本研究评估了该培训在改善CHWs烟草相关知识、动机、准备度和信心方面的有效性。
方法：我们对来自伊利诺伊州芝加哥的CHWs（N=155）的培训前、培训后及六个月随访数据进行了二次分析，这些人员通过一个公共卫生部门、多家社区组织及一个CHW学位项目招募。其中144人完成了培训后评估，98人完成了六个月评估。该参与式课程改编自WHO 5A's和5R's工具包，强调动机性访谈（MI）、文化定制化沟通以及烟草使用的社会决定因素。各时间点之间的变化采用配对样本t检验进行分析。
结果：从培训前到培训后观察到显著改善（所有p<.05）：知识（均值从4.89提升至7.91，满分10分）、动机（均值从7.81提升至8.71，满分10分）、准备度（均值从6.09提升至8.25，满分10分）、提供戒断支持的信心（均值从6.48提升至8.39，满分10分）以及MI信心（均值从6.96提升至8.57，满分10分）。在六个月时，所有均值得分相较培训后有所下降（p≤.05），但除动机外，所有领域的得分仍显著高于培训前（p≤.05）。
结论：C.H.A.N.G.E.培训有效提升了CHWs在提供烟草戒断咨询方面的能力和自我效能。研究结果支持采用社区驱动、文化适应的模式，将循证戒断干预推广到临床环境之外。持续的强化课程和培训师培训（train-the-trainer）方法可能有助于增强长期技能保持，并为减少低SES人群中烟草相关的癌症差异做出贡献。
查看英文原文 English abstract
Background: Commercial tobacco use drives approximately 30% of cancer-related deaths and remains disproportionately high among low-socioeconomic-status (SES) populations. Community health workers (CHWs) are uniquely positioned to promote tobacco cessation within this communities. The C.H.A.N.G.E. (Community Health Allies Nicotine Guidance Education) training was developed to enhance CHWs' capacity to deliver culturally responsive cessation counseling. This study evaluated its effectiveness in improving CHWs' tobacco-related knowledge, motivation, readiness, and confidence.
Methods: We conducted a secondary analysis of pre-, post-, and six-month follow-up data from CHWs (N=155) in Chicago, IL, recruited through a public health department, community-based organizations, and a CHW degree program. Of these, 144 completed post-training and 98 completed six-month assessments. The participatory curriculum, adapted from the WHO 5A's and 5R's Toolkit, emphasized motivational interviewing (MI), culturally tailored communication, and the social determinants of tobacco use. Changes across time points were analyzed using paired-sample t-tests.
Results: Significant improvements were observed from pre- to post-training (all p<.05): knowledge (Mean=4.89 to 7.91 out of 10), motivation (Mean=7.81 to 8.71 out of 10), readiness (Mean=6.09 to 8.25 out of 10), confidence in delivering cessation support (Mean=6.48 to 8.39 out of 10), and MI confidence (Mean=6.96 to 8.57 out of 10). At six months, all mean scores declined relative to post-training (p≤.05) but remained significantly higher than pre-training for all domains except motivation (p≤.05).
Conclusions: The C.H.A.N.G.E. training effectively improved CHWs' competence and self-efficacy in delivering tobacco cessation counseling. Findings support community-driven, culturally adapted models to extend evidence-based cessation interventions beyond clinical settings. Ongoing booster sessions and train-the-trainer approaches may enhance long-term skill retention and contribute to reducing tobacco-related cancer disparities in low-SES populations.
利益披露 Disclosure
A. Garcia-Sierra, None..
V. Nassar Abuabara, None..
T. Lu, None..
C. Tang, None..
A. Veluz-Wilkins, None..
M. Tan, None.