Evaluating the effectiveness of the C.H.A.N.G.E. training: A community-based tobacco cessation program for community health workers

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.