Family Health History–Based Cancer Prevention Training for Community Health Workers

Published:December 23, 2020DOI:
      Cancer is the second leading cause of death in the U.S. Utilizing family health history in cancer prevention holds promise in lessening the burden of cancer. Nevertheless, family health history is underutilized in public health and preventive medicine. Community health workers, also known as lay health educators, are ideal candidates to offer basic cancer family history–based education and services to the general public. The authors developed the first cancer family history–based genomics training program in cancer prevention tailored for community health workers. This paper details the development and pilot testing findings of the training. Specifically, a multidisciplinary research team of geneticists, genetic counselors, health educators, community health workers, and community health worker instructors developed a 7-module, 6-hour, bilingual (English and Spanish) cancer family history–based training focusing on cancer family history–based risk assessment, lifestyle recommendations, and genetic evaluation and testing. The curriculum was based on an integrated theoretical framework, the National Comprehensive Cancer Network guidelines, the community health worker core competencies, and the 4MAT instructional model. The Texas Department of State Health Services approved and certified the curriculum with 2 delivery formats: in-person/face-to-face workshops and online training. A total of 34 community health workers completed the pilot training in person (n=17) and online (n=17) in 2018 and 2019. Participating community health workers’ knowledge, attitudes, self-efficacy, and intention in delivering basic cancer family history–based genomics education and services significantly increased on the immediate post-test measures compared with their pretest data. Positive ratings and feedback were also reported by the community health workers. Findings from this pilot study suggest that wider training is warranted for educating more community health workers in the U.S.
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        • American Cancer Society
        Cancer facts and figures 2019.
        American Cancer Society, Atlanta, GAPublished 2019
      1. International Agency for Research on Cancer. Global Cancer Observatory. Accessed March 27, 2020.

        • Yoon PW
        • Scheuner MT
        • Peterson-Oehlke KL
        • Gwinn M
        • Faucett A
        • Khoury MJ
        Can family history be used as a tool for public health and preventive medicine?.
        Genet Med. 2002; 4: 304-310
        • Yoon PW
        • Scheuner MT
        • Khoury MJ
        Research priorities for evaluating family history in the prevention of common chronic diseases.
        Am J Prev Med. 2003; 24: 128-135
        • Valdez R
        • Yoon PW
        • Qureshi N
        • Green RF
        • Khoury MJ
        Family history in public health practice: a genomic tool for disease prevention and health promotion.
        Annu Rev Public Health. 2010; 31: 69-87
        • Guttmacher AE
        • Collins FS
        • Carmona RH
        The family history–more important than ever.
        N Engl J Med. 2004; 351: 2333-2336
        • Ziogas A
        • Anton-Culver H
        Validation of family history data in cancer family registries.
        Am J Prev Med. 2003; 24: 190-198
        • Brennan P
        • Wild CP
        Genomics of cancer and a new era for cancer prevention.
        PLoS Genet. 2015; 11e1005522
        • Murff HJ
        • Byrne D
        • Syngal S
        Cancer risk assessment: quality and impact of the family history interview.
        Am J Prev Med. 2004; 27: 239-245
        • Stadler ZK
        • Schrader KA
        • Vijai J
        • Robson ME
        • Offit K
        Cancer genomics and inherited risk.
        J Clin Oncol. 2014; 32: 687-698
        • O'Brien MJ
        • Halbert CH
        • Bixby R
        • Pimentel S
        • Shea JA
        Community health worker intervention to decrease cervical cancer disparities in Hispanic women.
        J Gen Intern Med. 2010; 25: 1186-1192
        • Martin MY
        Community health advisors effectively promote cancer screening.
        Ethn Dis. 2005; 15: S14-S16
        • Allen CG
        • McBride CM
        • Balcazar HG
        • Kaphingst KA
        Community health workers: an untapped resource to promote genomic literacy.
        J Health Commun. 2016; 21: 25-29
        • Ramos IN
        • Ramos KN
        • Ramos KS
        Driving the precision medicine highway: community health workers and patient navigators.
        J Transl Med. 2019; 17: 85
        • Chen LS
        • Zhao S
        • Stelzig D
        • et al.
        Development and evaluation of a genomics training program for community health workers in Texas.
        Genet Med. 2018; 20: 1030-1037
      2. Genomic workforce competencies 2001. Centers for Disease Control and Prevention. Updated November 18, 2010. Accessed March 27, 2020.

        • HHS, Secretary's Advisory Committee on Genetics Health and Society
        Genetics education and training: reports of the Secretary's Advisory Committee on Genetics Health and Society.
        HHS, Secretary's Advisory Committee on Genetics Health and Society, Bethesda, MDPublished February 1, 2011
        • Khoury MJ
        • Gwinn M
        • Burke W
        • Bowen S
        • Zimmern R
        Will genomics widen or help heal the schism between medicine and public health?.
        Am J Prev Med. 2007; 33: 310-317
        • Talwar D
        • Tseng TS
        • Foster M
        • Xu L
        • Chen LS
        Genetics/genomics education for nongenetic health professionals: a systematic literature review.
        Genet Med. 2017; 19: 725-732
      3. NCCN guidelines & clinical resources. National Comprehensive Cancer Network. Updated October 10, 2017. Accessed February 7, 2018.

        • Texas Department of State Health Services, Health Promotion and Chronic Disease Section
        Community health worker (CHW) core competencies.
        Texas Department of State Health Services, Health Promotion and Chronic Disease Section, Austin, TXPublished May 1, 2018
        • Erwin DO
        • Spatz TS
        • Turturro CL
        Development of an African-American role model intervention to increase breast self-examination and mammography.
        J Cancer Educ. 1992; 7: 311-319
        • Mccarthy B
        Using the 4MAT system to bring learning styles to schools.
        Educ Leadersh. 1990; 48 ( Accessed March 27, 2019): 31-37
        • McCarthy B
        • McCarthy D
        Teaching Around the 4MAT® Cycle: Designing Instruction for Diverse Learners With Diverse Learning Styles.
        Corwin Press, Thousand Oaks, CA2006
        • Bandura A
        Social Foundations of Thought and Action: A Social Cognitive Theory.
        Prentice Hall, Inc., Englewood Cliffs, NJ1986
        • Ajzen I
        The theory of planned behavior.
        Organ Behav Hum Decis Process. 1991; 50: 179-211
        • Rogers E
        Diffusion of Innovations.
        5th ed. Free Press, New York, NY2003
      4. My Family Health Portrait: a tool from the Surgeon General. Center for Disease Control and Prevention. Updated March 26, 2020. Accessed March 27, 2020.

      5. CHW certification requirements. Texas Department of State Health Services. Updated November 23, 2020. Accessed December 11, 2020.

        • McLaughlin G
        SMOG grading: a new readability formula.
        J Reading. 1969; 12 ( Accessed March 27, 2020): 639-646
      6. Find shortage areas. Health Resources and Services Administration. Accessed July 29, 2020.

      7. Robust open-source learning platform. Moodle. Accessed March 27, 2020.

        • HHS, Health Resources and Services Administration
        Training community health workers: using technology and distance education.
        HHS, Health Resources and Services Administration, Rockville, MDPublished April 2006
        • Sabo S
        • Wennerstrom A
        • Phillips D
        • et al.
        Community health worker professional advocacy: voices of action from the 2014 National Community Health Worker Advocacy Survey.
        J Ambul Care Manage. 2015; 38: 225-235