Authors :
Presenting Author: Katarzyna Czerniak, MLA, MPH, PhD Candidate – UTHealth School of Public Health
Alejandra Garcia-Quintana, MPH, DDS – Health Promotion and Behavioral Science – University of Texas School of Public Health; Denya Ardis, Self-Management Coordinator – Epilepsy Foundation Texas; Rosalia Guerrero, Ph.D. Candidate – University of Texas School of Public Health; Rebecca Moreau, Assistant Director – Epilepsy Foundation Texas; Susanne Thomas, Masters in Professional Counseling – Epilepsy Foundation Texas; Robert Addy, Ph.D. – Health Promotion and Behavioral Science – University of Texas School of Public Health; David Labiner, MD – Neurology – University of Arizona College of Medicine; Refugio Sepulveda, MPH, MPA, Ph.D. – Neurology – University of Arizona Mel and Enid Zuckerman College of Public Health; Ross Shegog, Ph.D. – Health Promotion and Behavioral Science – University of Texas School of Public Health
Rationale:
Community health workers (CHWs) are being incorporated within Epilepsy Foundation Texas (EFTx) clinics to provide people with epilepsy (PWE) healthcare navigation, health education, and linkage to services. A trial is underway to assess the benefits of providing CHWs with digital decision support to generate a patient-derived epilepsy self-management (ESM) action plan. CHW readiness to engage in navigation and education of PWE in EFTx affiliated clinics was assessed. Methods:
CHW training comprised the CHW Core Consensus Project Roles, Skills, and Qualities, the CDC CHW curriculum, EFTx training protocols, and MINDSET decision support facilitator training to enable CHW’s to assess ESM, comorbidities (depression, memory deficits), social determinants of PWE, and identify needed educational programs and social support services. A 83-item post-test readiness survey, compiled from existing scales, assessed knowledge about epilepsy (19 T/F items), self-efficacy to care for PWE (nine items) and provide ESM education (10 items) with 5-point Likert scale response sets (1 being "not at all" to 5 being "completely confident"); and 45 agree/disagree items on attitudes related to negative stereotypes (n=11 items), personal fear and social avoidance (n=9), risk and safety concerns (n=13), and work and role expectations (n=12). The survey was used as a post-test following training. Analysis comprised self-efficacy subscale internal consistency and descriptive statistics.Results:
The CHWs (n=5) were female, 60% AA and 40% Hispanic and Texas certified. Internal consistency for the self-efficacy to care for PWE and to provide ESM education was 0.94 and 0.98 respectively. The CHWs scored highly on knowledge about epilepsy and ESM (m=95.78%), confidence to care for PWE (m=4.62±0.42) and educate them about ESM (m=4.78 ±.43), and in their support of PWE in work and social contexts (m=100%). CHWs were mostly aware of negative stereotypes (m=87.27%). Scores were lower for work and role expectations (m=81.6%) and lowest for PWE risk and safety (m=55.38%). Forty percent CHWs did not believe PWE can safely do the same work activities or be held to the same work expectations as workers who do not have epilepsy. Most (80%) were against allowing a child to ride in the car with a driver who has epilepsy, would not allow PWE to babysit an infant, and believed that PWE could not operate heavy machinery safely. Most (60%) would not ride in a car driven by PWE, expect PWE not to drive even with a state-issued license, and believed that PWE already know everything about their condition.
Conclusions:
A comprehensive competency-based training program can prepare CHWs with knowledge, self-efficacy, and attitudes to manage PWE in EFTx clinics. Results indicate that increased focus on lifestyle issues of risk and safety expectations of work and roles may be beneficial.Funding: This research was funded by a CDC Special Interest Project Grant (SIP 20-006;
6U48DP006413).