Active CHWS: Advancing community health workers through physical activity awareness and health education

Selzer Ninomiya, Ana Laura

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https://hdl.handle.net/2142/129211 Copy

Description

Title

Active CHWS: Advancing community health workers through physical activity awareness and health education

Author(s)

Selzer Ninomiya, Ana Laura

Issue Date

2025-04-18

Director of Research (if dissertation) or Advisor (if thesis)

Aguiñaga, Susan

Doctoral Committee Chair(s)

Aguiñaga, Susan

Committee Member(s)

• Schwingel, Andiara
• Rodrigues Curi Hallal, Pedro
• Smith, Tracey

Department of Study

Kinesiology & Community Health

Discipline

Kinesiology

Degree Granting Institution

University of Illinois Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

community health workers, physical activity, health promotion, health education, public health, self-efficacy, health behaviors

Abstract

Noncommunicable diseases (NCDs) such as heart disease, cancer, and diabetes are currently the leading cause of death and disability in the United States, accounting for more than two thirds of all deaths in the United States each year. In addition, underserved populations are twice as likely to develop NCDs. Physical activity (PA) can prevent against the most prevalent NCDs; however, there is a need to create innovative, culturally sensitive, and sustainable strategies to reduce disparities through the promotion of PA. Training Community Health Workers (CHWs) on PA might be key to successful behavior change, as they play a unique role in public health by being trusted members of the community they serve. These professionals deliver health education, address social determinants of health, and improve cultural competency in institutions. Moreover, CHWs share lived experiences with their clients, helping to identify strategies for a feasible, culturally sensitive, and successful behavior change. On the other hand, because of being part of the same community, CHWs might also share similar health behaviors as their clients. In the first study, we administered a questionnaire on knowledge and awareness of the PA guidelines from the Office of Disease Prevention and Health Promotion to CHWs across the country. Among 108 surveyed CHWs (Mage=42 SD=9.70, 86% Female, 47.2% White), 77.6% reported that they have recommended PA to their clients; however, only 38% reported any familiarity with the PA guidelines. This is reflected through their overall score on the Knowledge and Awareness survey (Moverall score=3.18, SD=1.50), which ranged from 0-7 correct answers; thereby suggesting low knowledge of PA, largely driven by the lack of awareness on specific dosage recommendations. For example, only 19.4% selected the correct answer for the recommended weekly dose of moderate-intensity PA, 8.4% for vigorous-intensity PA, and 24.3% for muscle strengthening activities. The majority of CHWs had a good understanding of PA concepts, with over 50% correctly identifying what constitutes moderate-intensity and vigorous-intensity PA, along with relevant examples. Chi-Square analyses showed no statistically significant difference in PA knowledge across demographic groups, but those who reported having familiarity with PA guidelines were more likely to correctly respond to the questions on dosage of moderate (p=0.02) and vigorous intensity PA (p=0.02), and muscle strengthening (p=0.02). In the next study, CHWs underwent a 4-week PA training program and examined pre-post changes in PA and exercise self-efficacy. In this trial, CHWs (N=23) were recruited in Illinois and randomized into an intervention group (N=12) and a waitlist control group (N=11). The PA course was composed by 8 modules divided into 4 weeks. After the completion of the intervention group, the course was offered to participants in the waitlist control group. Device-assessed PA was assessed by Fitbit Inspire 3 devices from the start of the intervention group until the end of the waitlist control group course, resulting in a total of 8 weeks. We conducted a bivariate analysis to assess pre- and post-intervention changes within and between groups. Multiple linear regression models were used to explore the association between PA at post-testing and baseline knowledge and awareness of PA, self-efficacy, and stage of change. Effect sizes were calculated to show the magnitude of differences between means and variance. All participants had a decrease in the number of weekly steps; however, those in the intervention group presented a lower decrease when compared to their control counterparts, with a moderate effect size (2=0.07). For all intensities of PA (i.e., light, moderate and vigorous), there were no statistically significant changes in daily average PA. On the other hand, self-reported PA suggested small to medium effect sizes of the intervention on PA levels. Questionnaires showed that CHWs successfully increased knowledge in PA (p=0.03), but self-efficacy (p=0.41) and stages of health behavior change (p=0.52) did not change post course. In our third study, we qualitatively investigated CHWs’ perceptions on the 4-week PA training program. We conducted semi-structured interviews with 20 Illinois CHWs who participated in an online, 4-week PA training course designed by experts from the University of Illinois Urbana-Champaign. Data was transcribed verbatim and analyzed using an inductive thematic approach. Four major themes emerged: 1) Who cares for who is caring? describes that CHWs oftentimes prioritize the health of their communities and families, and do not focus on their own wellbeing. 2) Stand up for yourself! discusses the awareness of CHWs about their health behaviors and the need for change, alongside the barriers they face when trying to be physically active. 3) Barriers in motion brings attention to several challenges faced by CHWs when trying a more active lifestyle. Lastly, 4) Virtual learning, real-world impact describes CHWs’ perspectives on the features of the program and reflections on the application of this knowledge to their communities.

Graduation Semester

2025-05

Type of Resource

Thesis

Handle URL

https://hdl.handle.net/2142/129211

Copyright and License Information

Copyright 2025 Ana Laura Selzer Ninomiya

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