Implement an Evidence Based Program

Section 5.2

Working with Lay Leaders

Program developers are increasingly incorporating the use of lay leaders into their EBPs. Lay leaders are individuals who do not have formal healthcare credentials who are trained to lead EBPs. Through evaluation studies, many program developers have found that trained lay individuals can teach self-care and other health-related topics as well as healthcare professionals. In fact, lay leaders may be a better option than professional leaders when it comes to some health promotion programs. Because lay leaders live in the communities in which they work, they understand the unique needs of the communities, communicate in the language(s) spoken by community members, and can present EBPs in culturally competent manners. Additionally, lay leaders help make EBPs affordable because it costs less to compensate them for their work than it costs to compensate healthcare professionals.

The relevance of lay leaders varies by EBP. Some programs mandate that lay leaders lead program sessions. Some programs do not require the involvement of lay leaders, but leave room for their incorporation. Other programs do not allow for any incorporation of lay leaders. The role of lay leaders in the program your organization is implementing should be addressed in the program materials and during your training.

Recruiting lay leaders

Recruiting lay leaders is often a challenge; recruiting excellent lay leaders is an even bigger challenge. It is best to review your program materials and check with the program developers (if needed) before identifying potential lay leaders. This is because some programs necessitate that lay leaders have specific characteristics. For example, some programs require that lay leaders have chronic diseases similar to those that participants may have. Some programs require lay leaders to complete the program as a participant before they can lead it. Other programs require leaders to have access to a vehicle for transportation to classes.

Just because an individual has the specific characteristics required to lead a program does not mean he or she will make an excellent leader. Several general qualities that characterize excellent lay leaders are described below.

  • Motivation to help others. Lay leaders should enjoy helping others and desire to see the lives of others improved. This motivation will encourage lay leaders to put a lot of effort into their work and feel like their efforts are valuable.
  • Commitment to following program protocols. It is very difficult for leaders, both lay and professional, to implement a program without interjecting their own ideas and opinions. However, in the interest of fidelity, it is critical that lay leaders implement the program as designed. Even if lay leaders believe they have useful ideas (such as home remedies or alternative exercises) to supplement those presented in the program, it is important that they present the information they are instructed to in the program materials. Adding to and subtracting from the materials both jeopardize fidelity.
  • Level of comfort with own disease(s). If potential lay leaders have a health condition, it is important that they are comfortable with it. Individuals at the extreme ends of the comfort continuum—“victims” who feel depressed and “victors” who want to flaunt their accomplishments—can derail the program by drawing too much focus to themselves. Additionally, individuals at the extremes do not model healthy coping.
  • Encouraging and non-judgmental personality. Changing behaviors is difficult. Participants join health promotion programs to gain assistance in changing their behaviors. Effective lay leaders can accept participants and their previous behaviors without judgment while providing support and encouragement as they attempt behavior change.
  • Literacy and critical thinking skills. Lay leaders need to be able to read at a reading level that allows them to understand and follow the leaders’ manuals and other program materials. They also need critical thinking skills to be able to make spur-of-the-moment decisions if unexpected events happen during program sessions.
  • Respect from fellow community members. A lay leader is likely to be ineffective if he or she is not respected or trusted by peers in the community.

You can create a simple questionnaire to screen potential lay leaders to see if they possess the characteristics listed above. The National Council on Aging provides an example questionnaire used to screen potential lay leaders for the Chronic Disease Self-Management Program.

Where do you find these potential lay leaders? Several ideas for notifying community members of a lay leader opportunity are listed below.

  • Post the lay leader opportunity on a bulletin board at the local volunteer bureau and at senior centers, libraries, and recreation centers.
  • Check with local hospitals about listing the opportunity on their website and posting notices throughout their facilities.
  • See if the local chapters of voluntary health organizations (American Heart Association, Alzheimer’s Association, etc.) will include a notice in their newsletters.
  • Run an ad in the local newspaper and list the opportunity on Craigslist.
  • Mention the opportunity on your organization’s social media pages.
  • Consider people you already know. Do you have a neighbor, fellow church member, or workout buddy who might make a good lay leader? Ask him or her if the opportunity is of interest.
  • Contact your partners to see if they know individuals who might make good lay leaders.
  • After you begin offering the program, ask your leaders to identify participants who might make good lay leaders. Check with them to see if they would be interested in the opportunity.

Glossary of Terms

Toolkit Glossary

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Adaptation– Making changes to an evidence-based program in order to make it more suitable for a particular organization and/or audience.

Baseline – A starting point. In evidence-based programming, the term “baseline” is usually used in the context of data collection, where baseline data is data collected before a program is implemented.

Credentials – A testimony of qualification, competence, or authority issued to an individual by a third party. Examples of credentials include academic diplomas, academic degrees (e.g., MSW, MPH, PhD), licenses (e.g., MD, RN, LCSW), certifications (e.g., CHES, CPR, first aid), and security clearances.

Evidence – Facts or testimony in support of a conclusion, statement, or belief. In some settings, individuals may refer to “levels of evidence” or “types of evidence.” These terms will have specific definitions unique to the setting in which they are used. When referring to evidence-based programs, the term “evidence” is generally used to describe the findings or results of program evaluation studies.

Evidence-based program – A program that has been thoroughly evaluated by researchers who determined it produces positive outcomes.

Fidelity – The extent to which a program is being implemented as its developers intended for it to be.

Implementation – Putting into action or carrying out a program.

Instrument – A measurement tool. Instruments can take many forms including biomedical equipment (e.g., glucometer, blood pressure monitor, weight scale), pencil and paper tests, questionnaires, and interviews. A thermometer is an instrument used to measure body temperature. Likewise, a survey is an instrument that can be used to measure anxiety.

Medicaid – A publically-funded health insurance program for individuals who have low incomes and fall into certain categories of eligibility.

Objectives – Specific, measurable steps that can be taken to achieve goals.

Peer review – When experts review a professional’s performance, research, or writings. Peer review is a way that qualified professionals self-regulate their professions. Performance, research, or writings that pass the peer review process have increased credibility or trustworthiness.

Program champion – An individual who advocates for a program.

Quality assurance- A collection of planned, systematic activities applied to ensure that the components of a program are being implemented well.

Secondary data – Previously collected data that is being used for a purpose other than that for which it was originally collected.

Theory of behavior change – An attempt to explain how and why people change their behaviors. Researchers typically generate theories of behavior change from research in the fields of psychology, education, health, and other social sciences. When developing evidence-based programs, researchers will select a theory or components from several theories to guide program development.

Audience – The individuals for whom you implement your program. Depending on your setting, these individuals may also be referred to as a target population, population of interest, or clientele.

Buy-in – Typically used in the business world, buy-in refers to a financial exchange. In the context of health programs, the buy-in of stakeholders (community members, organizational leaders, participants, etc.) is generally non-financial. It involves their acceptance of a concept, idea, or proposal.

Data – A collection of facts, such as measurements and statistics.

Evidence-based practice – When clinicians (e.g., doctors, nurses) base their healthcare treatment decisions on the findings of current research, their clinical expertise, and the values/preferences of their patients.

Evidence-informed practice or program – A practice or program that is guided by theories and preliminary research. While there is some indication that these practices and programs produce positive outcomes, the evidence is too weak to refer to them as evidence-based. These are sometimes referred to as “promising” or “emerging” practices and programs.

Goals – General, non-measurable intentions or outcomes.

Incentives for participation – Factors that motivate an individual to take part in a program. Organizations sometimes provide incentives to encourage participants to begin and/or remain enrolled in a program. Common incentives include gift cards and program t-shirts.

Intervention – Organized efforts to promote health and prevent disease. This term is used because the efforts intervene, or come between, an individual and a negative health outcome in an attempt to prevent or delay the negative outcome. “Intervention” and “program” are often used interchangeably.

Interventionist – An individual who implements or carries out the components of a program.

Lay leaders – Individuals who do not have formal healthcare credentials who are trained to lead evidence-based programs.

Medicare – A publically-funded health insurance program for adults over age 65 and individuals with certain disabilities or health conditions.

Partnership – A cooperative relationship between two or more organizations that collaborate to achieve a common goal through the effective use of knowledge, personnel, and other resources.

Primary data – Original or new data being collected for a specific research goal.

Protocols - Predefined procedural methods. Examples include detailed program implementation procedures, required equipment, required data collection instruments with detailed instructions for administration, and recommended safety precautions.

Readiness – The degree to which an organization is prepared or ready for something.

Stakeholder – Any individual or group that has a stake or interest in a program.

Translation – The process of taking a program originally implemented in a controlled, laboratory-like setting and making it suitable for implementation in the community.

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