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CHIMPS: Partnering with Communities in Global Health Education—An Experience in Abelines, El Salvador Aaron Grigg, MD; Maya Maxym, MD; Lisa Cranmer, MD, MPH; John Cranmer, ARNP, MPH, MSN; Nancy Danoff, MD, MPH; Ali Hunt, MS1; Kelly Evans, MD; Sarah Bergman, MD; Lori Macklin, ENLACE; Ellie Graham, MD, MPH Context • Residents in the United States are increasingly committed to global health • Short-term experiences may not improve community outcomes longitudinally • Structuring an exchange based on collaboration, community involvement, service, education, and empowerment created a self- sustaining and mutually beneficial program • CHIMPS progressively developed culturally relevant, low literacy health education materials in collaboration with community members Future Directions • Develop a mental health charla • Partner with Abelines as they model action-learning for nearby communities • Provide technical support related to first aid and child birthing Key Lessons • Involve community—ask about needs and incorporate suggestions into brigada strategy • Use realistic, familiar and local pictures • Facilitate active participation of health committee in priority setting and teaching Background • Residents established longitudinal relationships between CHIMPS, ENLACE and Abelines with yearly medical brigadas from 2002-2008 • First “charlas” were based on WHO materials and addressed nutrition, dental health, parasites, and anemia • Annual brigada improvements are based on: • CHIMPS experience • Yearly community surveys • Annual feedback from the health committee • Strategic Planning trip before brigada, 2008: • Visits to various caserios and homes • Health committee focus group Factor Early Model 2008 Model Context Knowledge transfer Theoretical data Behavior modification Designed to impact health outcomes Literacy Verbal and text- based Graphic & Photo-Based Graphics Simple schematics Schematics with behavior focus Photos from community Simulation & Motivation Transfer knowledge Model and display behaviors Repetition of key points Cultural Fit Professional’s priorities, perspectives and values Issues identified by health committee & emerging from felt needs Affective Speaking and lecture Acting, demonstrating, participation, kinesthetic learning, humor Numerous barriers Knowledge is transferred for Evolving Charlas Outcomes • Health education owned by community • Dental care provided by trained health committee leaders from community • Local water source protected and methods of home water purification implemented • Micronutrient consumption increased and income generated from home gardens • Increased latrine utilization to minimize communicable disease transmission Abelines What is A Charla? 1.Definition: A brief health-related presentation targeted to marginally literate groups of 10-30 people 2.Purpose: Motivate health-related behavior changes which are feasible in the context of constrained resources 3.Format: Interactive, concrete, humorous, relational, and culturally relevant Delivering Action-Oriented Education through Charlas How Have Charlas Been Revised? Iteratively redesigned over time based on input from: 1. CHIMPS longitudinal experience in Abilenes community 2. Evidence-driven frameworks such as SEED-SCALE and Suitability Assessment of Materials 3. Input from health committee and community focus groups Moving from Didactic Lecture to Visual and Interactive Learning CHIMPS resident models dental health charla on first day Later, Julia teaches dental health in her own community Training Trainers To Improve Long-Term Health Outcomes CHIMPS physician models fluoride varnish application Spending Time in Community Supports Action-Learning Later, committee member prevents caries in her own community

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Page 1: CHIMPS: Partnering with Communities in Global Health Education— An Experience in Abelines, El Salvador Aaron Grigg, MD; Maya Maxym, MD; Lisa Cranmer, MD,

CHIMPS: Partnering with Communities in Global Health Education—An Experience in Abelines, El Salvador

Aaron Grigg, MD; Maya Maxym, MD; Lisa Cranmer, MD, MPH; John Cranmer, ARNP, MPH, MSN; Nancy Danoff, MD, MPH; Ali Hunt, MS1; Kelly Evans, MD; Sarah Bergman, MD; Lori Macklin, ENLACE; Ellie Graham, MD, MPH

Context• Residents in the United States are increasingly

committed to global health• Short-term experiences may not improve

community outcomes longitudinally• Structuring an exchange based on collaboration,

community involvement, service, education, and empowerment created a self-sustaining and mutually beneficial program

• CHIMPS progressively developed culturally relevant, low literacy health education materials in collaboration with community members

Future Directions• Develop a mental health charla • Partner with Abelines as they model action-

learning for nearby communities• Provide technical support related to first aid and

child birthing

Key Lessons• Involve community—ask about needs and

incorporate suggestions into brigada strategy• Use realistic, familiar and local pictures • Facilitate active participation of health

committee in priority setting and teaching

Background• Residents established longitudinal relationships

between CHIMPS, ENLACE and Abelines with yearly medical brigadas from 2002-2008

• First “charlas” were based on WHO materials and addressed nutrition, dental health, parasites, and anemia

• Annual brigada improvements are based on:• CHIMPS experience• Yearly community surveys• Annual feedback from the health committee

• Strategic Planning trip before brigada, 2008:• Visits to various caserios and homes• Health committee focus group feedback

o Identified goals/dreams for communityo Add new charla content (initiate women’s

health and mental health charlas)o Revise charla format (fewer written words

and more photographs)

Factor Early Model 2008 Model

ContextKnowledge transferTheoretical data

Behavior modificationDesigned to impact health outcomes

Literacy Verbal and text-based Graphic & Photo-Based

Graphics Simple schematicsSchematics with behavior focusPhotos from community

Simulation & Motivation

Transfer knowledgeModel and display behaviorsRepetition of key points

Cultural FitProfessional’s priorities, perspectives and values

Issues identified by health committee & emerging from felt needs

Affective Speaking and lectureActing, demonstrating, participation, kinesthetic learning, humor

TrajectoryNumerous barriers to knowledge transmission and behavior change

Knowledge is transferred for sustainable change; Committee observes, learns then delivers charlas

Evolving Charlas

Outcomes• Health education owned by community

• Dental care provided by trained health committee leaders from community

• Local water source protected and methods of home water purification implemented

• Micronutrient consumption increased and income generated from home gardens

• Increased latrine utilization to minimize communicable disease transmission

Abelines

What is A Charla? 1. Definition: A brief health-related presentation targeted to

marginally literate groups of 10-30 people2. Purpose: Motivate health-related behavior changes

which are feasible in the context of constrained resources3. Format: Interactive, concrete, humorous, relational, and

culturally relevant

Delivering Action-Oriented Education through Charlas

How Have Charlas Been Revised?Iteratively redesigned over time based on input from: 1. CHIMPS longitudinal experience in Abilenes community2. Evidence-driven frameworks such as SEED-SCALE and Suitability Assessment of Materials3. Input from health committee and community focus groups

Moving from Didactic Lecture to Visual and Interactive Learning

CHIMPS resident models dental health charla on first day

Later, Julia teaches dental health in her own community

Training Trainers To Improve Long-Term Health Outcomes

CHIMPS physician models fluoride varnish application

Spending Time in CommunitySupports Action-Learning

Later, committee member prevents caries in her own community

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