This article, titled “Increasing capacity for ethnically-based community leaders to engage in policy change: assessing the impact of a train-the-trainer approach,” describes a study aimed at addressing healthcare disparities that were exacerbated by the COVID-19 pandemic. The core focus was on training immigrant and refugee communities to advocate for their needs by increasing their capacity to campaign for policy-level changes.
The research was part of a larger initiative, the NIH-funded Community Engagement Alliance Against COVID-19 Disparities (CEAL), which involves community-academic partnerships across 11 U.S. states. The specific objective of this study was to evaluate the impact of a train-the-trainer policy advocacy program designed for ethnically-based community leaders within San Diego County.
Methodology and Program Design:
- The study employed a mixed-methods evaluation, combining quantitative and qualitative data to provide a comprehensive understanding and contextualize findings.
- Researchers partnered with the Global Action Research Center (ARC), a non-profit social change organization, to adapt and deliver the training.
- The program consisted of five in-person, 4-hour training sessions conducted over five weeks. The content and learning objectives for each session were refined by Global ARC with input from the UC San Diego team and adapted to the specific needs of the participating communities. For example, Session 1 focused on “Defining Values and Self-Interest,” Session 3 on “Power Analysis,” and Session 5 on “Base Building”.
- To ensure accessibility for all participants, appropriate language translations and live interpretation for monolingual speakers were provided.
- A total of 16 community leaders from South San Diego participated in the training. Their demographic breakdown was 50% Latino(a), 25% Somali Bantu, and 25% Karen. Participants were identified through collaboration with community leaders and organizers from these ethnically-based communities.
- The trainings were held at a Sudanese Community Center in the “City Heights” neighborhood of San Diego County, chosen for its geographical convenience and space availability.
- Participants received a $100 USD gift card for each session they attended and completed evaluation activities.
- Evaluation measures included:
- Surveys administered at baseline, pre- and post-each training session, and at the beginning of Session 1 and end of Session 5. These Likert-type scale surveys measured changes in perceived knowledge and confidence, and also included open-ended comment fields.
- Ethnographic documentation was utilized by trained research staff to capture the quality and degree of community member engagement both within and across training sessions. This involved documenting attendance, speaking time, language used, and types of interactions (e.g., “giving info,” “seeking info”).
- An “Engagement Survey” was completed at the end of each session, where individuals rated how well and how often the workshop leaders demonstrated engagement principles.
- A two-hour debriefing session was held approximately four months after the final training workshop, with 11 out of 16 participants attending. The primary purpose was to share a summary of the quantitative evaluation data, ensure findings were well understood, gather ideas for applying the campaign training, and facilitate the ongoing development of strong relationships between the research team and the community.
Key Findings:
- Participant Confidence:
- Initial self-assessment surveys from the first session showed a slight decrease in confidence among participants. This phenomenon is attributed to participants gaining a more realistic understanding of their knowledge gaps, a concept sometimes referred to as the Dunning-Kruger effect.
- However, subsequent sessions (3, 4, and 5) demonstrated consistent increases in confidence in policy advocacy skills. For instance, Session 3 saw an average increase of 0.5 points, and Sessions 4 and 5 both saw an average increase of 0.4 points across all questions.
- Overall, the training led to a slight positive change in participants’ capacity to advocate, with a notable average increase of 0.36 points in understanding how to influence local or national policy.
- Engagement Patterns:
- Ethnographic documentation revealed that engagement patterns evolved over time. Initially, Latino(a) participants showed the highest levels of engagement and speaking time in large group discussions. Documenters noted that the “Latino organizations are significantly more vocal”.
- However, by the final session, engagement became more equitable across all participant groups. One documenter observed, “This last session had a pretty equal variation in engagement across all groups. I think it might be because they got to know each other throughout the sessions and became comfortable with each other”.
- Suggestions from documenters included setting up questions requiring more direct communication among groups and ensuring more than one interpreter per language group, which were subsequently addressed by the training presenters and research staff.
- Qualitative Insights:
- Open-ended comments from participants revealed several recurring themes, including uncertainty about policy advocacy, praise for the study and staff, suggestions for improvement (e.g., more local gatherings, clear rules for respect), personal experiences related to advocacy challenges (e.g., lack of agency collaboration, limited funding), perceived barriers within their communities (e.g., lack of awareness in migrant communities), and a clear desire/need for more training.
- Debriefing Session Outcomes:
- The debriefing session proved valuable for data interpretation and sense-making, helping participants understand the initial lower confidence ratings as an accurate recalibration of their knowledge.
- Participants expressed enthusiasm for collaborating across their community organizations to develop and execute a more unified campaign to address social determinants of health needs. The session also strengthened the relationship between the research team and the community.
Strengths and Limitations:
- Strengths include the use of mixed methods for a comprehensive understanding, the demonstration of cultural sensitivity and awareness through providing translators and partnering with a trusted intermediary (Global ARC), and the ethnographic approach that captured real-time engagement.
- Limitations noted were challenges in data collection due to diverse languages and occasional recording issues (though these were promptly addressed), a relatively small sample size which limits generalizability, and the sample not being fully representative of all ethnic minorities in San Diego.
This study highlights the significant potential for community leaders to effectively advocate for public health policy changes through culturally sensitive training. The findings offer valuable insights for future empowerment initiatives by demonstrating how initial self-assessments can shift, how engagement patterns can evolve, and the critical role of culturally appropriate support and continuous engagement.
Reference: Lomeli, A., Stadnick, N. A., Cain, K. L., Watson, P., Oswald, W., Broyles, S. L., Ibarra, M., & Rabin, B. (2025). Increasing capacity for ethnically-based community leaders to engage in policy change: assessing the impact of a train-the-trainer approach. BMC Public Health, 25(968). https://doi.org/10.1186/s12889-024-20822-0
