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Introduction

Contents


Dear Community Health Worker:

You are important to us. We need your help to deliver lifesaving information to African Americans. Sadly, too many African Americans die of cardiovascular disease (CVD), particularly heart disease and stroke. Among African Americans, heart disease is the #1 killer, and stroke is the #3 leading cause of death. About 1 in 4 African American men and women dies of heart disease, and about 1 in 19 African American men and 1 in 13 African American women die of stroke.

The good news is that we already know a lot about what to do to prevent heart disease and stroke. High blood pressure, high blood cholesterol, obesity, smoking, not being physically active, and diabetes are all factors that increase a person's risk of heart disease and stroke. African Americans can lower their risk of heart disease and stroke by making healthy lifestyle changes, getting their risk factors checked, and seeing health care providers and following their advice if risk levels are elevated. Community health workers like you can help. The With Every Heartbeat Is Life project can guide you as you begin this journey.

"With Every Heartbeat Is Life: A Community Health Worker's Manual for African Americans" is a heart health manual created especially for African American communities by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH), U.S. Department of Health and Human Services (DHHS). You will notice that cultural adaptations are used to make the manual more appealing and relevant to African American communities.

The "With Every Heartbeat Is Life" manual provides all the information you need to put a heart health project into action in your community. Taught by trained community health workers, the manual helps people build skills to make practical, lasting changes to help fight heart disease. The manual can be used to train community health workers, to teach members of the African American community, and to serve as the basis for other community activities.

"With Every Heartbeat Is Life" is dedicated to community health workers like you who devote time and energy to help others improve their health and live longer. Thank you for making a difference.

Much success,

Gregory J. Morosco, Ph.D., M.P.H.
Director
Division for the Application of Research Discoveries
National Heart, Lung, and Blood Institute

U.S. Department of Health and Human Services
National Institutes of Health

Nationa Heart Liung and Blood Institute
People Science Health

NIH Publication No. 08-5844
October 2007


The Role of the Community Health Worker

Community health workers play a key role in promoting better health in African American communities. They help people learn about health issues and show them ways to live healthier lives. Without them, many African Americans might not receive such vital information.

Successful community health workers have special qualities. They know their communities well. They are dedicated to improving the health of their communities. They enjoy teaching others, feel comfortable in front of a group, and know how to work with a group. Successful community health workers are also:

  • Good listeners
  • Nonjudgmental
  • Caring
  • Pleasant
  • Patient
  • Approachable
  • Fair
  • Open minded
  • Helpful
  • Motivated
  • Reliable
  • Confident
  • Trustworthy
  • Willing to try ways to improve their own health

We thank you for your interest and efforts to help African Americans take steps to protect their hearts. We invite you to give us your feedback on how you are using the manual in your community.

Organizations

This manual has been reviewed by or received support from the following organizations:

Association of Black Cardiologists
Atlanta, GA

District of Columbia Housing Authority
Washington, DC

Acknowledgments

The "With Every Heartbeat Is Life" manual was developed with the dedication of many people. The NHLBI gratefully acknowledges the contributions of community health workers, families, groups, and organizations for the success of this manual.

Special Recognition

Special appreciation is extended to Lenee Simon, M.P.H., formerly of NHLBI, who initiated the development of this manual. Ms. Simon is currently with the Office of Disease Prevention and Health Promotion, DHHS.

NHLBI also wishes to acknowledge the resident leaders and public housing residents who provided input to the development of the "Baltimore City Public Housing Community Health Worker Educator's Manual," which was the springboard to the development of the "With Every Heartbeat Is Life" manual.

NHLBI extends special recognition to the following individuals for assisting NHLBI in pilot testing selected sessions and/or activities from this manual:

Barbara Abdullah
Lay Health Worker
Baltimore, MD

Janice Bowie, Ph.D.
Assistant Professor
The Johns Hopkins Bloomberg
School of Public Health
Baltimore, MD

Margaret Brewer
Lay Health Coordinator
Baltimore, MD

Anne B. Clark
District of Columbia Housing Authority
Speakers' Bureau
Washington, DC

Loretta Elbourne
Lay Health Worker
Baltimore, MD

Ellen Foster
Lay Health Worker
Baltimore, MD

Judith Fradkin, M.D.
Director, Diabetes, Endocrinology, and Metabolic Diseases Division
National Institute of Diabetes and Digestive and Kidney Diseases
Bethesda, MD

Joanne M. Gallivan, M.S., R.D.
Director
National Diabetes Education Program
National Institute of Diabetes and Digestive and Kidney Diseases
Bethesda, MD

Juanita Green
Community Health Worker
Housing Authority of Baltimore City
Healthy Hearts in Housing Project
Baltimore, MD

Mary Hollinger-Haye
District of Columbia Housing Authority Speakers' Bureau
Washington, DC

Debbie Johnson
Lay Health Coordinator
Baltimore, MD

Jennifer Joyner
Community Health Worker
Housing Authority of Baltimore City
Healthy Hearts in Housing Project
Baltimore, MD

Marie Y. King
District of Columbia Housing Authority
Speakers' Bureau
Washington, DC

Jean Lann
Lay Health Coordinator
Baltimore, MD

Samuel B. Little, Ph.D.
Director, Office of Resident Services
District of Columbia Housing Authority
Washington, DC

Kathy Love
Coordinator of Senior Programs,
Office of Resident Services
District of Columbia Housing Authority
Washington, DC

Patricia Malloy
District of Columbia Housing Authority Speakers' Bureau
Washington, DC

Dennis McRae
Community Health Worker
Housing Authority of Baltimore City
Healthy Hearts in Housing Project
Baltimore, MD

Darlene Miller
Lay Health Worker
Baltimore, MD

Sheila D. Moore
Lay Health Coordinator
Baltimore, MD

Carol Bryant Payne, M.S.N.
Baltimore Office, U.S. Department of
Housing and Urban Development
Baltimore, MD

Elisa Rodriguez, M.S.
Research Assistant
The Johns Hopkins Bloomberg
School of Public Health
Baltimore, MD

Angelia D. Scott
District of Columbia Housing Authority
Speakers' Bureau
Washington, DC

Mary Sessoms
District of Columbia Housing Authority
Speakers' Bureau
Washington, DC

Phyllis Seward
Lay Health Worker
Baltimore, MD

David Watson
District of Columbia Housing Authority Speakers' Bureau
Washington, DC

NHLBI

Matilde Alvarado, R.N., M.S.N.
Coordinator
Minority Health Education and
Outreach Activities
Division for the Application of Research Discoveries
Bethesda, MD

Camina Davis, M.S.H.P.
Community Health Specialist
Division for the Application of Research Discoveries
Bethesda, MD

Robinson Fulwood, Ph.D., M.S.P.H.
Branch Chief
Enhanced Dissemination and Utilization Branch
Division for the Application of Research Discoveries
Bethesda, MD

Janet de Jesus, M.S., R.D.
Nutrition Education Specialist
Division for the Application of Research Discoveries
Bethesda, MD

Laina Ransom, M.B.A.
Program Analyst
Division for the Application of Research Discoveries
Bethesda, MD

Madeleine Wallace, Ph.D.
Public Health Analyst
Division for the Application of Research Discoveries
Bethesda, MD

Contract Support

IQ Solutions, Inc.
Rockville, MD

Sources

Inspirational quotes for this manual were obtained from www.brainyquotes.com, http://leadershipaib.com/quote.php, and www.wikipedia.org.

About the With Every Heartbeat Is Life Project

This manual is one part of the With Every Heartbeat Is Life project. The project includes:

  • "With Every Heartbeat Is Life: A Community Health Worker's Manual for African Americans" manual and "With Every Heartbeat Is Life Picture Cards for Community Health Workers"
  • "Heart Healthy Home Cooking: African American Style" booklet features recipes for your favorite African American dishes that you can prepare in ways that protect you and your family from heart disease and stroke. Delicious foods from spicy southern barbecued chicken to sweet potato pie are included.
  • "On the Move to Better Heart Health for African Americans" booklet highlights techniques that you and your family can use to start or maintain activities that promote a heart healthy lifestyle.

Ordering information for these materials appears on page 453.

How To Use This Manual

Community Health Workers

This manual is for you! The "With Every Heartbeat Is Life" manual can be used to train community health workers. After you've been trained, you can conduct your own trainings, and teach others how to be community health workers.

The "With Every Heartbeat Is Life" manual consists of 12 sessions that include step-by-step instructions on how to teach 11 fun and educational sessions to community residents or patients. Each session is taught in motivational and interactive ways to keep the attention of the group members. Each session helps people learn about what they can do to prevent heart disease. The manual includes worksheets and handouts for project participants (group members) to take home to read and share with their family and friends.

It also includes a special session for community health workers on how to evaluate completed projects. This session helps community health workers determine how successful they have been in implementing their training and educational activities and helping community residents to adopt heart healthy habits. The Appendix features special training activities and teaching tips and explains how to start a project in your community.
(See pages 427—453.)

"With Every Heartbeat Is Life" Sessions

  1. Knowledge Is Power: Know Your Risk for Heart Disease
  2. Act in Time to Heart Attack Signs
  3. Get Energized! Say YES to Physical Activity
  4. Help Your Heart: Control Your High Blood Pressure
  5. Be Heart Smart: Keep Your Cholesterol in Check
  6. Embrace Your Health! Aim for a Healthy Weight
  7. Protect Your Heart: Take Good Care of Your Diabetes for Life
  8. Make Heart Healthy Eating an Everyday Family Reunion
  9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight
  10. Take Control of Your Health: Enjoy Living Smoke Free
  11. Review and Graduation
  12. Use Evaluation To Track Your Progress (Especially for Community Health Workers)

About the Sessions

Each session covers a different topic related to heart health. The sessions generally follow the same structure, which will be explained next. Sessions also include "More Information" boxes, which have extra facts on selected health topics to help you answer questions from group members.

Length of Sessions

Most sessions last about 2 hours. Session 5, "Be Heart Smart: Keep Your Cholesterol in Check," and Session 7, "Protect Your Heart: Take Good Care of Your Diabetes for Life," could last a little longer.

Evaluation

Session 12, "Use Evaluation To Track Your Progress (Especially for Community Health Workers)," describes how to evaluate the effectiveness of the "With Every Heartbeat Is Life" manual. This session is designed to guide community health workers and project evaluators in the planning, implementation, and evaluation of the project. The purpose of the session is to provide ideas for tracking project activities and tools for measuring changes in group members' behaviors and clinical values. You can use the ideas and tools to: (1) improve the quality of the project, (2) show that your activities work, and (3) provide information to organizations that support your project through funding, referrals, and in-kind contributions.

Glossary

Community Health Workers may find it helpful to have a glossary of terms or more information on cardiovascular topics covered in this manual.  The NHLBI Diseases and Conditions Index, http://www.nhlbi.nih.gov/health/dci/index.html, contains information on diseases, conditions, and procedures related to heart disease.

Session Outline

Each session begins with a summary page that explains:

  • What you want group members to do or learn
  • Materials and supplies that you will need
  • Handouts and take-home materials
  • The session outline

In addition, each session includes five major parts:

Part 1—Introducing the Session

  • Welcome the group members.
  • Review the information from the last session.
  • Ask the group members to talk about their pledges. (See the Weekly Pledge section under this outline.)
  • Explain what you will talk about in today's session.

Part 2—Conducting the Session

  • Present new information.
  • Lead the group in fun and educational activities.
  • Ask the group members questions.
  • Allow the group members to ask questions about what they have heard.

Part 3—Review of Today's Key Points

  • Ask questions to help the group members review what they just learned.
  • Emphasize the important points.

Part 4—Weekly Pledge

  • Help group members come up with a pledge to make healthy lifestyle changes that relate to the information they have learned during the session.
  • Give several examples of pledges that are specific and realistic.
  • Share the personal value. The value helps encourage participants to keep their pledge and gain confidence to make lasting lifestyle changes.

Part 5—Closing

  • Thank the group members for their comments, and ask them what they thought of the session.

Symbols

The following symbols are used throughout the manual to let you know quickly what comes next:

  • Do an activity.
  • Use a picture card.
  • Give out a handout.
  • Help group members create a pledge for heart health.
  • Give out a recipe.
  • Do a training activity.

Picture Cards

The "With Every Heartbeat Is Life" picture cards can be used with the manual to help you present information for each session. When you see the picture card symbol in the manual, you will know to show a picture that relates to the information you will be presenting. On the back of each picture card is a script that you can read aloud while you show the picture card.

Breaks and Refreshments

You should take a short break about halfway through each session. You may want to use the time to do some easy stretches (see the "Stretching Activities" handout). Another option is to serve a small healthy snack with water during the break. Snack ideas include light yogurt, fruit or vegetables with low-fat dip, and water. Or you can prepare one of the recipes from this manual and have group members taste it.

Getting Started

At Least 6 Weeks in Advance

  1. Find a location where you can teach the With Every Heartbeat Is Life sessions. Find a place in your area that people can get to easily. Local clinics, schools, churches, and community centers are possible sites for holding sessions. Call them to find out if you can reserve a room at a time that is most convenient for community residents.
  2. Tell people about the project. Let community leaders and others know that you will be presenting the sessions. Ask clinic staff, clergy, and caseworkers to recommend the project to their patients, congregations, and clients.
    • Say:
      These are some benefits of the project:
      • It can help participants and their families find out their own risk for heart disease and learn how to lead healthier lives.
      • Participants will learn how to start their own journeys, and journeys for their families, toward healthier hearts. They will learn how to prevent or control high blood pressure, high blood cholesterol, overweight, and diabetes; prepare healthy meals at a low cost; become more physically active; keep a healthy weight; and quit smoking.
      • The course is also for people who have risk factors for heart disease or are under a doctor's care because of heart disease. These sessions will guide participants to take steps to protect and improve their heart health.
      • Participants will learn that whatever your age or current health status, it's never too late to take steps to protect your heart.
  3. Advertise the sessions. Post flyers at health fairs and in community sites, such as clinics, grocery stores, churches, and other places in your community. (See the sample flyer.) Place project announcements in local media outlets.
  4. Class size. A small group of about 10 to 12 people is best. Try to get about 20 people to sign up because some may not show up, and others may drop out.

At Least 1 Week Before Each Session

  1. Read through the sessions, picture cards, and handouts. Read through these materials two or three times to be prepared.
  2. Carefully read the information that you will present to the group members. Practice what you will say in front of a mirror or to a friend or family member. Be sure to use the picture cards. Also practice making a few healthy changes in your own life.
  3. Review the instructions for each activity. Make a list of things you need to do before the session, such as displaying items on a table or getting a TV monitor. For some sessions, you will need to create lists of places where people can get their blood pressure, blood cholesterol, and blood glucose (blood sugar) checked.
  4. Pay attention to the "More Information" boxes. This extra information helps you answer questions from the group.
  5. Ask a health educator, registered dietitian, nurse, or doctor to explain any information you do not understand. Contact these health professionals at your local hospital or neighborhood clinic.
  6. Review the list of handouts, materials, and supplies you will need for each session.
    • Make enough copies of the handouts for all group members.
    • Gather all the materials and supplies needed to conduct the session.

The Day of the Session

  1. Review the list of materials, supplies, and handouts. Make sure that you have everything.
  2. Arrive 30 to 60 minutes ahead of time. This will allow you to set up the room.
  3. Tell group members when sessions will meet and how often.

Working With Your Group

Leading the Group

  • Get to know the members of your group. They may have different backgrounds, interests, and needs.
  • Encourage group members to ask questions. Asking questions helps them apply the information to their own lives and remember what they have learned.
  • Keep the sessions flowing smoothly, so everyone is interested and involved.
    • Be ready to deal with people who talk too much. If someone begins to talk too long, thank the person for sharing his or her opinion. Then quickly ask if anyone else has something to share.
    • Help group members who do not read or write well. Do this in a way that will not bring attention to them.
    • Offer help, but do not force anyone to accept help.
    • Change the activity to a group discussion if only a few people are talking.
  • Be observant. Watch for clues from group members who do not understand, and try to present the information in a different way if you see these clues:
    • Puzzled looks
    • Wrinkled foreheads
    • Looking away from you
    • Being quiet

Motivating Group Members

  • Praise or reward group members' efforts in order to keep them motivated.
    • Give praise when it is deserved. This gives more meaning to what you are teaching.
    • Praise people in front of others. This can help them stay committed.
  • Encourage group members to share their opinions.
    • Show interest in group members and what they have to say.
    • Be patient. Some people may not speak because they have never been asked to share their opinions in a group setting.
    • Try to involve everyone in the discussion and activities, but do not force anyone to speak. People will speak up when they become used to the group.

Taking Small Steps Toward Change

People are more likely to develop new habits if you promote small changes slowly. This brings more success.

Getting People To Attend

  • Remind group members that it's important to come to all the sessions. Tell them that they will:
    • Learn something new at each session.
    • Help family members.
    • Socialize and meet new people.
  • Ask people to team up and call one another as a reminder to attend the sessions. This encourages people to attend.
  • Remind them of the meeting time and how long the sessions will last.

Answering Hard Questions

Remember that it's okay not to know all the answers! Say that you will have the correct answer by the next session. Call a local health educator, registered dietitian, or nurse to find out the correct information.

Keeping People on Track

Give the correct information when a group member gives incorrect or incomplete information. Give the person credit for any part of his or her answer that is correct. Say that people often hear incorrect information and believe it to be true. Tell the group members that this is one important reason why they are coming to the sessions—to get correct information.

And Finally . . .

Have a good time. You are doing an important service for yourself and your community. Thank you!

Let's Hear From You!

We thank you for your interest and efforts to help African Americans take steps to protect their hearts. We invite you to give us your feedback on how you are using the "With Every Heartbeat Is Life" manual in your community.

Your feedback will help promote the expansion of the project and contribute to the growth of the With Every Heartbeat Is Life network. Establishing a large network of community health workers is important to keep the project going strong!

You may send your feedback to:
With Every Heartbeat Is Life Project
Division for the Application of Research Discoveries


Did You Know…

About one out of four African Americans dies of heart disease.
But you can do something about it!

The With Every Heartbeat Is Life project will help you:

  • Learn how to keep your heart and your family's hearts healthy through games, role-playing, and other activities that make learning fun.
  • Find ways to increase your physical activity, eat in a heart healthy way, keep a healthy weight, and not smoke.
  • Learn how to talk to your family, neighbors, and friends about heart disease.
  • Understand and connect to heart healthy practices through cultural activities.
  • Get take-home materials you can share with others.

Classes meet once a week for 11 weeks.

Classes meet: __________

Sponsored by: __________

Location: __________

Day/time: __________

Classes begin on: __________

For more information or to register, contact: __________

The course is free.

Everyone who completes the classes will receive a certificate.


 

Begin With a Heart

Graphic of Heart to cut out.

Use this shape to cut out the heart.
You will need these heart shapes in session 1.


Go To SESSION 1

Last Updated December 2010

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