Promotoras

Promotoras entered the study with higher baseline knowledge and attitude scores than patients. Promotoras had higher baseline knowledge scores than patients, with a statistically significant difference. Thirty-four promotoras enrolled and completed the full study. Promotoras were excluded from the primary pre/post effectiveness analysis because their baseline scores differed from patients. CHWs completed nearly all first visits and most participants completed all six planned visits. CHWs delivered most observed sessions as planned, but fidelity was imperfect. CHW interaction quality was mostly strong in observed sessions. Community health workers facilitate warm handoffs by scheduling referrals, sharing consented contact information, or initiating three-way calls. Community health workers use a structured manual with county resource lists and risk response protocols. Six salaried CHWs with nursing or health assistant certification were recruited and trained for the intervention. Future CHW training should strengthen behaviour-change planning using COM-B and the Behaviour Change Wheel. If a participant sends STOP, the research team assesses safety and explains how to resume message…