Support from the sponsoring organization and clear role expectations are critical for the success of lay health advisors.1

Lay health advisors are trained peers or community members who deliver health education and support in a range of community and clinical settings to enhance access to care and improve health outcomes. Health disparities are reduced by lay health advisors who share similar social, economic, cultural, and linguistic backgrounds and values with the medically underserved groups they interact with.

A recent study gathered data from 76 African American lay health advisors over 18 to 24 months in the northeast, south, and midwest regions of the United States. These advisors are participants in the Witness Project, which is an evidence-based program that has been shown to increase breast and cervical screening among African American women.

Continue Reading

“We investigated individual, social, and organizational factors that predict activity level and retention among a community-based sample of African American lay health advisors,” said senior author Deborah Erwin, PhD, director of the Office of Cancer Health Disparities Research at Roswell Park Cancer Institute in Buffalo, New York. “Our findings will inform strategies to successfully recruit, train, support, and sustain lay advisors in a community setting, toward the goal of improving both the sustainability and the effectiveness of these programs.”

The team collected information through telephone questionnaires administered to lay advisors and from National Witness Project assessments of the lay advisors’ level of engagement with their programs.

The study found that lay advisors were involved with the program for an average of 5.5 years. Over 50% of the advisors were survivors of breast or cervical cancer and 92% of the advisors were unpaid.

Those lay health advisors who reported a greater commitment and understanding of their role were more than 5 times as likely to stay with the program. Also, women who had been in the program longer were less likely than newer recruits to stay with the program. Being assigned as an advisor at a National Witness Project site that was partnered with an academic institution, which describes 71% of the program sites, was the strongest and most consistent predictor of both retention and activity levels among lay health advisors.

“A notable finding from this study is that role-related and organizational factors were consistently associated with higher retention and greater activity levels among lay advisors,” added first author Rachel Shelton, ScD, MPH, assistant professor of Sociomedical Sciences at Columbia University’s Mailman School of Public Health in New York, New York. “Given that many of the lay health advisors were volunteers who were not paid for their participation, the rates of retention and activity levels are impressive and indicate a strong commitment to the program.”

Lay advisors are increasingly being enlisted in efforts to improve health and address health disparities. So, the researchers explained that further research on program implementation and sustainability is critical in order to maximize their reach and impact.


1. Shelton RC, Dunston SK, Leoce N, et al. Predictors of activity level and retention among African American lay health advisors (LHAs) from The National Witness Project: Implications for the implementation and sustainability of community-based LHA programs from a longitudinal study. [Published online March 22, 2016] Implementation Science. doi:10.1186/s13012-016-0403-9.