Successful strategies for educating hard-to-reach populations: Lessons learned from Massachusetts' train-the-trainer project using the Helping You Take Care of Yourself curriculum

Objective: To assess the effectiveness of providing education on breast, cervical and cardiovascular health to hard-to-reach women throughout Massachusetts using an innovative derivation of the 'train-the-trainer' approach. Innovation included use of contracts with community-based organizations (CBOs) that required data collection in return for payment.Design: Quantitative and qualitative evaluation.Setting: Hard-to-reach women throughout Massachusetts.Methods: Contracted with CBOs to conduct educational sessions on breast, cervical, and cardiovascular health using a standardized curriculum. Collected and analyzed quantitative data from 2,526 women educated by CBOs to assess the programme's reach and effectiveness. Interviewed staff involved in programme implementation and conducted focus groups with women educated to identify programme successes and areas for improvement.Results: Thirty-three unique CBOs conducted 264 educational sessions, educating 2,526 women in one or more units (breast, cervical, or cardiovascular health) of the Helping You Take Care of Yourself curriculum. Quantitative data were obtained to assess programme effectiveness and the curriculum successfully increased knowledge for all health units. Qualitative evaluation identified several factors that contributed to the success of the programme, including: establishing relationships with CBOs that had existing ties in target communities; executing memoranda of understanding that required data collection for payment; developing curriculum toolkits and intensive staff training; and delivering education in small group settings.Conclusion: The innovative structure of implementation of a 'train-the-trainer' approach allowed for expanded reach of the health education curriculum, educating more than 2,000 hard-to-reach women. The strategies employed can be applied to other health education programmes.