Lay health worker-led health promotion interventions are well received within racial and ethnic minority communities. Increasing numbers of trained lay health workers will be needed to meet global health goals. The purpose of this process evaluation was to gain insights about how lay health worker as interventionists used theory-based approaches within a nutrition and physical activity health behavior change intervention in a clinical trial enrolling immigrant and refugee families. Data were comprised of ongoing reflective writing statements from four health workers about their implementation of the intervention. Using content analysis three themes emerged: (i) encouraging setting of small, family focused and relevant goals, (ii) being flexible in content delivery and (iii) being personally transformed (i.e. gained a sense of meaning from their experience). Lay health worker interventionist reflections on practice revealed they delivered the intervention within the primacy of the family partnering relationship by attending to unique family needs, and adjusting educational content and goal setting accordingly. Our results provide guidance for training and process evaluation of lay health worker intervention delivery in ethnically and racially diverse populations. Incorporating real-time reflection upon what was learned about skills of facilitating family motivation and family confidence enhanced affective learning and may be useful in future research studies and health promotion practice. The processes identified including setting small goals, flexibility and personal transformation could be considered in future lay health worker-delivered health promotion interventions.

Health programs taught by lay health workers from within racial and ethnic communities are often more successful than those not taught by persons from these communities. Lay health workers are specifically trained in these programs. It is hard to know how lay health workers use this training. We asked lay health workers about how they used a specific approach of teaching and goal setting to help families change nutrition and physical activity behaviors. Four different lay health workers wrote notes after each time they met with families. We read these notes to see what we could learn about how they used their training. Lay health workers wrote that they followed their training by listening to each family so they could encourage families to set small goals that made sense to the family. They also followed their training by being flexible while doing the teaching and goal setting because there were many other things going on in the family. Lay health workers were personally changed and got better at teaching because of the relationships they had with each family. Writing these notes helped lay health workers focus on the skills and emotions needed to put their training into place.

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