{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:09:27Z","timestamp":1782752967532,"version":"3.54.5"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2014,9,17]],"date-time":"2014-09-17T00:00:00Z","timestamp":1410912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100007299","name":"Harvard Catalyst","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007299","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007299","name":"Harvard Clinical and Translational Science Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007299","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["UL1 RR 025758"],"award-info":[{"award-number":["UL1 RR 025758"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007229","name":"Harvard University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007229","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective.<\/jats:title>\n                  <jats:p>Breast cancer is a leading cause of morbidity and mortality in Mexico. We assessed the effectiveness of a train-the-trainer program in two Mexican states in improving knowledge among professional and nonprofessional community health workers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods.<\/jats:title>\n                  <jats:p>We worked with local organizations to develop and implement a train-the-trainer program to improve breast cancer knowledge among community health workers, including professional health promoters (PHPs) who were trained and then trained nonprofessional community health promoters (CHPs). We surveyed participants before and after training that included in-person and online classes and again approximately 3 months later. We used paired t tests and chi-square tests to compare survey responses at the different times. We also used logistic regression to assess whether promoter characteristics were associated with greater improvements in breast cancer knowledge after training.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results.<\/jats:title>\n                  <jats:p>Overall, 169 PHPs (mean age, 36 years) completed training and provided a 10-hour training course to 2,651 CHPs, who also completed the pre- and post-training survey. For both PHPs and CHPs, post-training surveys demonstrated increases in an understanding of breast cancer as a problem; an understanding of screening, treatment, and insurance coverage issues; and knowledge of breast cancer risk factors, symptoms, and what constitutes a family history of breast cancer (all p &amp;lt; .05). These improvements were maintained 3 to 6 months after training.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion.<\/jats:title>\n                  <jats:p>Train-the-trainer programs hold promise for leveraging community health workers, who far outnumber other health professionals in many low- and middle-income countries, to engage in health promotion activities for cancer and other noncommunicable diseases.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2014-0104","type":"journal-article","created":{"date-parts":[[2014,9,18]],"date-time":"2014-09-18T06:42:55Z","timestamp":1411022575000},"page":"1091-1099","source":"Crossref","is-referenced-by-count":28,"title":["Evaluation of Breast Cancer Knowledge Among Health Promoters in Mexico Before and After Focused Training"],"prefix":"10.1093","volume":"19","author":[{"given":"Nancy L.","family":"Keating","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA;"},{"name":"Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena M.","family":"Kouri","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9ctor Arreola","family":"Ornelas","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Mexicana para la Salud and T\u00f3matelo a Pecho A.C., Mexico City, Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"M\u00e9ndez","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Mexicana para la Salud and T\u00f3matelo a Pecho A.C., Mexico City, Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Maga\u00f1a","family":"Valladares","sequence":"additional","affiliation":[{"name":"National Institute of Public Health, Cuernavaca, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia Marie","family":"Knaul","sequence":"additional","affiliation":[{"name":"Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts, USA;"},{"name":"Fundaci\u00f3n Mexicana para la Salud and T\u00f3matelo a Pecho A.C., Mexico City, Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2014,9,17]]},"reference":[{"key":"2021122308560116500_B1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1056\/NEJMp0708307","article-title":"\u201cWesternizing\u201d women's risks? Breast cancer in lower-income countries","volume":"358","author":"Porter","year":"2008","journal-title":"N Engl J Med"},{"key":"2021122308560116500_B2","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/S0140-6736(11)61351-2","article-title":"Breast and cervical cancer in 187 countries between 1980 and 2010: A systematic analysis","volume":"378","author":"Forouzanfar","year":"2011","journal-title":"Lancet"},{"key":"2021122308560116500_B3","volume-title":"2008: Cancer Incidence and Mortality Worldwide","author":"GLOBOCAN","year":"2010"},{"key":"2021122308560116500_B4","volume-title":"Latest world cancer statistics: Global cancer burden rises to 14.1 million new cases in 2012: Marked increase in breast cancers must be addressed. 2013","author":"International Agency for Research on Cancer","year":"2014"},{"key":"2021122308560116500_B5","volume-title":"Numeralia: Sobre c\u00e1ncer de c\u00e9rvix y mama en M\u00e9xico. 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