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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. (Contains 1 table and 1 figure.)

Background: Significant health disparities exist between limited English proficient and English-proficient patients. Little is known about the impact of language services on chronic disease outcomes such as for diabetes. Methods/Principal Findings: To determine whether the amount and type of language services received during primary care visits had an impact on diabetes-related outcomes (hospitalization, emergency room utilization, glycemic control) in limited English proficient patients, a retrospective cohort design was utilized. Hospital and medical record data was examined for 1425 limited English proficient patients in the Cambridge Health Alliance diabetes registry. We categorized patients receiving usual care into 7 groups based on the amount and combination of language services (language concordant providers, formal interpretation and nothing) received at primary care visits during a 9 month period. Bivariate analyses and multiple logistic regression were used to determine relationships between language service categories and outcomes in the subsequent 6 months. Thirty-one percent of patients (445) had no documentation of interpreter use or seeing a language concordant provider in any visits. Patients who received 100% of their primary care visits with language concordant providers were least likely to have diabetes-related emergency department visits compared to other groups (p<0001) in the following 6 months. Patients with higher numbers of co-morbidities were more likely to receive formal interpretation. Conclusions/Significance: Language concordant providers may help reduce health care utilization for limited English proficient patients with diabetes. However, given the lack of such providers in sufficient numbers to meet patients' communication needs, strategies are needed to both increase their numbers and ensure that the highest risk patients receive the most appropriate language services. In addition, systems serving diverse populations must clarify why some limited English proficient patients do not receive language services at some or all of their visits and whether this has an impact on quality of care.