Programs that train natural helpers, or members of the community to whom others naturally turn for help, to be lay health advisors (LHAs) have proliferated throughout the United States; evaluations of these programs, however, are uncommon. The goal of this exploratory study was to understand how the natural helper LHA approach, as operationalized by the North Carolina Breast Cancer Screening Program (NC-BCSP), was translated from idea into practice. Data from document review and in-depth interviews with 24 LHAs and four of their coordinators were used to compare theory-based program plans with actual practice. Results suggest that although in large part the natural helper model was followed, program implementation departed from program plans in several unanticipated ways in the areas of (a) recruitment, (b) program direction, and (c) LHA activities. Differences illustrate the tensions between theory and practice and between community and program planners that may be inherent in a natural helper program, and highlight the need to include community members and program participants in all aspects of planning.
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