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Walker L, Burke S, McGeechan GJ. Understanding perceptions of the public and key stakeholders toward a localised cancer screening promotion campaign. PSYCHOL HEALTH MED 2024; 29:317-333. [PMID: 36907829 DOI: 10.1080/13548506.2023.2188230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
The aim of this study was to explore perceptions of members of the public and key stakeholders of a localised campaign to increase engagement with cervical cancer screening. Whilst numerous interventions have been trialled to increase engagement with cancer screening, the evidence for their effectiveness is somewhat mixed. In addition, few studies have explored the perceptions of members of the public targeted by such campaigns nor the perceptions of healthcare professionals who may be involved in delivering such campaigns in the United Kingdom. Members of the public who had potentially been exposed to the campaign in the North-East of England were approached to take part in individual interviews whilst stakeholders were invited to take part in a focus group. A total of 25 participants (13 members of the public, 12 stakeholders) took part. All interviews were audio recorded, transcribed verbatim and analysed using applied thematic analysis. Four themes were identified, two of which were cross-cutting (barriers to screening and factors promoting screening), with one theme identified as specific to the public interviews (knowledge of and attitudes toward awareness campaigns) and one theme specific to the focus group (keeping campaigns relevant. Awareness of the localised campaign was limited; however, when made aware, participants were mostly positive towards the approach, although mixed responses were noted in relation to financial incentives. Members of the public and stakeholders identified some common barriers to screening although differed in their perceptions of promotional factors. This study highlights the importance of multiple strategies to promote cervical screening as one size fits all approach may limit engagement.
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Affiliation(s)
- Lauren Walker
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
| | - Shani Burke
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
| | - Grant J McGeechan
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
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Hallgren E, Yeary KHK, DelNero P, Johnson-Wells B, Purvis RS, Moore R, Loveless S, Shealy K, McElfish PA. Barriers, facilitators, and priority needs related to cancer prevention, control, and research in rural, persistent poverty areas. Cancer Causes Control 2023; 34:1145-1155. [PMID: 37526781 PMCID: PMC10547626 DOI: 10.1007/s10552-023-01756-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/06/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE The purpose of this study was to identify the barriers, facilitators, and priority needs related to cancer prevention, control, and research in persistent poverty areas. METHODS We conducted three focus groups with 17 providers and staff of primary care clinics serving persistent poverty areas throughout the state of Arkansas. RESULTS We identified multiple barriers, facilitators, and priority needs related to cancer prevention and control at primary care clinics serving persistent poverty areas. Barriers included transportation, medical costs, limited providers and service availability, and patient fear/discomfort with cancer topics. Facilitators identified were cancer navigators and community health events/services, and priority needs included patient education, comprehensive workflows, improved communication, and integration of cancer navigators into healthcare teams. Barriers to cancer-related research were lack of provider/staff time, patient uncertainty/skepticism, patient health literacy, and provider skepticism/concerns regarding patient burden. Research facilitators included better informing providers/staff about research studies and leveraging navigators as a bridge between clinic and patients. CONCLUSION Our results inform opportunities to adapt and implement evidence-based interventions to improve cancer prevention, control, and research in persistent poverty areas. To improve cancer prevention and control, we recommend locally-informed strategies to mitigate patient barriers, improved patient education efforts, standardized patient navigation workflows, improved integration of cancer navigators into care teams, and leveraging community health events. Dedicated staff time for research, coordination of research and clinical activities, and educating providers/staff about research studies could improve cancer-related research activities in persistent poverty areas.
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Affiliation(s)
- Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA.
| | - Karen H K Yeary
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Peter DelNero
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Beverly Johnson-Wells
- UAMS Regional Programs, University of Arkansas for Medical Sciences, West Helena, AR, USA
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Stephanie Loveless
- UAMS Regional Programs, University of Arkansas for Medical Sciences, West Helena, AR, USA
| | - Kristen Shealy
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
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Etoori D, Desai M, Mandal S, Rosenberg W, Sabin CA. A scoping review of media campaign strategies used to reach populations living with or at high risk for Hepatitis C in high income countries to inform future national campaigns in the United Kingdom. BMC Infect Dis 2023; 23:629. [PMID: 37752434 PMCID: PMC10523688 DOI: 10.1186/s12879-023-08603-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND With the advent of direct acting antivirals, the World Health Organisation proposed eliminating Hepatitis C as a public health threat by 2030. To achieve this, countries need to diagnose, engage in care and treat their undiagnosed populations. This will require sensitisation campaigns. However previous media campaigns have had mixed impact. We conducted a scoping review to identify and understand the impact of previous Hepatitis C media campaigns. These findings could inform the delivery of future campaigns. METHODS We searched five electronic databases for published literature on media campaigns conducted for Hepatitis C awareness, testing, and treatment in Organisation for Economic Co-operation and Development (OECD) countries since 2010. Two independent reviewers screened citations for inclusion. Additionally, we spoke to stakeholders in the Hepatitis C field in the UK and conducted a Google search to identify any unpublished literature. A quantitative synthesis was conducted to identify targeted populations, strategies and media used, aims and impact of the campaigns. RESULTS A title and year of publication screening of 3815 citations resulted in 113 papers that had a full abstract screen. This left 50 full-text papers, 18 were included of which 9 (50%) were from Europe. 5 (27.8%) of campaigns targeted minority ethnicities, and 9 (50%) aimed to increase testing. A Google search identified 6 grey literature sources. Most campaigns were not evaluated for impact. Discussions with stakeholders identified several barriers to successful campaigns including lack of targeted messaging, stigmatising or accusatory messaging, and short-lived or intermittent campaign strategies. CONCLUSION Future campaigns will likely need to be multifaceted and have multiple tailored interventions. Campaigns will need to be sizeable and robust, integrated into health systems and viewed as an ongoing service rather than one-offs.
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Affiliation(s)
- David Etoori
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at UCL in partnership with the UK Health Security Agency (UKHSA), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Monica Desai
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Sema Mandal
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - William Rosenberg
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at UCL in partnership with the UK Health Security Agency (UKHSA), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Caroline A Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at UCL in partnership with the UK Health Security Agency (UKHSA), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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Alam Z, Cairns JM, Scott M, Dean JA, Janda M. Interventions to increase cervical screening uptake among immigrant women: A systematic review and meta-analysis. PLoS One 2023; 18:e0281976. [PMID: 37267330 DOI: 10.1371/journal.pone.0281976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/05/2023] [Indexed: 06/04/2023] Open
Abstract
Numerous intervention studies have attempted to increase cervical screening uptake among immigrant women, nonetheless their screening participation remains low. This systematic review and meta-analysis aimed to summarise the evidence on interventions to improve cervical screening among immigrant women globally and identify their effectiveness. Databases PubMed, EMBASE, Scopus, PsycINFO, ERIC, CINAHL and CENTRAL were systematically searched from inception to October 12, 2021, for intervention studies, including randomised and clinical controlled trials (RCT, CCT) and one and two group pre-post studies. Peer-reviewed studies involving immigrant and refugee women, in community and clinical settings, were eligible. Comparator interventions were usual or minimal care or attention control. Data extraction, quality appraisal and risk of bias were assessed by two authors independently using COVIDENCE software. Narrative synthesis of findings was carried out, with the main outcome measure defined as the cervical screening uptake rate difference pre- and post-intervention followed by random effects meta-analysis of trials and two group pre-post studies, using Comprehensive Meta-Analysis software, to calculate pooled rate ratios and adjustment for publication bias, where found. The protocol followed PRISMA guidelines and was registered prospectively with PROSPERO (CRD42020192341). 1,900 studies were identified, of which 42 (21 RCTS, 4 CCTs, and 16 pre-post studies) with 44,224 participants, were included in the systematic review, and 28 with 35,495 participants in the meta-analysis. Overall, the uptake difference rate for interventions ranged from -6.7 to 96%. Meta-analysis demonstrated a pooled rate ratio of 1.15 (95% CI 1.03-1.29), with high heterogeneity. Culturally sensitive, multicomponent interventions, using different modes of information delivery and self-sampling modality were most promising. Interventions led to at least 15% increase in cervical screening participation among immigrant women. Interventions designed to overcome logistical barriers and use multiple channels to communicate culturally appropriate health promotion messages are most effective at achieving cervical screening uptake among immigrant women.
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Affiliation(s)
- Zufishan Alam
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Marissa Scott
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Judith Ann Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Le Bonniec A, Sun S, Andrin A, Dima AL, Letrilliart L. Barriers and Facilitators to Participation in Health Screening: an Umbrella Review Across Conditions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1115-1142. [PMID: 35705780 DOI: 10.1007/s11121-022-01388-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
Screening is an essential prevention practice for a number of health conditions. However, screening coverage remains generally low. Studies that investigate determinants of screening participation are becoming more common, but oftentimes investigate screening for health conditions in an individualized rather than integrated fashion. In routine clinical practice, however, healthcare professionals are often confronted with situations in which several screening procedures are recommended for the same patient. The consideration of their common determinants may support a more integrated screening approach. The objectives of this umbrella review were therefore to examine: 1) the determinants (barriers and facilitators) that have been identified in relation to recommended health screening procedures; and 2) the modifiable determinants (in primary care) common across health conditions or specific to individual procedures. Results were presented through a narrative synthesis. PubMed, PsycInfo and Cochrane were searched up to January 2022. Systematic reviews reporting determinants of participation in health screening procedures with grade A or B recommendation according to the US Preventive Services Task Force were included. A total of 85 systematic reviews were included, most which contained both qualitative and quantitative studies on determinants that describe individual factors (961 occurrences), social factors (113 occurrences, healthcare professional factors (149 occurrences), health system factors (105 occurrences) and screening procedure factors (99 occurrences). The most studied screening procedures concerned cervical cancer/human papillomavirus (n = 33), breast cancer (n = 28), colorectal cancer (n = 25) and the human immunodeficiency virus (n = 12). Other conditions have been under-studied (e.g. cardiovascular problems, lung cancer, syphilis). The individual domain, including determinants such as knowledge, beliefs and emotions, was the most covered across health conditions. Healthcare professional's recommendations and the quality of patient-provider communication were identified to have a strong influence on screening participation in most conditions. The other three domains included determinants which were more specific to a condition or a population. Various determinants modifiable in primary care were found in the individual domain and in the health system, healthcare professional and screening procedure domains. Quality was assessed as low for most systematic reviews included. The identification of various modifiable determinants common across conditions highlights the potential of an integrated screening participation approach. Interventions may address common determinants in a broader person-centred framework within which tailoring to specific procedures or populations can be considered. This approach needs to be explored in intervention studies. The systematic review registration is PROSPERO CRD42019126709.
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Affiliation(s)
- Alice Le Bonniec
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.
- Groupe de Recherche en Psychologie Sociale (GRePS) EA4163, Université Lumière Lyon 2, Lyon, France.
| | - Sophie Sun
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
| | - Amandine Andrin
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Groupe de Recherche en Psychologie Sociale (GRePS) EA4163, Université Lumière Lyon 2, Lyon, France
| | - Alexandra L Dima
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Letrilliart
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
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Schear RM, Hoyos JM, Davis AQ, Woods PL, Poblete S, Richardson RN, Finney Rutten LJ. Patient engagement and advocacy considerations in development and implementation of a multicancer early detection program. Cancer 2022; 128 Suppl 4:909-917. [PMID: 35133663 DOI: 10.1002/cncr.34047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/01/2021] [Accepted: 10/21/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Rebekkah M Schear
- Livestrong Cancer Institutes, Dell Medical School, University of Texas at Austin, Austin, Texas
| | | | - Anjee Q Davis
- American Cancer Society Cancer Action Network, Inc, Washington, District of Columbia
| | - Phylicia L Woods
- American Cancer Society Cancer Action Network, Inc, Washington, District of Columbia.,Fight Colorectal Cancer, Springfield, Missouri
| | | | - Robin N Richardson
- Livestrong Cancer Institutes at the Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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Herman PM, Bucho-Gonzalez J, Menon U, Szalacha LA, Larkey L. Cost-Effectiveness of Community-to-Clinic Tailored Navigation for Colorectal Cancer Screening in an Underserved Population: Economic Evaluation Alongside a Group-Randomized Trial. Am J Health Promot 2022; 36:678-686. [PMID: 35081762 DOI: 10.1177/08901171211068454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Although screening for colorectal cancer (CRC) lowers mortality and morbidity and is generally cost-effective, little is known about the cost-effectiveness of screening promotion. DESIGN Cost-effectiveness analysis alongside a group-randomized trial. Setting: Multicultural, underinsured communities in the Phoenix, Arizona, area. SUBJECTS English- or Spanish-speaking adults who were out of compliance for CRC screening guidelines. INTERVENTION All participants received community-based group education (GE), and the intervention group also received tailored community-to-clinic navigation (GE+TN). MEASURES Number of participants screened and costs of tailored navigation, clinic visits, and CRC screening tests. ANALYSIS Incremental cost per additional person screened from the perspective of the healthcare system with bootstrapped confidence intervals. RESULTS Community sites were recruited and randomized to GE (n = 120) and GE + TN (n = 119). Across these sites 1154 individuals were screened, 504 were eligible, and 345 attended the group education class (n = 134 GE; n = 211 GE + TN). Screening rates (26.5% GE + TN; 10.4% GE; 16.1% increase 95% CI: 7%, 23%) and costs per participant ($271 GE + TN; $167 GE; a net cost increase of $104 95% CI: $1, $189) were significantly higher in the intervention group. Incremental cost-effectiveness was $646 (95% CI: -$68, $953) per additional person screened. CONCLUSION Depending on the value placed on an additional person screened, the addition of community-to-clinic tailored navigation to a community-based CRC screening promotion program may be highly cost-effective.
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Affiliation(s)
| | - Julie Bucho-Gonzalez
- Edson College of Nursing and Health Innovation, 15679Arizona State University, Phoenix, AZ, USA
| | - Usha Menon
- College of Nursing, 7831University of South Florida, Tampa, FL, USA
| | - Laura A Szalacha
- Morsani College of Medicine and College of Nursing, 7831University of South Florida, Tampa, FL, USA
| | - Linda Larkey
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, 15679Arizona State University, Phoenix, AZ, USA
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Chan TKC, Tan LWL, van Dam RM, Seow WJ. Cancer Screening Knowledge and Behavior in a Multi-Ethnic Asian Population: The Singapore Community Health Study. Front Oncol 2021; 11:684917. [PMID: 34476210 PMCID: PMC8406849 DOI: 10.3389/fonc.2021.684917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022] Open
Abstract
Background Cancer has become the leading cause of mortality in Singapore and among other Asian populations worldwide. Despite the presence of National Cancer Screening programmes in Singapore, less than half of the population has had timely screening according to guidelines. The underlying factors of poor cancer screening rates and health outcomes among Asian ethnic groups remain poorly understood. We therefore examined cancer screening participation rates and screening behavior in a multi-ethnic Singapore population. Methods We collected data from 7,125 respondents of the 2015–2016 Singapore Community Health Study. Factors associated with cervical, breast, and colorectal cancer screening were evaluated using modified Poisson regression. Adjusted prevalence ratios were computed with 95% confidence intervals after adjusting for confounders. Results The mean age of the respondents was 57.7 ± 10.9 years; 58.9% were female and were predominately Chinese (73.0%), followed by Malay (14.2%), and Indian (10.9%). Less than half of the respondents in the recommended age groups had undergone cancer screening (cervical, 43%; breast, 35.1%; colorectal, 27.3%). Malay respondents were significantly less likely to screen as recommended for cervical (aPR = 0.75, CI = 0.65–0.86, p < 0.001), breast (aPR = 0.83, CI = 0.68–0.99, p = 0.045), and colorectal cancer (aPR = 0.55, CI = 0.44–0.68, p < 0.001), as compared to Chinese respondents. Respondents who had obtained lower secondary level education were 42% more likely to screen for cervical cancer (aPR = 1.42, CI = 1.23–1.64, p < 0.001), and 22% more likely to screen for breast cancer (aPR = 1.22, CI = 1.02–1.46, p = 0.032), compared to those with primary level education and below. Respondents with a household income ≥S$10,000/month were 71% more likely to screen for breast cancer (aPR = 1.71, CI = 1.37–2.13, p < 0.001), as compared with <$2,000/month. Conclusions Ethnicity and socio-economic status were significantly associated with lower uptake of cancer screening tests in Singapore. To improve the screening uptake among disadvantaged groups, a multi-faceted approach is needed that addresses the barriers to screening such as the adequacy of subsidy schemes and ethnic differences.
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Affiliation(s)
| | - Linda Wei Lin Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Wei Jie Seow
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
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Jang SH, Cole A, Brown EVR, Ko L. Adaptation of a Mailed-FIT Kit and Patient Navigation Intervention to Increase Colorectal Cancer (CRC) Screening Among Spanish-Speaking Hispanic/Latino Patients. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:80-88. [PMID: 34159831 DOI: 10.1177/15404153211024116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hispanic/Latino populations experience significant barriers to colorectal cancer (CRC) screening. ProCRCScreen is a multicomponent CRC screening program that can help primary care clinics improve CRC screening rates, but it needs adaptation to better meet the health care needs of Spanish-speaking Hispanic/Latino populations. METHODS We conducted four focus groups with 22 Spanish-speaking Latino patients and used inductive qualitative content analysis to identify potential program adaptations. RESULTS We identified lack of social support for CRC screening and confusion about completing stool-based testing as important barriers to CRC screening. Participants recommended increased specificity of the fecal immunochemical test (FIT) instructions to increase the likelihood of successful test completion, especially for first-time screening. They also endorsed patient navigation for support in completing CRC screening. DISCUSSION We adapted the informational materials and workflows for the ProCRCScreen program. Future research to test the adapted program is needed.
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Affiliation(s)
- Sou Hyun Jang
- Department of Sociology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Allison Cole
- Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Linda Ko
- Fred Hutchison Cancer Research Center, Seattle, WA, USA
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Majlesi M, Montazeri A, Rakhshani F, Nouri-Khashe-Heiran E, Akbari N. 'No to unnecessary caesarean sections': Evaluation of a mass-media campaign on women's knowledge, attitude and intention for mode of delivery. PLoS One 2020; 15:e0235688. [PMID: 32780747 PMCID: PMC7418979 DOI: 10.1371/journal.pone.0235688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/02/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Improvement of women’s knowledge and attitude toward vaginal birth is recognized as an important strategy to control caesarean sections (CS) on maternal request. This study aimed to evaluate the effectiveness of a mass-media campaign in improving knowledge, attitude and intention of women for vaginal birth. Methods This was a population-based study carried out in Tehran, Iran. A national ‘No to unnecessary caesarean sections’ campaign was launched in April 2016 and was televised for ten days. A random sample of pregnant women from all defined geographical areas of Tehran were recruited and assessed for knowledge about the benefits of vaginal birth and the risk of CS, attitude and intention toward mode of delivery at two points in time: before and after the campaign. A comparison was made to evaluate outcome measures among those who had seen the campaign and those who had not. Results In all, 37 public and private maternity care centers were selected randomly and 702 eligible pregnant women attending these centers were entered in the study. Pre- and post-intervention data for 466 women were available for analysis. Of these, 194 women indicated that they had seen the campaign and the remaining 272 women said that they had not. A comparison of the outcome measures between the two study groups showed that there were significant differences between those who had seen the campaign and those who had not. Those who had seen the campaign reported increased knowledge, had a more positive attitude and indicated increased behavioral intention toward vaginal birth. Conclusions In general, the findings indicated that the mass-media campaign improved pregnant women’s knowledge, attitude and intention towards vaginal birth. However, the long-term effects of such campaigns need further investigation.
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Affiliation(s)
- Maedeh Majlesi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
- Faculty of Humanity Sciences, University of Science &Culture, ACECR, Tehran, Iran
- * E-mail: (AM); (NA)
| | - Fatemeh Rakhshani
- Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elmira Nouri-Khashe-Heiran
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Akbari
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- * E-mail: (AM); (NA)
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Parambil NA, Philip S, Tripathy JP, Philip PM, Duraisamy K, Balasubramanian S. Community engaged breast cancer screening program in Kannur District, Kerala, India: A ray of hope for early diagnosis and treatment. Indian J Cancer 2019; 56:222-227. [PMID: 31389385 DOI: 10.4103/ijc.ijc_397_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Community based programs can assist in early detection and improved survival of breast cancer. AIMS To assess the feasibility and explore challenges of a district-wide door-to-door breast cancer screening program "ASWAS" conducted in Kannur district, Kerala, India from 2011 to 2014. METHODS: Aggregate data from survey records were collected in terms of the population screened, referred, diagnosed, and treated. Case records of breast cancer patients who were identified were reviewed and updated. In-depth interviews were conducted with program stakeholders. The contents of the interview were organized into a strength, weakness, opportunity and threat (SWOT) matrix to describe the screening program. RESULTS A total of 1,049,410 eligible women above 30 years residing in 81 panchayats were visited door-to-door by 8,200 community volunteers; of them, 93% were screened using a symptom-risk factor checklist. Of those referred with symptoms (n = 5353), 81% attended the cancer camp. In total, 23 breast cancer cases were confirmed. 14 (61%) were in early stages, treated, and are disease free at 3-year follow-up. Those in the advanced stage and old age had poor outcomes. SWOT analysis identified political support, female volunteers, community engagement, dedicated fund for treatment, and teamwork as strengths. Weaknesses included poor healthcare access, maintaining volunteer motivation, and issues around sustainability. CONCLUSION Community participation with the engagement of the health system and local self-government are required for implementing a comprehensive cancer screening strategy. Breast-cancer screening program using local volunteers for early detection is feasible in low-income settings, thereby improving survival.
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Affiliation(s)
| | - Sairu Philip
- Department of Community Medicine, Government T.D Medical College, Alappuzha, Kerala, India
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India
| | - Phinse M Philip
- Department of Community Oncology, Malabar Cancer Center, Thalassery, Kerala, India
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Murillo R, Robles C. Research Needs for Implementing Cancer Prevention and Early Detection in Developing Countries: From Scientists' to Implementers' Perspectives. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9607803. [PMID: 31205949 PMCID: PMC6530220 DOI: 10.1155/2019/9607803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/01/2019] [Accepted: 04/14/2019] [Indexed: 12/29/2022]
Abstract
Implementation of evidence-based cancer prevention and early detection in low- and middle-income countries (LMIC) is challenging. Limited and inappropriate introduction of novel alternatives results in an equity gap whereby low-income populations receive a lower benefit. Implementation research represents an opportunity to foster the adoption and expansion of evidence-based cancer control strategies; however, scientific development in high-income countries does not necessarily fulfill the particular needs of LMIC in the field. A review on the link between implementation research and practice, the tension between theory and pragmatism, the conflict around implementation research methods, and determinants of research priority definition was carried out by considering the perspective of cancer prevention and early detection implementers in LMIC. Basic principles and alternatives to overcome implementation research challenges in these settings are discussed.
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Affiliation(s)
- Raúl Murillo
- Centro Javeriano de Oncología – Hospital Universitario San Ignacio – Bogotá, Colombia
- Prevention and Implementation Group – International Agency for Research on Cancer – Lyon, France
| | - Claudia Robles
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme - Institut Catala d' Oncologia – Barcelona, Spain
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Hou SI, Cao X. A Systematic Review of Promising Strategies of Faith-Based Cancer Education and Lifestyle Interventions Among Racial/Ethnic Minority Groups. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1161-1175. [PMID: 28905305 DOI: 10.1007/s13187-017-1277-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Church-based interventions have been used to reach racial/ethnic minorities. In order to develop effective programs, we conducted a comprehensive systematic review of faith-based cancer prevention studies (2005~2016) to examine characteristics and promising strategies. Combination terms "church or faith-based or religion," "intervention or program," and "cancer education or lifestyle" were used in searching the five major databases: CINAHL; ERIC; Health Technology Assessments; MEDLINE; and PsycInfo. A total of 20 studies met study criteria. CDC's Community Guide was used to analyze and review group interventions. Analyses were organized by two racial groups: African American (AA) and Latino/Hispanic American groups. Results showed most studies reviewed focused on breast cancer alone or in combination with other cancers. Studies of Latino/Hispanic groups targeted more on uninsured, Medicare, or Medicaid individuals, whereas AA studies generally did not include specific insurance criteria. The sample sizes of the AA studies were generally larger. The majority of these studies reviewed used pre-post, posttest only with control group, or quasi-experience designs. The Health Belief Model was the most commonly used theory in both groups. Community-based participatory research and empowerment/ecological frameworks were also used frequently in the Latino/Hispanic studies. Small media and group education were the top two most popular intervention strategies in both groups. Although one-on-one strategy was used in some Latino studies, neither group used reducing client out-of-pocket costs strategy. Client reminders could also be used more in both groups as well. Current review showed church-based cancer education programs were effective in changing knowledge, but not always screening utilization. Results show faith-based cancer educational interventions are promising. To maximize intervention impact, future studies might consider using stronger study designs, incorporating a variety of proven effective strategies, including those frequently used evidence-based strategies, as well as exploring promising strategies among specific target groups.
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Affiliation(s)
- Su-I Hou
- Doctoral Program in Public Affairs/Health Management & Informatics, College of Health & Public Affairs, University of Central Florida, HPA I, Room 217, 12805 Pegasus Drive, Orlando, FL, 32816-1600, USA.
| | - Xian Cao
- Doctoral Program in Public Affairs/Health Management & Informatics, College of Health & Public Affairs, University of Central Florida, HPA I, Room 217, 12805 Pegasus Drive, Orlando, FL, 32816-1600, USA
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Wallington S, Oppong B, Dash C, Coleman T, Greenwald H, Torres T, Iddirisu M, Adams-Campbell LL. A Community-Based Outreach Navigator Approach to Establishing Partnerships for a Safety Net Mammography Screening Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:782-787. [PMID: 27995458 PMCID: PMC5940570 DOI: 10.1007/s13187-016-1152-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Washington, DC, has one of the highest incidence and mortality rates for breast cancer in the USA. Patient navigation coupled with informational and community resources are important strategies that assist patients' access and help them understand the complex world of cancer care. The Georgetown Lombardi Comprehensive Cancer Center's Capital Breast Care Center (CBCC) is a safety net mammography screening center that utilizes a community-based navigation program. In addition to providing assistance with coordination of clinical services, navigators at CBCC are integral in establishing intra-community partnerships to educate members of the community about breast cancer screening. The aim of this study was to detail the role of patient navigation at the CBCC, with an emphasis on community engagement and community-based partnerships. We describe the process by which CBCC established partnerships with multiple community organizations between 2004 and 2015 and analyzed data of women screened in relationship to the evolution of the patient navigation services. Application of the CBCC navigation model that integrates individual patient outreach with community engagement has yielded viable and lasting community partnerships that have resulted in an increase in mammography uptake, especially among medically underserved minority women.
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Affiliation(s)
| | - Bridget Oppong
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Chiranjeev Dash
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Tesha Coleman
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Holly Greenwald
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Tanya Torres
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Marquita Iddirisu
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
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Slater JS, Parks MJ, Nelson CL, Hughes KD. The Efficacy of Direct Mail, Patient Navigation, and Incentives for Increasing Mammography and Colonoscopy in the Medicaid Population: A Randomized Controlled Trial. Cancer Epidemiol Biomarkers Prev 2018; 27:1047-1056. [PMID: 29891726 DOI: 10.1158/1055-9965.epi-18-0038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/24/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Despite lower cancer screening rates and survival rates in the Medicaid population compared with those with private insurance, there is a dearth of population-based, evidence-based interventions targeting Medicaid clients to address this problem.Methods: This study reports results of a population-based randomized controlled trial (RCT) among all individuals enrolled in Minnesota's Medicaid program who were overdue for breast cancer (n = 22,113) and/or colorectal cancer (n = 94,294) screening. Individuals were randomized to intervention or control groups. The intervention group received persuasive and innovative direct mail materials coupled with a $20 incentive for using their Medicaid benefit to get screened. Direct mail materials provided a phone number to a call center staffed by patient navigators who addressed barriers and scheduled appointments via three-way calls. The control group received the intervention 15 months later. Primary outcomes were completion of mammography or colonoscopy within 12 weeks of the intervention. Billing claims served as evidence of screening.Results: Multivariate logistic regression showed significant differences for both breast cancer (P < 0.001) and colorectal cancer (P < 0.01). The odds of receiving a mammogram for the treatment group were significantly higher than the control group [OR = 1.30; 95% confidence interval (95% CI) = 1.16-1.46], and the treatment group was more likely to receive a colonoscopy than the control group (OR = 1.12; 95% CI = 1.04-1.21).Conclusions: This population-based intervention increased breast cancer and colorectal cancer screening in a Medicaid population overdue for screening.Impact: These findings may have broad application for reaching individuals who generally remain outside the health care system despite having public health insurance. Cancer Epidemiol Biomarkers Prev; 27(9); 1047-56. ©2018 AACR.
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Affiliation(s)
- Jonathan S Slater
- Minnesota Department of Health, Cancer Control Section, St. Paul, Minnesota.
| | - Michael J Parks
- Minnesota Department of Health, Cancer Control Section, St. Paul, Minnesota
| | - Christina L Nelson
- Minnesota Department of Health, Cancer Control Section, St. Paul, Minnesota
| | - Kelly D Hughes
- Minnesota Department of Health, Cancer Control Section, St. Paul, Minnesota
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Berkowitz Z, Zhang X, Richards TB, Nadel M, Peipins LA, Holt J. Multilevel Small-Area Estimation of Colorectal Cancer Screening in the United States. Cancer Epidemiol Biomarkers Prev 2018; 27:245-253. [PMID: 29500250 PMCID: PMC5836477 DOI: 10.1158/1055-9965.epi-17-0488] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/01/2017] [Accepted: 12/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background: The U.S. Preventive Services Task Force recommends routine screening for colorectal cancer for adults ages 50 to 75 years. We generated small-area estimates for being current with colorectal cancer screening to examine sociogeographic differences among states and counties. To our knowledge, nationwide county-level estimates for colorectal cancer screening are rarely presented.Methods: We used county data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS; n = 251,360 adults), linked it to the American Community Survey poverty data, and fitted multilevel logistic regression models. We post-stratified the data with the U.S. Census population data to run Monte Carlo simulations. We generated county-level screening prevalence estimates nationally and by race/ethnicity, mapped the estimates, and aggregated them into state and national estimates. We evaluated internal consistency of our modeled state-specific estimates with BRFSS direct state estimates using Spearman correlation coefficients.Results: Correlation coefficients were ≥0.95, indicating high internal consistency. We observed substantial variations in current colorectal cancer screening estimates among the states and counties within states. State mean estimates ranged from 58.92% in Wyoming to 75.03% in Massachusetts. County mean estimates ranged from 40.11% in Alaska to 79.76% in Florida. Larger county variations were observed in various race/ethnicity groups.Conclusions: State estimates mask county variations. However, both state and county estimates indicate that the country is far behind the "80% by 2018" target.Impact: County-modeled estimates help identify variation in colorectal cancer screening prevalence in the United States and guide education and enhanced screening efforts in areas of need, including areas without BRFSS direct-estimates. Cancer Epidemiol Biomarkers Prev; 27(3); 245-53. ©2018 AACR.
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Affiliation(s)
- Zahava Berkowitz
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Chamblee, Georgia.
| | - Xingyou Zhang
- Economic Research Service, U.S. Department of Agriculture, Washington, District of Columbia
| | - Thomas B Richards
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Chamblee, Georgia
| | - Marion Nadel
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Chamblee, Georgia
| | - Lucy A Peipins
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Chamblee, Georgia
| | - James Holt
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Chamblee, Georgia
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17
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The prostate cancer screening clinic in the Bahamas: a model for low- and middle-income countries. Cancer Causes Control 2017; 28:1187-1193. [PMID: 29119339 DOI: 10.1007/s10552-017-0972-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Grand Bahama (pop. 51,000) is an island within the Bahamas archipelago. A local chapter of International Us TOO Prostate Cancer Support Group (UTGB) has led an annual community-based prostate cancer screening clinic in Grand Bahama each September since 2009. Features of this initiative, characteristics of attendees, and a description of found cancers were summarized to determine the clinic's value and to guide improvements. METHOD We analyzed the established clinic from 2012 to 2015, wherein UTGB attracted corporate funding, volunteers managed clinics, and health professionals provided healthcare services. An explicit algorithm was used to sort clients by age, comorbidities, and findings from digital rectal examinations, and prostate-specific antigen (PSA) values, to determine which clients would undergo secondary assessment and prostate biopsy. RESULTS Overall, 1,844 males were registered (mean age 57.6 years), and only 149 men attended on more than one occasion for a total of 1,993 clinic visit. The urologist reviewed 315 men in secondary follow-up, for elevated PSA and/or an abnormal digital rectal examination. Of these, 45 men fulfilled criteria for trans-rectal ultrasound biopsy, and there were 40 found cases of prostate cancer, for a positive-predictive value of 89%. By D'Amico risk-stratification, these 40 cases were low (10%), intermediate (40%), and high risk (50%). The urologist counseled all 40 cases and facilitated access to standard care. CONCLUSION This study suggests that low-resource countries can advance cost-effective screening clinics, apply policy guidelines, and provide services within acceptable standards of care. It is the expectation, with a sustained effort and community participation over the ensuing years, that earlier disease presentation will occur and, consequently, a concomitant decrease in the disease-specific mortality.
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18
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Effectiveness of patient-targeted interventions to promote cancer screening among ethnic minorities: A systematic review. Cancer Epidemiol 2016; 44:22-39. [DOI: 10.1016/j.canep.2016.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 11/23/2022]
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Melanoma Disparities among US Hispanics: Use of the Social Ecological Model to Contextualize Reasons for Inequitable Outcomes and Frame a Research Agenda. J Skin Cancer 2016; 2016:4635740. [PMID: 27651954 PMCID: PMC5019891 DOI: 10.1155/2016/4635740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022] Open
Abstract
Cutaneous melanoma is a significant public health concern, accounting for thousands of deaths annually in the US. Early detection and diagnosis are critical given the poor prognosis and limited treatment options of advanced-stage disease. While non-Hispanic whites have higher incidence rates of melanoma, Hispanics are typically diagnosed at later disease stages and suffer higher morbidity and mortality. Currently, there is a paucity of literature investigating the root causes underlying these trends among Hispanics. Given that Hispanics are the most rapidly expanding demographic segment in the US, it is essential for cancer control efforts to elucidate the major determinants of their poor melanoma outcomes. Herein, we use the social ecological model as a framework to explore the multitude of influences on melanoma disparities among Hispanics and provide recommendations for planning future studies and interventions.
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20
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Peitzmeier SM, Khullar K, Potter J. Effectiveness of four outreach modalities to patients overdue for cervical cancer screening in the primary care setting: a randomized trial. Cancer Causes Control 2016; 27:1081-91. [DOI: 10.1007/s10552-016-0786-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
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Katz ML, Young GS, Reiter PL, Pennell ML, Plascak JJ, Zimmermann BJ, Krieger JL, Slater MD, Tatum CM, Paskett ED. Process Evaluation of Cancer Prevention Media Campaigns in Appalachian Ohio. Health Promot Pract 2016; 18:201-210. [PMID: 27178838 DOI: 10.1177/1524839916641638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this study is to provide process data from campaigns (2009-2010) to improve colorectal cancer (CRC; intervention) screening and fruit and vegetable (F&V; comparison) consumption in 12 Appalachian Ohio counties. County-specific campaigns included one billboard, posters, and articles for local newspapers. Participants in CRC screening counties who reported seeing CRC screening billboards had greater intention to talk to a doctor/nurse about screening in the next 6 months (odds ratio [OR] = 2.92, 95% confidence interval [CI; 1.71, 4.99]) and had twice the odds of talking to a doctor/nurse about screening in the past year (OR = 2.15, 95% CI [1.29, 3.60]) compared to those who did not see the billboards. Participants in F&V counties who reported seeing F&V billboards had twice the odds (OR = 2.27, 95% CI [1.35, 3.84]) of talking to a doctor/nurse in the past year about F&Vs compared to those who did not see the billboards. Participants who reported campaign exposure lived closer to the billboards compared to those who did not report campaign exposure (mean distance in miles from home to billboard: 8.8 vs. 10.9; p < .01). Most participants reported campaign messages were clear and important. Results suggest that partnering with community members to develop campaign materials is important to ensure cultural appropriateness and that exposure to the intervention components may affect health-related outcomes.
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Affiliation(s)
- Mira L Katz
- 1 The Ohio State University, Columbus, OH, USA
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22
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Maar M, Wakewich P, Wood B, Severini A, Little J, Burchell AN, Ogilvie G, Zehbe I. Strategies for Increasing Cervical Cancer Screening Amongst First Nations Communities in Northwest Ontario, Canada. Health Care Women Int 2014; 37:478-95. [PMID: 25375661 DOI: 10.1080/07399332.2014.959168] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The high burden of cervical cancer in Indigenous populations worldwide is due to underscreening and inadequate follow-up. Using qualitative, participatory action research, we interviewed health care staff to identify ways to increase screening recruitment in First Nations communities in Northwest Ontario, Canada. Our findings suggest the value of a multilevel social-ecological model to promote behavioral changes at the community, health care service and stakeholder, and decision-maker level. Participants emphasized the central role of First Nations women as nurturers of life and for the well-being of their family members. They stressed the importance of building awareness and motivation for cervical cancer screening through various activities including continuous education, hosting screening events specifically for women, improving the attitude and service of health care providers, and promoting screening tools and policies that complement and are respectful of First Nations women.
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Affiliation(s)
- Marion Maar
- a Northern Ontario School of Medicine , Sudbury , Ontario , Canada
| | - Pamela Wakewich
- b Department of Sociology and Women's Studies, Lakehead University , Thunder Bay , Ontario , Canada
| | - Brianne Wood
- c Thunder Bay Regional Research Institute , Thunder Bay , Ontario , Canada
| | - Alberto Severini
- d Viral Exanthemata and STD Section, National Microbiology Laboratory, Public Health Agency of Canada , Winnipeg , Manitoba , Canada
| | - Julian Little
- e Department of Epidemiology and Community Medicine , University of Ottawa , Ottawa , Ontario , Canada
| | - Ann N Burchell
- f Ontario HIV Treatment Network; and Dalla Lana School of Public Health , Toronto , Ontario , Canada
| | - Gina Ogilvie
- g Clinical Prevention Services, BC Centre for Disease Control , Vancouver , British Columbia , Canada
| | - Ingeborg Zehbe
- a Northern Ontario School of Medicine , Sudbury , Ontario , Canada.,b Department of Sociology and Women's Studies, Lakehead University , Thunder Bay , Ontario , Canada
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Ports KA, Reddy DM, Rameshbabu A. Cervical cancer prevention in Malawi: a qualitative study of women's perspectives. JOURNAL OF HEALTH COMMUNICATION 2014; 20:97-104. [PMID: 25116413 DOI: 10.1080/10810730.2014.908986] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Researchers posit that cervical cancer knowledge is central to participation in prevention behaviors. However, of the many barriers to cervical cancer prevention in low- and middle-income countries, cervical cancer knowledge remains severely limited among communities at great risk for the disease. Malawi is one such country where the burden of cervical cancer is considerably high. Formative research targeting cervical cancer prevention is needed, particularly research that explores ways to deliver cervical cancer information efficiently and effectively to Malawian women. In this study, the authors aimed to garner Malawian women's understanding of cervical cancer and to shed light on preferences for health information delivery, including community health advocacy. Qualitative, in-depth interviews were conducted with 30 Malawian women and analyzed for recurring themes. In general, women had limited cervical cancer knowledge, which supported misperceptions about the disease, including factors pertaining to risk and prevention. Nonetheless, women reported that receiving cervical cancer information from trusted sources would help promote preventive behaviors. Women noted that they received most of their health information from hospital personnel, but distance was a barrier. Women also expressed interest in community health advocacy. Perspectives from Malawian women may be vital toward informing efforts to increase cervical cancer knowledge and prevention.
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Affiliation(s)
- Katie A Ports
- a Department of Social and Behavioral Health , Virginia Commonwealth University , Richmond , Virginia , USA
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Lairson DR, Dicarlo M, Deshmuk AA, Fagan HB, Sifri R, Katurakes N, Cocroft J, Sendecki J, Swan H, Vernon SW, Myers RE. Cost-effectiveness of a standard intervention versus a navigated intervention on colorectal cancer screening use in primary care. Cancer 2014; 120:1042-9. [PMID: 24435411 PMCID: PMC3961516 DOI: 10.1002/cncr.28535] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/18/2013] [Accepted: 11/18/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening is cost-effective but underused. The objective of this study was to determine the cost-effectiveness of a mailed standard intervention (SI) and tailored navigation interventions (TNIs) to increase CRC screening use in the context of a randomized trial among primary care patients. METHODS Participants (n = 945) were randomized either to a usual care control group (n = 317), to an SI group (n = 316), or to a TNI group (n = 312). The SI group was sent both colonoscopy instructions and stool blood tests irrespective of baseline preference. TNI group participants were sent instructions for scheduling a colonoscopy, a stool blood test, or both based on their test preference, as determined at baseline; then, they received a navigation telephone call. Activity cost estimation was used to determine the cost of each intervention and to compute incremental cost-effectiveness ratios. Statistical uncertainty within the base case was assessed with 95% confidence intervals derived from net benefit regression analysis. The effects of uncertain parameters, such as the cost of planning, training, and involvement of those receiving "investigator salaries," were assessed with sensitivity analyses. RESULTS Program costs of the SI were $167 per participant. The average cost of the TNI was $289 per participant. CONCLUSIONS The TNI was more effective than the SI but substantially increased the cost per additional individual screened. Decision-makers need to consider cost structure, level of planning, and training required to implement these 2 intervention strategies and their willingness to pay for additional individuals screened to determine whether a tailored navigation would be justified and feasible.
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Affiliation(s)
- David R Lairson
- School of Public Health, University of Texas Health Science Center, Houston, Texas
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Wang JHY, Sheppard VB, Liang W, Ma GX, Maxwell AE. Recruiting Chinese Americans into cancer screening intervention trials: strategies and outcomes. Clin Trials 2014; 11:167-77. [PMID: 24567288 DOI: 10.1177/1740774513518849] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cancer is the leading cause of death among Asian Americans. While Asian Americans are the fastest growing minority population in the United States, they are underrepresented in cancer research and report poor adherence to cancer screening guidelines. PURPOSE This study utilized data from two large randomized intervention trials to evaluate strategies to recruit first-generation Chinese American immigrants from community settings and Chinese American physician practices. Findings will inform effective strategies for promoting Asian American participation in cancer control research. METHODS Chinese Americans who were non-adherent to annual mammography screening guidelines (Study 1 with 664 immigrant women > 40 years of age) and to colorectal cancer screening guidelines (Study 2 with 455 immigrants > 50 years of age) were enrolled from the greater Washington DC, New York City (NYC), and Philadelphia (PA) areas. Both studies trained bilingual staff to enroll Chinese-speaking participants with the aid of linguistically appropriate fliers and brochures to obtain consent. Study 1 adopted community approaches and worked with community organizations to enroll participants. Study 2 randomly selected potential participants through 24 Chinese American primary-care physician offices, and mailed letters from physicians to enroll patients, followed by telephone calls from research staff. The success of recruitment approaches was assessed by yield rates based on number of participants approached, ineligible, and consented. RESULTS Most participants (70%) of Study 1 were enrolled through in-person community approaches (e.g., Chinese schools, stores, health fairs, and personal networks). The final yield of specific venues differed widely (6% to 100%) due to various proportions of ineligible subjects (2%-64%) and refusals (0%-92%). The Study 2 recruitment approach (physician letter followed by telephone calls) had different outcomes in two geographic areas, partially due to differences in demographic characteristics in the DC and NYC/PA areas. The community approaches enrolled more recent immigrants and uninsured Chinese Americans than the physician and telephone call approach (p < .001). Enrollment cost is provided to inform future research studies. LIMITATIONS Our recruitment outcomes might not be generalizable to all Chinese Americans or other Asian American populations because they may vary by study protocols (e.g., length of trials), target populations (i.e., eligibility criteria), and available resources. CONCLUSIONS Use of multiple culturally relevant strategies (e.g., building trusting relationships through face-to-face enrollment, use of bilingual and bicultural staff, use of a physician letter, and employing linguistically appropriate materials) was crucial for successfully recruiting a large number of Chinese Americans in community and clinical settings. Our data demonstrate that substantial effort is required for recruitment; studies need to budget for this effort to ensure the inclusion of Asian Americans in health research.
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Affiliation(s)
- Judy Huei-yu Wang
- aDepartment of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Halbert CH, Briggs V, Bowman M, Bryant B, Bryant DC, Delmoor E, Ferguson M, Ford ME, Johnson JC, Purnell J, Rogers R, Weathers B. Acceptance of a community-based navigator program for cancer control among urban African Americans. HEALTH EDUCATION RESEARCH 2014; 29:97-108. [PMID: 24173501 PMCID: PMC3894667 DOI: 10.1093/her/cyt098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 09/10/2013] [Indexed: 06/02/2023]
Abstract
Patient navigation is now a standard component of cancer care in many oncology facilities, but a fundamental question for navigator programs, especially in medically underserved populations, is whether or not individuals will use this service. In this study, we evaluated acceptance of a community-based navigator program for cancer control and identified factors having significant independent associations with navigation acceptance in an urban sample of African Americans. Participants were African American men and women ages 50-75 who were residents in an urban metropolitan city who were referred for navigation. Of 240 participants, 76% completed navigation. Age and perceived risk of developing cancer had a significant independent association with navigation acceptance. Participants who believed that they were at high risk for developing cancer had a lower likelihood of completing navigation compared with those who believed that they had a low risk for developing this disease. The likelihood of completing navigation increased with increases in age. None of the socioeconomic factors or health care variables had a significant association with navigation acceptance. There are few barriers to using community-based navigation for cancer control among urban African Americans. Continued efforts are needed to develop and implement community-based programs for cancer control that are easy to use and address the needs of medically underserved populations.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
| | - Vanessa Briggs
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
| | - Marjorie Bowman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
| | - Brenda Bryant
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
| | - Debbie Chatman Bryant
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
| | - Ernestine Delmoor
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
| | - Monica Ferguson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
| | - Marvella E. Ford
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
| | - Jerry C. Johnson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
| | - Joseph Purnell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
| | - Rodney Rogers
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
| | - Benita Weathers
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Health Promotion Council of Southeastern Pennsylvania, 260 Broad Street, Philadelphia, PA 19102, USA, Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates, Philadelphia, PA 19104, USA, Department of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA, Philadelphia Chapter, National Black Leadership Initiative on Cancer, Leon Sullivan Human Resources Building, 1415 N Broad Street, Suite 221B, Philadelphia, PA 19122, USA, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, USA, Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA, Southwest Action Coalition, 5214 Woodland Avenue, Philadelphia, PA 19143, USA and Christ of Calvary Community Development Corporation, 500 S 61st Street, Philadelphia, PA 19143, USA
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Sohng HY, Kuniyuki A, Edelson J, Weir RC, Song H, Tu SP. Capability for Change at Community Health Centers Serving Asian Pacific Islanders: An Exploratory Study of a Cancer Screening Evidence-based Intervention. Asian Pac J Cancer Prev 2013; 14:7451-7. [DOI: 10.7314/apjcp.2013.14.12.7451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hunt BR, Allgood K, Sproles C, Whitman S. Metrics for the systematic evaluation of community-based outreach. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:633-8. [PMID: 23857186 DOI: 10.1007/s13187-013-0519-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
There is an extensive literature on the use of community-based outreach for breast health programs. While authors often report that outreach was conducted, there is rarely information provided on the effort required for outreach. This paper seeks to establish a template for the systematic evaluation of community-based outreach. We describe three types of outreach used by our project, explain our evaluation measures, present data on our outreach efforts, and demonstrate how these metrics can be used to inform a project's decisions about which types of outreach are most effective.
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Affiliation(s)
- Bijou R Hunt
- Sinai Urban Health Institute, Mount Sinai Hospital, 1500 S. California Ave, Chicago, IL, 60608, USA,
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De Abreu C, Horsfall H, Learmonth D. Adherence barriers and facilitators for cervical screening amongst currently disadvantaged women in the greater Cape Town region of South Africa. Afr J Prim Health Care Fam Med 2013. [PMCID: PMC4709491 DOI: 10.4102/phcfm.v5i1.492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background In South Africa cervical cancer is the second most commonly occurring cancer amongst women, and black African women have the highest risk of developing this disease. Unfortunately, the majority of South African women do not adhere to recommended regular cervical screening. Objectives The purpose of this research was to explore the perceptions, experiences and knowledge regarding cervical screening of disadvantaged women in two informal settlements in South African urban areas. Method The Health Belief Model (HBM) provided a theoretical framework for this study. Four focus groups (n = 21) were conducted, using questions derived from the HBM, and thematic analysis was used to analyse the data. The ages of the women who participated ranged from 21 to 53 years. Results The analysis revealed lack of knowledge about screening as a key structural barrier to treatment. Other structural barriers were: time, age at which free screening is available, and health education. The psychosocial barriers that were identified included: fear of the screening procedure and of the stigmatisation in attending screening. The presence of physical symptoms, the perception that screening provides symptom relief, HIV status, and the desire to know one's physical health status were identified as facilitators of cervical screening adherence. Conclusion This knowledge has the potential to inform healthcare policy and services in South Africa. As globalisation persists and individuals continue to immigrate or seek refugee status in foreign countries, increased understanding and knowledge is required for successful acculturation and integration. Developed countries may therefore also benefit from research findings in developing countries.
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Affiliation(s)
| | - Hannah Horsfall
- Psychology Department, University of Cape Town, South Africa
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Andreeva VA, Pokhrel P. Breast cancer screening utilization among Eastern European immigrant women worldwide: a systematic literature review and a focus on psychosocial barriers. Psychooncology 2013; 22:2664-75. [PMID: 23824626 DOI: 10.1002/pon.3344] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 05/28/2013] [Accepted: 05/31/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many countries host growing Eastern European immigrant communities whose breast cancer preventive behaviors are largely unknown. Thus, we aimed to synthesize current evidence regarding secondary prevention via breast cancer screening utilized by that population. METHODS All observational, general population studies on breast cancer screening with Eastern European immigrant women and without any country, language, or age restrictions were identified. Screening modalities included breast self-examination, clinical breast examination, and mammography. RESULTS The selected 30 studies were published between 1996 and 2013 and came from Australia, Canada, Denmark, Germany, Israel, the Netherlands, Spain, Switzerland, the UK, and the USA. The reported prevalence of monthly breast self-examination was 0-48%; for yearly clinical breast examination 27-54%; and for biennial mammography 0-71%. The substantial methodologic heterogeneity prevented a meta-analysis. Nonetheless, irrespective of host country, healthcare access, or educational level, the findings consistently indicated that Eastern European immigrant women underutilize breast cancer screening largely because of insufficient knowledge about early detection and an external locus of control regarding decision making in health matters. CONCLUSIONS This is a vulnerable population for whom the implementation of culturally tailored breast cancer screening programs is needed. As with other underscreened immigrant/minority groups, Eastern European women's inadequate engagement in prevention is troublesome as it points to susceptibility not only to cancer but also to other serious conditions for which personal action and responsibility are critical.
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Mullins R, Coomber K, Broun K, Wakefield M. Promoting cervical screening after introduction of the human papillomavirus vaccine: the effect of repeated mass media campaigns. J Med Screen 2013; 20:27-32. [DOI: 10.1177/0969141313478588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives In 2007, Australia implemented an ongoing, school-based human papillomavirus (HPV) vaccination programme for school-aged girls, and a catch-up programme for 18–26-year-old women that ran until the end of 2009. The availability of what is widely known as the ‘cervical cancer vaccine’ means there is the potential for women to believe, incorrectly, that they no longer require regular cervical screening, and this risk needs to be addressed. The current study aimed to assess the effect of three mass media campaigns to promote cervical screening on the rate of cervical screening tests in the Australian state of Victoria, after HPV vaccine became available. Methods Seasonal time series assessed the effect of media campaigns broadcast in 2007, 2009 and 2010 on the rate of weekly cervical screening tests in Victorian women from 2006 to 2010, stratified by time since last screening test. Results The 2007 and 2009 media campaigns significantly increased the number of cervical screening tests per week. The 2007 campaign had a significant impact on lapsed screeners (>36 months since last test), overdue screeners (28–36 months since last test), and women never previously screened. The 2009 campaign significantly increased screening tests for overdue screeners, and the 2010 media campaign was associated with a significant increase in screening tests for lapsed screeners. Conclusions A well-researched and carefully pretested television advertising campaign with accurate, actionable messages can elicit appropriate screening behaviour among some of the appropriate groups even in a changed environment of complex, and potentially competing, messages.
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Affiliation(s)
- R Mullins
- Centre for Behavioral Research in Cancer, Cancer Council Victoria, Carlton, Victoria, Australia
| | - K Coomber
- Centre for Behavioral Research in Cancer, Cancer Council Victoria, Carlton, Victoria, Australia
| | - K Broun
- Cancer Prevention Centre, Cancer Council Victoria, Carlton, Victoria, Australia
| | - M Wakefield
- Centre for Behavioral Research in Cancer, Cancer Council Victoria, Carlton, Victoria, Australia
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Katz ML, Heaner S, Reiter P, van Putten J, Murray L, McDougle L, Cegala DJ, Post D, David P, Slater M, Paskett ED. Development of an Educational Video to Improve Patient Knowledge and Communication with Their Healthcare Providers about Colorectal Cancer Screening. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2009.10599097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mira L. Katz
- a College of Public Health and the Comprehensive Cancer Center , Ohio State University , Columbus , OH , 43210
| | - Sarah Heaner
- b College of Public Health and the Comprehensive Cancer Center , Ohio State University , Columbus , OH , 43210
| | - Paul Reiter
- c College of Public Health and the Comprehensive Cancer Center , Ohio State University , Columbus , OH , 43210
| | | | - Lee Murray
- e Columbus Neighborhood Health Center, Inc. , Columbus , OH
| | - Leon McDougle
- f College of Medicine , Ohio State University , Columbus , OH , 43210
| | - Donald J. Cegala
- g College of Communications , Ohio State University , Columbus , OH , 43210
| | - Douglas Post
- h College of Medicine , Ohio State University , Columbus , OH , 43210
| | - Prabu David
- i College of Communications , Ohio State University , Columbus , OH , 43210
| | - Michael Slater
- j College of Communications , Ohio State University , Columbus , OH , 43210
| | - Electra D. Paskett
- k College of Public Health and the Comprehensive Cancer Center , Ohio State University , Columbus , OH , 43210
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Walsh JME, Gildengorin G, Green LW, Jenkins J, Potter MB. The FLU-FOBT Program in community clinics: durable benefits of a randomized controlled trial. HEALTH EDUCATION RESEARCH 2012; 27:886-94. [PMID: 22641790 PMCID: PMC3442378 DOI: 10.1093/her/cys063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 04/04/2012] [Indexed: 05/24/2023]
Abstract
The objective of the study was to determine the extent to which the FLU-FOBT Program, a colorectal cancer screening (CRCS) intervention linking the provision of fecal occult blood tests (FOBT) to the time of annual influenza vaccination, resulted in practice changes in six primary care clinics 1 year after it was introduced in a randomized controlled trial (RCT). We assessed CRCS rate changes for influenza vaccine recipients, administered brief serial clinic staff surveys and interviewed clinic leaders 1 year after the RCT. CRCS rates for influenza vaccination recipients between the ages of 50 and 75 years were 42.5% before the RCT, 54.5% immediately after the RCT and 55.8% 1 year after the RCT (P < 0.001 for difference between baseline and 1 year after RCT). Many FLU-FOBT Program components were maintained in most clinics at 1-year follow-up. Only 63% of clinic staff survey respondents (26 of 41) continued offering FOBT with influenza vaccines, but 85% (35 of 41) continued to provide mailing kits with FOBT. Many patient education materials were maintained and staff satisfaction with the intervention remained high. Clinic leaders acknowledged barriers to maintenance but also observed several beneficial practice changes. Many components of the FLU-FOBT Program were maintained, with beneficial outcomes for participating practices.
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Affiliation(s)
- Judith M E Walsh
- Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, 1600 Divisadero Street San Francisco, CA 94115, USA.
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Tum SJ, Maree JE, Clarke M. Creating awareness and facilitating cervical and breast cancer screening uptake through the use of a Community Health Worker: a pilot intervention study. Eur J Cancer Care (Engl) 2012; 22:107-16. [PMID: 22966910 DOI: 10.1111/ecc.12005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In South Africa, cervical cancer is the most common female cancer followed by breast cancer. Despite the high incidence of these cancers, population-based screening is limited to cervical screening available at primary health clinics. Cervical screening uptake is, however, low. In 2009 a new cancer prevention initiative was launched in a specific resource poor community in Tshwane, South Africa. The low cervical screening uptake as well as a potentially low breast screening uptake could have resulted in the failure of this initiative. The purpose of the study was to develop and pilot test an intervention to address this risk. A Community Health Worker was trained and tasked to raise awareness of cervical and breast cancer and motivate women to take up screening. The intervention was assessed in terms of three outcomes: screening uptake, awareness and the value of the Community Health Worker. Despite the fact that the Community Health Worker's role was valued, screening uptake was disappointing and the level of awareness remained low. Unfortunately this intervention failed and once again we are left with the challenge of improving screening uptake.
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Affiliation(s)
- S J Tum
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Pretoria, South Africa
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Wang JHY, Schwartz MD, Brown RL, Maxwell AE, Lee MM, Adams IF, Mandelblatt JS. Results of a randomized controlled trial testing the efficacy of a culturally targeted and a generic video on mammography screening among chinese-american immigrants. Cancer Epidemiol Biomarkers Prev 2012; 21:1923-32. [PMID: 22971901 DOI: 10.1158/1055-9965.epi-12-0821] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Research comparing the effects of culturally targeted and generic but linguistically appropriate intervention programs is limited. We conducted a randomized controlled trial comparing the efficacy of a culturally targeted video, a generic video, and a fact sheet (control) in promoting mammography screening among Chinese-American immigrants. METHODS We randomized 664 Chinese-American women from the Washington, DC, and New York City areas who were older than 40 years and nonadherent to annual mammography screening guidelines to three study arms (each with ∼221 women). The outcome was self-reported mammography screening 6 months post intervention. Measures of knowledge, Eastern cultural views, and health beliefs were administered before and after the intervention. RESULTS The culturally targeted video, the generic video, and the fact sheet increased mammography use by 40.3%, 38.5%, and 31.1% from baseline, respectively. A significant intervention effect was observed only in one subgroup: The culturally targeted video significantly increased mammography screening among low-acculturated women over the fact sheet [OR, 1.70; 95% confidence interval (CI), 1.04-2.78]. Overall, women who obtained a mammogram during the follow-up period reported significantly fewer barriers to screening after intervention than those who had not obtained screening. Both of the video groups reported fewer barriers after intervention than the control group. CONCLUSIONS Both theoretically guided videos increased the likelihood of mammography use to a similar extent. Cultural targeting was only effective for low-acculturated women. Both videos reduced perceived barriers to screening and consequently increased screening behavior. IMPACT The results of this study provide empirical evidence on the efficacy of cultural targeting for minority immigrants.
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Affiliation(s)
- Judy Huei-yu Wang
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA.
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Debar LL, Kindler L, Keefe FJ, Green CA, Smith DH, Deyo RA, Ames K, Feldstein A. A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework. Transl Behav Med 2012; 2:523-530. [PMID: 23440672 DOI: 10.1007/s13142-012-0163-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chronic pain affects at least 116 million adults in the USA and exacts a tremendous cost in suffering and lost productivity. While health systems offer specialized pain services, the primary care setting is where most patients seek and receive care for pain. Primary care-based treatment of chronic pain by interdisciplinary teams (including behavioral specialists, nurse case managers, physical therapists, and pharmacists) is one of the most effective approaches for improving outcomes and managing costs. To ensure robust integration of such services into sustainable health-care programs, evaluations must be conducted by researchers well versed in the methodologies of clinical trials, mixed methods and implementation research, bioinformatics, health services, and cost-effectiveness. Recent national health policy changes, in addition to the increasing recognition of the high prevalence and cost of chronic pain conditions, present a unique opportunity to shift the care paradigm for patients with chronic pain.
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Affiliation(s)
- Lynn L Debar
- Kaiser Permanente Center for Health Research, Portland, OR, USA
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Lo S, Vart G, Snowball J, Halloran S, Wardle J, Von Wagner C. The impact of media coverage of the Flexible Sigmoidoscopy Trial on English colorectal screening uptake. J Med Screen 2012; 19:83-8. [DOI: 10.1258/jms.2012.012017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To assess the impact of media coverage of the UK Flexible Sigmoidoscopy Trial on colorectal screening uptake in England. Setting In April 2010, publication of the UK Flexible Sigmoidoscopy (FS) Trial results generated considerable media interest in both FS and colorectal cancer (CRC) generally. Methods We used routinely collected data from the south of England (excluding London) to analyse return of faecal occult blood test (FOBt) kits within 28 days of the invitation (early uptake) among 60–69 year olds, before (T1, n = 31,229), around the time of (T2, n = 39,571), and one month after (T3, n = 33,430) the FS publicity. Results FOBt uptake over the whole period was 58.2%, with 38.4% of the kits returned within 28 days (early uptake). Across the three time periods, early uptake was 35.8% at T1, 39.4% at T2, and 39.7% at T3. Multivariate regression controlling for age, gender and socioeconomic status confirmed that uptake was higher if people received the FOBt kit around the time of the media coverage (T2: odds ratio [OR] = 1.17, 95% CI = 1.13–1.20), or one month after (T3: OR = 1.18, 95% CI = 1.15–1.22) than before (T1). Sub-group analyses demonstrated that the impact was stronger among previous non-responders than among first-time invitees or previous responders (P < 0.001). Conclusion Media coverage of the FS Trial appeared to have a small but positive impact on FOBt screening uptake, especially among people who had previously abstained from screening.
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Affiliation(s)
- Sh Lo
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
| | - G Vart
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
| | - J Snowball
- Bowel Cancer Screening Programme, Southern Hub, Royal Surrey County Hospital
| | - Sp Halloran
- Bowel Cancer Screening Programme, Southern Hub, University of Surrey and Royal Surrey County Hospital NHS Trust
| | - J Wardle
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
| | - C Von Wagner
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
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Zapka J, Taplin SH, Ganz P, Grunfeld E, Sterba K. Multilevel factors affecting quality: examples from the cancer care continuum. J Natl Cancer Inst Monogr 2012; 2012:11-9. [PMID: 22623591 PMCID: PMC3482973 DOI: 10.1093/jncimonographs/lgs005] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The complex environmental context must be considered as we move forward to improve cancer care and, ultimately, patient and population outcomes. The cancer care continuum represents several care types, each of which includes multiple technical and communication steps and interfaces among patients, providers, and organizations. We use two case scenarios to 1) illustrate the variability, diversity, and interaction of factors from multiple levels that affect care quality and 2) discuss research implications and provide hypothetical examples of multilevel interventions. Each scenario includes a targeted literature review to illustrate contextual influences upon care and sets the stage for theory-informed interventions. The screening case highlights access issues in older women, and the survivorship case illustrates the multiple transition challenges faced by patients, families, and organizations. Example interventions show the potential gains of implementing intervention strategies that work synergistically at multiple levels. While research examining multilevel intervention is a priority, it presents numerous study design, measurement, and analytic challenges.
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Affiliation(s)
- Jane Zapka
- Department of Medicine, Division of Biostatistics and Epidemiology, Medical University of South Carolina, Rm 302H, 135 Cannon St, Charleston, SC 29425, USA.
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Schoenberg NE, Howell BM, Fields N. Community strategies to address cancer disparities in Appalachian Kentucky. FAMILY & COMMUNITY HEALTH 2012; 35:31-43. [PMID: 22143486 PMCID: PMC3262170 DOI: 10.1097/fch.0b013e3182385d2c] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Central Appalachian residents suffer disproportionate health disparities, including an all-cancer mortality rate 17% higher than the general population. During 10 focus groups and 19 key informant interviews, 91 Appalachian residents identified cancer screening challenges and strategies. Challenges included (1) inadequate awareness of screening need, (2) insufficient access to screening, and (3) lack of privacy. Strategies included (1) witnessing/storytelling, (2) capitalizing on family history, (3) improving publicity about screening resources, (4) relying on lay health advisors, and (5) bundling preventive services. These insights shaped our community-based participatory research intervention and offered strategies to others working in Appalachia, rural locales, and other traditionally underserved communities.
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Affiliation(s)
- Nancy E Schoenberg
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky 40536, USA.
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Renaud J, Gagnon F, Michaud C, Boivin S. Evaluation of the effectiveness of arsenic screening promotion in private wells: a quasi-experimental study. Health Promot Int 2011; 26:465-75. [DOI: 10.1093/heapro/dar013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jedele JM, Ismail AI. Evaluation of a multifaceted social marketing campaign to increase awareness of and screening for oral cancer in African Americans. Community Dent Oral Epidemiol 2010; 38:371-82. [PMID: 20646014 DOI: 10.1111/j.1600-0528.2010.00545.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A 2-year social marketing media campaign and community education activities were organized to promote screening for oral cancer in a high-risk population in Detroit/Wayne County, Michigan. Long-term goals of the campaign were to reduce the oral cancer death rate, increase the proportion of oral cancers detected at an early stage, and increase the proportion of adults who report having been screened. The intermediate goals of the campaign were to increase awareness of oral cancer and of oral cancer screening. This article presents outcomes related to the intermediate goals of the campaign. METHODS The intermediate goals of the campaign were assessed by the number of calls to a toll-free hotline, which media venues led to calls, number of screenings conducted by the free screening clinic, number of precancers and cancers detected, and the number of sessions conducted, organizations involved, and persons participating in the community education program. The costs per screened case and cancers detected were also evaluated. The media campaign promoted screening using billboards, radio and newspaper ads, and a toll-free hotline. Culturally relevant messages were developed collaboratively with focus groups representing the target audience. Billboards were placed in highly visible locations around Detroit, Michigan. Sixty-second messages on the impact of oral cancer and that screening is 'painless and free' were aired on radio stations popular with the target audience. Ads displaying the hotline were placed in two local newspapers. Callers to the hotline were scheduled for a free screening with a clinic operated by the project. Referral to an oral surgeon was scheduled if a suspicious lesion was found. Free education sessions were also conducted with community-based organizations. Costs associated with the campaign and hotline were totaled, and the cost per screening and cancer detected were calculated. RESULTS During the campaign, 1327 radio spots aired; 42 billboards were displayed; two newspaper ads were printed; and 242 education sessions were conducted. The hotline received 1783 calls. The majority of callers reported that their call was prompted by a radio ad (57%). The clinic screened 1020 adults and referred 78 for further examination. Three cancers, two precancers, and 12 benign tumors were detected. The total cost associated with the campaign and toll-free hotline was $795,898. CONCLUSIONS A multifaceted social marketing campaign including radio ads, billboards, and education sessions can effectively target a high-risk population and that given an outlet could result in a significant number of people getting screened at a relatively low cost.
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Affiliation(s)
- J M Jedele
- Detroit Oral Cancer Prevention Project, School of Dentistry, University of Michigan, 1011 N. University Ave, Ann Arbor, MI, USA.
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Abstract
Mass media campaigns are widely used to expose high proportions of large populations to messages through routine uses of existing media, such as television, radio, and newspapers. Exposure to such messages is, therefore, generally passive. Such campaigns are frequently competing with factors, such as pervasive product marketing, powerful social norms, and behaviours driven by addiction or habit. In this Review we discuss the outcomes of mass media campaigns in the context of various health-risk behaviours (eg, use of tobacco, alcohol, and other drugs, heart disease risk factors, sex-related behaviours, road safety, cancer screening and prevention, child survival, and organ or blood donation). We conclude that mass media campaigns can produce positive changes or prevent negative changes in health-related behaviours across large populations. We assess what contributes to these outcomes, such as concurrent availability of required services and products, availability of community-based programmes, and policies that support behaviour change. Finally, we propose areas for improvement, such as investment in longer better-funded campaigns to achieve adequate population exposure to media messages.
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Affiliation(s)
- Melanie A Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Carlton, Australia.
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Williams KP, Mabiso A, Lo YJ, Penner LA. Mammography screening trends: the perspective of African American women born pre/post World War II. J Natl Med Assoc 2010; 102:452-60. [PMID: 20575209 DOI: 10.1016/s0027-9684(15)30552-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Researchers have traditionally combined aging women (aged > or =50 years) when reporting their mammography use. This may inadvertently mask important cohort effects in mammography use, which are likely to result from distinct personal life experiences and generational differences. Using the Health and Retirement Study samples of 1998, 2000, and 2004, we examined cohort differences in mammography use between African American women born before 1946 (non-baby boomers) and those born in 1946 to 1953 (baby boomers). Between 1998 and 2004, screening rates for non-baby boomers declined, while those for baby boomers remained relatively steady. Hierarchical linear modeling (HLM) analyses suggest that while screening rates decreased with age (OR, 0.957; 95% CI, 0.947-0.968) cohort effects may have partially reversed the age effect, with non-baby boomers having an increased likelihood of receiving a mammogram compared to baby boomers (OR, 1.697; 95% CI, 1.278-2.254). Because African American women are diagnosed at later stages of breast cancer, documentation of cohort differences in mammography use among older African American women is important as health care professionals design intervention programs that are maximally effective for women from different cohorts. This is particularly critical as more African American women in the baby boomer cohort become part of the aging population.
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Affiliation(s)
- Karen Patricia Williams
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan 48824-1316, USA.
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Hade EM, Murray DM, Pennell ML, Rhoda D, Paskett ED, Champion VL, Crabtree BF, Dietrich A, Dignan MB, Farmer M, Fenton JJ, Flocke S, Hiatt RA, Hudson SV, Mitchell M, Monahan P, Shariff-Marco S, Slone SL, Stange K, Stewart SL, Strickland PAO. Intraclass correlation estimates for cancer screening outcomes: estimates and applications in the design of group-randomized cancer screening studies. J Natl Cancer Inst Monogr 2010; 2010:97-103. [PMID: 20386058 DOI: 10.1093/jncimonographs/lgq011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Screening has become one of our best tools for early detection and prevention of cancer. The group-randomized trial is the most rigorous experimental design for evaluating multilevel interventions. However, identifying the proper sample size for a group-randomized trial requires reliable estimates of intraclass correlation (ICC) for screening outcomes, which are not available to researchers. We present crude and adjusted ICC estimates for cancer screening outcomes for various levels of aggregation (physician, clinic, and county) and provide an example of how these ICC estimates may be used in the design of a future trial. METHODS Investigators working in the area of cancer screening were contacted and asked to provide crude and adjusted ICC estimates using the analysis of variance method estimator. RESULTS Of the 29 investigators identified, estimates were obtained from 10 investigators who had relevant data. ICC estimates were calculated from 13 different studies, with more than half of the studies collecting information on colorectal screening. In the majority of cases, ICC estimates could be adjusted for age, education, and other demographic characteristics, leading to a reduction in the ICC. ICC estimates varied considerably by cancer site and level of aggregation of the groups. CONCLUSIONS Previously, only two articles had published ICCs for cancer screening outcomes. We have complied more than 130 crude and adjusted ICC estimates covering breast, cervical, colon, and prostate screening and have detailed them by level of aggregation, screening measure, and study characteristics. We have also demonstrated their use in planning a future trial and the need for the evaluation of the proposed interval estimator for binary outcomes under conditions typically seen in GRTs.
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Affiliation(s)
- Erinn M Hade
- Center for Biostatistics, The Ohio State University, 2012 Kenny Rd, Columbus, OH 43221, USA.
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Walsh JME, Salazar R, Nguyen TT, Kaplan C, Nguyen LK, Hwang J, McPhee SJ, Pasick RJ. Healthy colon, healthy life: a novel colorectal cancer screening intervention. Am J Prev Med 2010; 39:1-14. [PMID: 20547275 PMCID: PMC4282133 DOI: 10.1016/j.amepre.2010.02.020] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 12/29/2009] [Accepted: 02/25/2010] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening rates are increasing, but they are still low, particularly in ethnic minority groups. In many resource-poor settings, fecal occult blood test (FOBT) is the main screening option. INTERVENTION Culturally tailored telephone counseling by community health advisors employed by a community-based organization, culturally tailored brochures, and customized FOBT kits. DESIGN RCT. Participants were randomized to (1) basic intervention: culturally tailored brochure plus FOBT kit (n=765); (2) enhanced intervention: brochure, FOBT plus telephone counseling (n=768); or (3) usual care (n=256). SETTING/PARTICIPANTS Latino and Vietnamese primary care patients at a large public hospital. MAIN OUTCOME MEASURES Self-reported receipt of FOBT or any CRC screening at 1-year follow-up. RESULTS 1358 individuals (718 Latinos and 640 Vietnamese) completed the follow-up survey. Self-reported FOBT screening rates increased by 7.8% in the control group, by 15.1% in the brochure group, and by 25.1% in the brochure/telephone counseling group (p<0.01 for differences between each intervention and usual care and for the difference between brochure/telephone counseling and brochure alone). For any CRC screening, rates increased by 4.1% in the usual care group, by 11.9% in the FOBT/brochure group, and by 21.4% in the brochure/telephone counseling group (p<0.01 for differences between each intervention and usual care and for the difference between the basic and the enhanced intervention). CONCLUSIONS An intervention that included culturally tailored brochures and tailored telephone counseling increased CRC screening in Latinos and the Vietnamese. Brochure and telephone counseling together had the greatest impact. Future research should address replication and dissemination of this model for Latinos and Vietnamese in other communities, and adaptation of the model for other groups.
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Affiliation(s)
- Judith M E Walsh
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, San Francisco, California 94115, USA.
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Dissemination and implementation research on community-based cancer prevention: a systematic review. Am J Prev Med 2010; 38:443-56. [PMID: 20307814 DOI: 10.1016/j.amepre.2009.12.035] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 09/30/2009] [Accepted: 12/07/2009] [Indexed: 11/20/2022]
Abstract
CONTEXT An extensive array of effective interventions for the prevention of cancer exists, suggesting that evidence is ready for widespread use. However, few of these approaches have been extensively utilized in real-world settings. Further, little is known on how to best disseminate and implement evidence-based interventions for the primary prevention of cancer in community settings. EVIDENCE ACQUISITION A systematic review of the dissemination and implementation literature was conducted between 2006 and 2008 in the topic areas of smoking, healthy diet, physical activity, and sun protection. English-language peer-reviewed articles published between 1980 and 2008 that met the inclusion criteria were classified by suitability of study design (i.e., greatest, moderate, least); quality of execution (i.e., good, fair, limited); and effectiveness (i.e., substantial, some, or little/no evidence of effectiveness) and were abstracted for dissemination- and implementation-related content. EVIDENCE SYNTHESIS Twenty-five unique dissemination and implementation studies were identified. The majority of included studies were conducted in the U.S., in schools, and with children as the ultimate target population, had the least suitability of study design, had fair or limited execution, and used a theoretic framework, active dissemination and implementation approaches, and multimodal strategies. There was considerable heterogeneity across studies in reported mediators, moderators, and outcomes. CONCLUSIONS Key implications from this review include the need for uniform language, studies targeting various populations and settings, valid and reliable measures, triangulation of and more practice-based evidence, standardized reporting criteria, and active and multimodal strategies.
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Kagawa-Singer M, Tanjasiri SP, Valdez A, Yu H, Foo MA. Outcomes of a breast health project for Hmong women and men in California. Am J Public Health 2009; 99 Suppl 2:S467-73. [PMID: 19443830 PMCID: PMC4504377 DOI: 10.2105/ajph.2008.143974] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We used a community-based research approach to test a culturally based breast cancer screening program among low-income Hmong women in central and southern California. METHODS We designed a culturally informed educational program with measures at baseline and 1-year follow-up in 2 intervention cities and 1 comparison city. Measures included changes in breast cancer screening, knowledge, and attitudes. RESULTS Compared with women in the comparison community, women in the intervention community significantly improved their attitudes toward, and increased their knowledge and receipt of, breast cancer screenings. Odds of women in the intervention group having had a mammogram, having had a clinical breast examination, and having performed breast self-examination was 6.75, 12.16, and 20.06, respectively, compared with women in the comparison group. CONCLUSIONS Culturally informed education materials and intervention design were effective methods in conveying the importance of maintaining and monitoring proper breast health. The strength of community collaboration in survey development and intervention design highlighted the challenges of early detection and screening programs among newer immigrants, who face significant language and cultural barriers to care, and identified promising practices to overcome these health literacy challenges.
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Affiliation(s)
- Marjorie Kagawa-Singer
- Department of Community Health Sciences, UCLA School of Public Health, 650 Charles Young Dr South, Box 951772, Los Angeles, CA 90095-1772, USA.
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Anderson JO, Mullins RM, Siahpush M, Spittal MJ, Wakefield M. Mass media campaign improves cervical screening across all socio-economic groups. HEALTH EDUCATION RESEARCH 2009; 24:867-875. [PMID: 19342422 DOI: 10.1093/her/cyp023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Low socio-economic status (SES) has been associated with lower cervical screening rates. Mass media is one known strategy that can increase cervical screening participation. This study sought to determine whether a mass media campaign conducted in Victoria, Australia, in 2005 was effective in encouraging women across all SES groups to screen. Data were obtained from the Victorian Cervical Cytology Registry for each Pap test registered during 2005 and categorized into SES quintiles using the Index of Socio-Economic Advantage/Disadvantage. Negative binomial regression was used to determine the impact of the campaign on the weekly number of Pap tests and whether the media campaign had a differential effect by SES, after adjusting for the number of workdays per week, age group and time since previous test. Cervical screening increased 27% during the campaign period and was equally effective in encouraging screening across all SES groups, including low-SES women. Mass media campaigns can prompt increased rates of cervical screening among all women, not just those from more advantaged areas. Combining media with additional strategies targeted at low-SES women may help lessen the underlying differences in screening rates across SES.
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Burke NJ, Joseph G, Pasick RJ, Barker JC. Theorizing social context: rethinking behavioral theory. HEALTH EDUCATION & BEHAVIOR 2009; 36:55S-70S. [PMID: 19805791 PMCID: PMC3548316 DOI: 10.1177/1090198109335338] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Major behavioral theories focus on proximal influences on behavior that are considered to be predominantly cognitive characteristics of the individual largely uninfluenced by social context. Social ecological models integrate multiple levels of influence on health behavior and are noted for emphasizing the interdependence of environmental settings and life domains. This theory-based article explains how social context is conceptualized in the social sciences and how the social science conceptualization differs from and can broaden the analytic approach to health behavior. The authors use qualitative data from the Behavioral Constructs and Culture in Cancer Screening study to illustrate our conceptualization of social context. We conclude that the incorporation into health behavior theory of a multidimensional socioculturally oriented, theoretical approach to social context is critical to understand and redress health disparities in multicultural societies like the United States.
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Affiliation(s)
- Nancy J Burke
- Helen Diller Family Comprehensive Cancer Center and Department of Anthropology, History, and Social Medicine, University of California, San Francisco, CA 94143-0981, USA.
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