Gatekeepers' perceptions of the quality and availability of services for breast and cervical cancer patients in the English-speaking Windward Islands: an exploratory investigation

Woman-to-woman: Feasibility of a lay health advisor program for cervical cancer education in Grenada, W.I

Objective

The aim of this study was to evaluate the impact of Woman- to-Woman, a lay health advisor (LHA)-led educational intervention on cervical cancer and human papillomavirus (HPV) knowledge in a cohort of at-risk Grenadian women.

Methods

LHAs from high-risk parishes were trained in the administration of the intervention and administered the program to 78 local women. Participants completed a pre- and post-knowledge test and a session evaluation. LHAs participated in a process evaluation focus group.

Results

Sixty-eight percent (68%) of participants obtained higher knowledge scores following the educational intervention. The difference between the pre- and post-test scores was statistically significant (p = 0.05). Almost 94% agreed that they were taught new and useful information by credible, community informed and responsive LHAs. Ninety percent (90%) indicated great satisfaction and high motivation to recommend to others. LHAs reported on the intervention and their community interactions.

Conclusions

Results demonstrate that a LHA-led educational intervention significantly improved participants' knowledge of cervical cancer, HPV, Papanicolaou test and vaccination against HPV. Innovations: Researchers trancreated an evidenced based intervention originally designed for Latina women for Grenadian women. There is no evidence in the literature of previous LHA- cervical cancer education studies conducted in Grenada nor the Caribbean.

Catherine J, Radix C, Luce D, Barul C. Cancer Survivors in Saint Lucia Deeply Value Social Support: Considerations for Cancer Control in Under-Resourced Communities

Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; "Availability of support groups", "Importance of support from family and friends", "Access to finances" and "Health education and patient navigation". Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted.

Woman to Woman: Implementation of a Cervical Cancer Education Training Program for Grenadian Lay Health Advisors

The reduction in cervical cancer (CC) in developed countries, due mainly to Pap testing, has not filtered down to Caribbean countries including Grenada despite accessible screening. This is attributed to a lack of knowledge and low screening. Researchers in low resource settings successfully trained lay health advisors (LHAs), using theory-based, culturally relevant interventions to reverse this trend. The use of LHAs in Grenada was not documented in the literature; therefore, the purpose of this study was to implement and evaluate a culturally relevant curriculum in an effort to educate Grenadian LHAs on CC. Using convenience sampling, 8 Grenadian women were recruited from the parishes with the highest rates of CC. They participated in Woman to Woman (W2W), a 2-day CC, and human papilloma virus (HPV) prevention education program facilitated by local content experts. W2W was adapted from an evidence-based curriculum and tailored for the Grenadian context. Training consisted of modules on CC and HPV. Knowledge of LHAs was measured pre- and post-intervention. Summative evaluation was assessed using a focus group discussion. There was a significant increase in CC knowledge among LHA post-training (p < 0.05) and LHAs had positive opinions about the intervention. They had an enhanced sense of self-efficacy and valued feeling part of a team. The W2W results indicated that an evidence-based and culturally tailored educational intervention has the potential for significant gains in CC and HPV knowledge. Future research will evaluate the LHA-led CC and HPV educational intervention in the community setting.