1
|
Rodriguez EM, Jandorf L, Devonish JA, Saad-Harfouche FG, Clark N, Johnson D, Stewart A, Widman CA, Erwin DO. Translating new science into the community to promote opportunities for breast and cervical cancer prevention among African American women. Health Expect 2019; 23:337-347. [PMID: 31800158 PMCID: PMC7104642 DOI: 10.1111/hex.12985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND New evidence has found breast and cervical cancer risk factors unique to African American women. Thus, there is a significant need to increase their knowledge and understanding of relevant risk factors and the potential protective benefits associated with breast-feeding and HPV vaccination. The National Witness Project is a robust, evidence- and community-based lay health advisor programme that uses group education, navigation and survivor narratives to increase cancer screening among diverse underserved women. METHODS A multi-phase, community-based participatory research study was conducted across three sites in Buffalo, NY, New York City and Arkansas between October 2016 and January 2017. Pre-/post-test surveys were administered during volunteer trainings and community programmes. An evaluation survey was also administered at the Annual Meeting for Education and Networking. Paired sample t tests were used to compare pre-/post-test survey scores. RESULTS Trainee survey results showed the overall mean per cent correct pre-/post-test scores were 47.7% (SD: 21.87) and 79.2% (SD: 16.14). Altogether, 31 educational programmes reached 332 community participants. Participants' breast and cervical cancer knowledge scores were significantly higher after the education programme (84.4%) than before (55.3%) with a mean change score of 29% (P ≤ .001). CONCLUSION This paper reveals the underlying complexities to update the educational curriculum content of a multi-site, community-based outreach organization. The new curriculum significantly improved African American women's knowledge about breast and cervical cancer by 10%-36%, clearly demonstrating that this information was new to them. The need for education programming in African American communities to disseminate cancer prevention and risk information remains high.
Collapse
Affiliation(s)
- Elisa M Rodriguez
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Population Sciences, Buffalo, New York
| | - Lina Jandorf
- Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Julia A Devonish
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Population Sciences, Buffalo, New York
| | - Frances G Saad-Harfouche
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Population Sciences, Buffalo, New York
| | - Nikia Clark
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Population Sciences, Buffalo, New York
| | - Detric Johnson
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Population Sciences, Buffalo, New York
| | - Anika Stewart
- Witness Project of Long Island, Long Island, New York
| | - Christy A Widman
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Population Sciences, Buffalo, New York
| | - Deborah O Erwin
- Roswell Park Comprehensive Cancer Center, Cancer Prevention and Population Sciences, Buffalo, New York
| |
Collapse
|
2
|
Lollier A, Rodriguez EM, Saad-Harfouche FG, Widman CA, Mahoney MC. HPV vaccination: Pilot study assessing characteristics of high and low performing primary care offices. Prev Med Rep 2018; 10:157-161. [PMID: 29868360 PMCID: PMC5984216 DOI: 10.1016/j.pmedr.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/13/2018] [Accepted: 03/09/2018] [Indexed: 10/26/2022] Open
Abstract
This pilot study was undertaken to identify characteristics and approaches (e.g., social, behavioral, and/or systems factors) which differentiate primary care medical offices achieving higher rates of HPV vaccination. Eligible primary care practice sites providing care to adolescent patients were recruited within an eight county region of western New York State between June 2016 and July 2016. Practice sites were categorized as higher (n = 3) or lower performing (n = 2) based on three dose series completion rates for HPV vaccinations among females aged 13-17 years. Interviewer administered surveys were completed with office staff (n = 37) and focused on understanding approaches to adolescent vaccination. Results were summarized using basic descriptive statistics. Higher performing offices reported more full-time clinical staff (median = 25 vs. 9.5 in lower performing clinics), larger panels of patients ages 11-17 years (median = 3541 vs. 925) and completion of NYSIIS data entry within two weeks of vaccination. (less than a month vs. two). Staff in higher performing offices reviewed medical charts prior to scheduled visits (100% vs. 50) and identified their office vaccine champion as a physician and/or a nurse manager (75% vs. 22%). Also, staffs from higher performing offices were more likely to report the combination of having an office vaccine champion, previewing charts and using standing orders. These preliminary findings support future research examining implementation of organizational processes including identifying a vaccine champion, using standing orders and previewing medical charts prior to office visits as strategies to increase rates of HPV vaccination in primary care offices.
Collapse
Affiliation(s)
- Allison Lollier
- School of Public Health & Health Professions, State University of New York at Buffalo, 401 Kimball Tower, Buffalo, NY, USA.,School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo, 285 Kapoor Hall, Buffalo, NY, USA
| | - Elisa M Rodriguez
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA
| | - Frances G Saad-Harfouche
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA
| | - Christy A Widman
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA
| | - Martin C Mahoney
- School of Public Health & Health Professions, State University of New York at Buffalo, 401 Kimball Tower, Buffalo, NY, USA.,Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA.,Department of Family Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| |
Collapse
|
3
|
Widman CA, Rodriguez EM, Saad-Harfouche F, Twarozek AM, Erwin DO, Mahoney MC. Clinician and Parent Perspectives on Educational Needs for Increasing Adolescent HPV Vaccination. J Cancer Educ 2018; 33:332-339. [PMID: 27640203 PMCID: PMC5357204 DOI: 10.1007/s13187-016-1105-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Human papillomavirus (HPV)-related morbidity and mortality remain a significant public health burden despite the availability of HPV vaccines for cancer prevention. We engaged clinicians and parents to identify barriers and opportunities related to adolescent HPV vaccination within a focused geographic region. This mixed-method study design used an interviewer-administered semi-structured interview with clinicians (n = 52) and a written self-administered survey with similar items completed by parents (n = 54). Items focused on experiences, opinions, and ideas about HPV vaccine utilization in the clinical setting, family, and patient perceptions about HPV vaccination and potential future efforts to increase vaccine utilization. Quantitative items were analyzed using descriptive statistics, while qualitative content was analyzed thematically. Suggested solutions for achieving higher rates of HPV vaccination noted by clinicians included public health education, the removal of stigma associated with vaccines, media endorsements, and targeting parents as the primary focus of educational messages. Parents expressed the need for more information about HPV-related disease, HPV vaccines, vaccine safety, sexual concerns, and countering misinformation on social media. Results from this mixed-method study affirm that educational campaigns targeting both health care professionals and parents represent a key facilitator for promoting HPV vaccination; disease burden and cancer prevention emerged as key themes for this messaging.
Collapse
Affiliation(s)
- Christy A Widman
- Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY, 14263, USA
| | - Elisa M Rodriguez
- Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY, 14263, USA
| | - Frances Saad-Harfouche
- Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY, 14263, USA
| | - Annamaria Masucci Twarozek
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Deborah O Erwin
- Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY, 14263, USA
| | - Martin C Mahoney
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| |
Collapse
|
4
|
Saad-Harfouche FG, Rodriguez EM, Twarozek AM, Widman CA, Erwin DO, Underwood W, Fox C, Mahoney MC. Abstract A08: Leveraging technology to promote smoking cessation in primary care medical offices. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-a08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose of the Study: While smoking represents the leading preventable cause of premature morbidity and mortality in the U.S., research has demonstrated that only a limited scope of cessation services are delivered to patients in many medical offices. We examined the use of an automated voice recognition (AVR) messaging intervention among smokers from primary care practices located in underserved urban and rural communities as a strategy to promote smoking cessation.
Methods: We utilized community-based participatory research (CBPR) involving smokers as a foundation for creating AVR messaging and partnered with urban and rural primary care medical office sites (n=7), including community clinics and federally qualified health centers. Current smokers, 18 years and older, who had an office visit within the previous 12 months, from these sites were used to create a smoker's registry (n=5,872). Between 2012 and 2014 participants were contacted over six month intervals using the AVR system. Smoker's registry data including demographic variables, medical office, and phone contact information. AVR results from each practice were aggregated and analyzed to assess cessation outcomes.
Results: Of the seven practice sites, a total of 5,872 smokers were accrued of whom 1,899 (32%) were reached through the AVR system. The average number of calls to smokers was 44 (median 51). 28% of the smokers reached were African American, 79% were age 40 and over, and 57% were female. Self-reported quit rates among reached smokers were 30%; quit rates were variable across selected variables.
Conclusions: An AVR based smoking cessation intervention provided added value beyond typical tobacco cessation efforts available in these primary care offices. This intervention required no additional clinical staff time and served to satisfy a component of patient center medical home requirements for many of these practices. Building partnerships with primary care medical offices can aid in the development and testing of community-based interventions such as smoking cessation delivered to medically underserved and diverse patient populations.
Citation Format: Frances G. Saad-Harfouche, Elisa M. Rodriguez, Annamaria Masucci Twarozek, Christy A. Widman, Deborah O. Erwin, Willie Underwood, III, Chester Fox, Martin C. Mahoney. Leveraging technology to promote smoking cessation in primary care medical offices. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A08.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Chester Fox
- 2State University of New York at Buffalo, Buffalo, New York
| | | |
Collapse
|
5
|
duPont NC, Mahoney MC, Kahn LS, Vest BM, Widman CA, Clark-Hargrave NS, Erwin DO. Developing a Smoking Cessation Intervention for Low Income and Minority Women. ACTA ACUST UNITED AC 2016; 5. [PMID: 28824830 PMCID: PMC5558895 DOI: 10.4172/2167-0420.1000309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this qualitative pilot study was to elicit patient and provider feedback on how to develop a smoking cessation program for low income women with cervical dysplasia in an urban Women's Health Center. METHODS A community-based participatory research project incorporating a focus group and structured interviews was utilized to elicit feedback on how to develop a culturally appropriate smoking cessation program appealing to low-income and minority women smokers. RESULTS Qualitative data from 13 patients, 4 nurses, and 6 staff members collected between January 2012-August 2012 described the challenges of finding effective mechanisms for cessation interventions that met the schedules and needs of low income and minority patients. Input from office staff indicated insufficient educational resources to offer patients, limited skills to assist patients and the importance of perceived patient readiness to quit as barriers to creating an effective smoking cessation program. CONCLUSION Smoking cessation services targeting low-income and minority female smokers can be enhanced by providing clinic staff with patient education materials and smoking cessation training.
Collapse
Affiliation(s)
- Nefertiti C duPont
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Martin C Mahoney
- Departments of Medicine and Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
| | - Linda S Kahn
- Department of Family Medicine, University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Bonnie M Vest
- Department of Family Medicine, University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Christy A Widman
- Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
| | - Nikia S Clark-Hargrave
- Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
| | - Deborah O Erwin
- Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
| |
Collapse
|
6
|
Mahoney MC, Saad-Harfouche FG, Widman CA, Twarozek AM, Erwin DO, Rodriguez EM. Clinician Misperceptions about the Importance of Adolescent HPV Vaccination. World J Vaccines 2016; 6. [PMID: 29795800 PMCID: PMC5962284 DOI: 10.4236/wjv.2016.61002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Adolescent HPV vaccination rates remain suboptimal. The purpose of the study was to investigate attitudes about HPV vaccine relative to other adolescent vaccines among clinical staff from primary care offices and school based clinics. Methods We interviewed clinicians in primary care offices and school-based clinics regarding their attitudes about HPV vaccine relative to Tdap and MCV4. Results Respondents (n = 36) included clinical staff in family medicine (47%), pediatrics (25%), obstetrics/gynecology (19%) and school-based health clinics (8%). Only 3% strongly agreed and 17% agreed that completion of HPV vaccine was more important than completion of pertussis vaccine (Tdap), while 6% strongly agreed and 33% agreed that completion of HPV vaccine was more important than completion of meningitis vaccine (MCV4). Discussion Providing clinicians with additional information about the cancer prevention benefits of the HPV vaccine and the greater risk for HPV infection/disease relative to other vaccine preventable adolescent diseases may help to increase HPV vaccination rates among adolescents.
Collapse
Affiliation(s)
- Martin C Mahoney
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Frances G Saad-Harfouche
- Department of Cancer Prevention and Control, Office of Cancer Health Disparities Research, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Christy A Widman
- Department of Cancer Prevention and Control, Office of Cancer Health Disparities Research, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Deborah O Erwin
- Department of Cancer Prevention and Control, Office of Cancer Health Disparities Research, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Elisa M Rodriguez
- Department of Cancer Prevention and Control, Office of Cancer Health Disparities Research, Roswell Park Cancer Institute, Buffalo, NY, USA
| |
Collapse
|