Abstract
Introduction: The Breast Health Research Champion (BHRC) program was developed in order to train breast health advocates in the community on breast health basics, clinical trials, and ...biospecimen donations. Data collection is underway for the 4th cohort, and focuses on the rural area of Lawrenceville, Virginia. Lawrenceville is a part of Brunswick County, which is a large county encompassing 569 square miles and a population of 16,500 persons. This is the second cohort involving rural communities. When working with small, tight-knit communities, we have encountered some challenges and have developed methods/strategies to address them.
Methods: From experiences in a past rural cohort, several adaptations were made in the program in order to ensure success. These minor adaptations were developed in conjunction with community facilitators from the target area. Conversations were held throughout the facilitator training sessions, encouraging facilitators to problem-solve potential issues in order to assist in preparing for the program. Although the changes are small, it is thought that the adjustments made created a more engaged, sustainable relationship between researchers, community partners, and community members.
Summary: The community partner identified two women from different geographic areas in the large county of Brunswick. This served multiple purposes; it helped reduce the burden on any one community member, and it increased the areas that participants were recruited from. The recruitment from various areas was critical as it provided a greater impact of the key messages of the program going out into the community. Particularly in the rural areas, we have found that communication from a community facilitator as opposed to research staff is crucial for engaging individuals. Participants were more likely to attend sessions and continued education when contacted by the community facilitator. The facilitators also identified alternate options to engage participants who were unable to travel or attend a session. iPads were used to record videos from education sessions in order to facilitate their understanding. Internet connectivity is not readily available in this area; however, the community partner was able to provide space for additional viewing sessions with Internet access. Another challenge we encountered was a lack of healthy foods available for the sessions. Facilitators worked with local community members to plan menus and prepare healthy food options for the sessions.
Conclusion: Engaging communities in research involves flexibility and a multifaceted approach. When preparing for community-involved research, make sure community members understand that challenges will be encountered, but research staff are there to troubleshoot issues that arise. Open and honest communication with community partners about past challenges and listening to their suggestions for improvements are crucial for successful engagement in rural communities. These conversations are integral as it fosters a sense of trust, which ultimately strengthens the partnership.
Citation Format: Katelyn Schifano. Potential challenges and strategies for working with community cancer advocates in a rural population abstract. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B16.
Abstract
Background From 2016-2023 Massey Cancer Center (MCC) was one of 42 sites implementing the Screen to Save (S2S) Colorectal Cancer education program. At MCC, during 2016-2019 this program was ...implemented by MCC health educators. In 2020 we shifted to a community facilitator model to improve reach and receptivity within racially and ethnically diverse communities. We report our results by facilitator type in changes in CRC and CT knowledge and intentions to act on CRC screening. We also report on a subgroup who was given a clinical trials education session. Methods The MCC facilitators (n=3) were health educators with CHES and graduate level education in public health. Community facilitators (n=16) completed the MCC CRC Cancer Champs training, Each facilitator was responsible for recruiting their S2S participants. S2S participants completed pre-post CRC knowledge surveys; intentions to act were assessed on post surveys. Actions included talking to a doctor, getting screened, talking to friends/family, making dietary changes and making exercise changes. A subset of n=129 completed CT knowledge pre-post surveys. Initial pre-post change in CRC and CT knowledge was assessed with paired t-tests. Multiple regression was used to examine pre-education scores, facilitator type and participant demographics on post-session knowledge. Intention to act about CRC screening are described; chi square compared intentions by facilitator. Results/Findings MCC and Community facilitators reach n=357 participants aged 18-87 (mean 51 years). Participants were predominantly (58%) African American. Knowledge about CRC significantly increased (t=9.43,df=356, p<0.01). In the multiple regression model only pre-knowledge scores were significant (beta= 0.23, 95% CI: 0.18-0.27). CT knowledge significantly increased (t=6.78, df=128, p<0.01). Multiple regression showed being Latinx (beta = 0.7, 95% CI: 0.21, 1.19), White (beta = 0.55, CI 0.18-0.93), A/AI (beta =-1.42, 95% CI: –2.51, -0.33) were associated with higher post-session CT knowledge score. Community facilitators reached significantly more males (x2=27.55, df= 1, p <0.01), Latinx (x2= 89.34, df=1, p <0.01), and younger participants (t=-7.35, mean diff=5.06 CI: (3.71, 6.42) value<0.01). Intention to act on the five behaviors ranged from 89%-92%. Intention to speak to a doctor and speak to friends/family about CRC and screening were significantly higher in the MCC facilitators group as compared to the Community facilitators. Discussion and Conclusion The Cancer Champs model is an effective method of training community members on CRC and CT as there were no differences in knowledge change by facilitator. Results suggest there may be a difference in participants' comfort discussing CRC with others by facilitator type. Further examination of communication skills facilitation is indicated. Our work illustrates that community Cancer Champs successfully can reach individuals that are sometimes left out of research, allowing for a more diverse and representative sample with comparable results in terms of knowledge exchange.
Citation Format: Katelyn Schifano, Jackie Knight-Wilt, Vanessa Sheppard, Maria Thomson. Efficacy of community members versus employees for delivering colorectal health and clinical trial information abstract. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A037.
In Virginia, 56% of colorectal cancers (CRC) are diagnosed late, making it one of three enduring CRC mortality hotspots in the US. Cervical cancer (CCa) exhibits a similar pattern, with 48% ...late-stage diagnosis. Mortality for these cancers is worse for non-Latinx/e(nL)-Black people relative to nL-White people in Virginia, but preventable with equitable screening access and timely diagnostic follow-up. However, structural barriers, such as fractured referral systems and extended time between medical visits, remain. Because Federally Qualified Health Centers (FQHCs) care for a large proportion of racial and ethnic minorities, and underserved communities, regardless of ability to pay, they are ideal partners to tackle structural barriers to cancer screenings. We piloted a quality improvement initiative at five FQHCs in southcentral Virginia to identify and address structural, race-related barriers to CRC, as well as CCa screening and diagnostic follow-up using evidence-based approaches. Uniquely, FQHCs were paired with local community organizations in a didactic partnership, to elevate the community's voice while together, increase support, acceptance, uptake, and intervention sustainability. We report on project development, and share preliminary data within the context of project goals, namely, to increase cancer screenings by 5-10%, improve knowledge and diagnostic follow-up processes, and build longitudinal partnerships.
In 2022, the Virginia Chickahominy Indian Tribe partnered with Virginia Commonwealth University Massey Comprehensive Cancer Center to investigate concerns about a potential cancer cluster near a ...local landfill. While investigating cancer clusters is complex due to long latency and multifactorial causes, the community's concerns about structural factors driving cancer risk warrant exploration. Thus, the Chickahominy T.R.U.T.H. (Trust, Research, Understand, Teach, and Heal) Project was created as a community-academic partnership to (1) identify structural factors and barriers associated with perceived cancer risk and care; (2) assess cancer knowledge, care access gaps, and perceived risks, including testing private and community water sources; (3) develop and deploy culturally tailored cancer education and resource navigation, including groundwater safety education, policies, and remediation. We will conduct 150 in-person interviews and water tests among residents within a four-mile radius of the landfill, and deploy 1000 structured questionnaires among Charles City County residents. In this paper, we provide an overview of the ongoing project design, development, and progress in support of the project's objectives. This collaborative investigation aims to address cancer health disparities, enhance research and health policy advocacy, and honor the sacred knowledge of an underserved community, laying the groundwork for a long-term partnership to guide future research questions.
Abstract
Introduction: The Geographic Management of Cancer Health Disparities Program (GMaP) is a national NCI program with the goal of increasing cancer health disparities (CHD) research. GMaP ...Region 1 North (R1N) is one of seven GMaP Regional “hubs” based at NCI-designated cancer centers (CCs) across the country, covering the states of DE, KY, ME, MD, NH, VA, VT, WV, and the District of Columbia. The National Outreach Network (NON) is a national NCI program with the goal of conducting cancer education and outreach in underserved communities to reduce CHD. NON Community Health Educators (CHEs) are based at 38 NCI-designated CCs across the country. Six NCI-designated CCs with NON CHEs fall within the GMaP R1N coverage area.
Methods: GMaP R1N staff and NON CHEs within the R1N coverage area met bimonthly to collaborate on the Screen to Save (S2S): NCI Colorectal Cancer (CRC) Outreach and Screening Initiative. The goal of S2S was to educate underserved communities on CRC and CRC screening. NON CHEs conducted the projects in diverse urban and rural communities within their CC catchment areas. Participants attended a CRC education event that provided an inflatable colon or a PowerPoint presentation and completed demographic and pre-/post-event surveys to gauge their knowledge of CRC screening. Surveys were submitted to NCI Center to Reduce Cancer Health Disparities program staff for review and data entry. Raw data files were returned to NON CHEs and shared with GMaP R1N staff for analysis. R1N staff provided research expertise to compare results between urban and rural S2S participants.
Results: There were a total of 328 participants in S2S (n=200 urban; n=128 rural) in the GMaP R1N/NON coverage area. The median age of urban participants was 59.5 vs. 49.0 for rural participants. 95% of urban participants and 96.1% of rural participants reported having health insurance (public or private). 92.9% of urban and 88.1% of rural participants attained at least a high school diploma or GED. 76.5% of urban and 41.4% of rural participants reported ever being screened for CRC by any method. The percent increase between pre- and post-test scores for the educational intervention was 15% for urban vs. 13.3% for rural participants, with an overall percent increase in knowledge of 14.2%.
Conclusions: The urban and rural participants were similar in educational and health insurance attainment levels. Urban residents reported much higher rates of previous CRC screening than rural residents, but this is likely due to the fact that more rural participants were younger than the recommended CRC initial screening age at the time (age 50). The S2S educational intervention was effective in increasing knowledge of CRC screening among both rural and urban participants, with similar increase between the two groups. Overall, this project demonstrated that two different yet complementary programs, GMaP and NON, can work together by utilizing program strengths to successfully implement an educational intervention conducted across a wide and diverse geographic area.
Citation Format: Mark Cromo, Rhonda Boozer-Yeary, Melinda L. Rogers, Katelyn Schifano, Jenna Schiffelbein, Katherine L. Jones, Marcela Blinka, Julia F. Houston, Betsy Grossman, Lindsay Hauser, James Zabora, Mark B. Dignan, Tracy Onega. Integrating research and outreach to increase CRC screening knowledge in underserved communities: The Geographic Management of Cancer Health Disparities Program and National Outreach Network Screen to Save partnership abstract. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A015.
The Center to Reduce Cancer Health Disparities (CRCHD), NCI, implemented Screen to Save, NCI's Colorectal Cancer Outreach and Screening Initiative to promote awareness and knowledge of colorectal ...cancer in racial/ethnic and rural populations.
The initiative was implemented through CRCHD's National Outreach Network (NON). NON is a national network of Community Health Educators (CHE), aligned with NCI-designated Cancer Centers across the nation. In phases I and II, the CHEs focused on the dissemination of cancer-related information and implementation of evidence-based educational outreach.
In total, 3,183 pre/post surveys were obtained from male and female participants, ages 50 to 74 years, during the 347 educational events held in phase I. Results demonstrated all racial/ethnic groups had an increase in colorectal cancer-related knowledge, and each group strongly agreed that the educational event increased the likelihood that they would engage in colorectal cancer-related healthful behaviors (e.g., obtain colorectal cancer screening and increase physical activity). For phase II, Connections to Care, event participants were linked to screening. Eighty-two percent of the participants who obtained colorectal cancer screening during the 3-month follow-up period obtained their screening results.
These results suggest that culturally tailored, standardized educational messaging and data collection tools are key change agents that can serve to inform the effectiveness of educational outreach to advance awareness and knowledge of colorectal cancer.
Future initiatives should focus on large-scale national efforts to elucidate effective models of connections to care, related to colorectal cancer screening, follow-up, and treatments that are modifiable to meet community needs.
Abstract
Background: Medical mistrust and lack of clinical trial awareness are often cited as barriers to clinical trial enrollment for Black/African American and rural residents. However, our ...community needs assessment at the Virginia Commonwealth University (VCU) Massey Cancer Center (MCC), identified a striking discordance: our community reported high awareness of clinical trials and willingness to participate, but this was in contrast to their abysmal participation in research and/or clinical trials. Given the role of misinformation in perpetuating communication barriers between researchers and the community, we sought to determine if targeting scientists’ communication led by community feedback would decrease the barriers between science and community. We did so by connecting two most distal groups: basic scientists from the VCU-MCC cancer biology (CB) program and lay community members from urban and rural under-resourced neighborhoods within MCC’s catchment area. Methods: CB program researchers shared 10-minute presentations of their work with urban (Petersburg) and rural (Brunswick) community members. Thereafter, 30-minute semi-structured focus group discussions with a subset of attendees were audio recorded and transcribed verbatim; results were summarized using thematic analysis. Notably, the racial/ethnic makeup of both counties are such that Black/African American is the majority with Petersburg and Brunswick counties having 60% and 20% less White, respectively. Results: Seven themes emerged: (1) relevance and application of scientific knowledge, (2) improve comprehension and salience, (3) interactive visuals to connect with audience, (4) community values science to improve quality of life (advancement & sustainability), (5) authentic dialogue is critical for building trust and mutual learning, (6) there is limited knowledge of cancer biologists role, and (7) actionable steps that impact the cancer care continuum. Both urban and rural participants expressed an interest in understanding the application of the presented scientific knowledge to the lives of people that share aspects of their salient identities. A participant from the urban sample said, “… I would’ve loved to have had more knowledge on Black women, uh, prone to cancer over the White women.” Rural participants generally thought that the verbage used in the presentations would not be easily understood by fellow laypeople suggesting the presenter “slow it down” and include “animated videos.” When asked what they would like scientists to focus on next, rural participants expressed interest in actionable steps that impact the cancer care continuum. One person stated, “Prevention things can never be heard enough…and how you deal with it.” Conclusions: Results reveal a striking opportunity to improve understanding among basic scientists on how they can be of value to both urban and rural communities. A video-based curriculum intervention for community biologists to improve community-science bilingualism and promote bidirectional learning and engagement is underway.
Citation Format: Bianca Owens, Maghboeba Mosavel, Katelyn Schifano, Josly Pierre-Louis, Stephanie Sullivan, Vanessa Sheppard, Robert Winn, Katherine Tossas. The power of bidirectional learning: Bridging the gap between communities and scientists by promoting “inreach” and community-science bilingualism abstract. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B014.
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