Adebola Adegboyega

Analysis of Kentucky's Law Protecting the Rights of Schoolchildren With Type 1 Diabetes Mellitus: Application of Kingdon's Policy Stream Model.

Type 1 diabetes mellitus is a chronic, life-threatening disorder that affects children of all ages. Based on data from 2008 to 2009, the Centers for Disease Control and Prevention estimates that in the United States, 191,986 youth younger than age 20 require treatment for diabetes, the majority of whom have Type 1 diabetes mellitus. These children require assistance with counting carbohydrates, testing blood glucose, and administering subcutaneous insulin. Establishing appropriate diabetes care models in schools is necessary for children’s immediate safety, long-term well-being, and optimal academic performance. Kentucky House Bill 98 was passed by the state legislature in 2014 to allow unlicensed school personnel to assist children with diabetes care. The purpose of this article is to apply Kingdon’s policy streams model to an analysis of a state policy allowing unlicensed school personnel to assist children with diabetes care. The article covers potential policy alternatives and concludes with a discussion of implications for nursing practice.

Factors Influencing Pap Screening Use Among African Immigrant Women

Purpose: Papanicolau (Pap) screenings disparities exist for immigrant women in the United States. This study sought to have an understanding of factors influencing Pap screening among sub-Saharan African immigrant women. Method: This is a qualitative descriptive study. Women were recruited from the community and by word of mouth following institutional review board approval. Data were gathered through in-depth focus group and demographic questionnaires. Interview sessions were digitally recorded and transcribed verbatim. Transcripts were analyzed for themes. Findings: Twenty-two women aged 24 to 65 years were interviewed. Barriers to screening included low knowledge of screening, cost, cultural beliefs, fear and communication issues. Motivators to improve Pap use include provider’s recommendations, enlightenment, and family support. Discussion: Interventions addressing the barriers peculiar to this population may alleviate these barriers and improve Pap screening use in this population. Providers have the opportunity to influence screening attitudes of African-born women by providing awareness and patient-targeted interventions.

Social support and breast cancer screening in rural Appalachia

Women in the Appalachian region have a high mortality rate attributable to cancer in spite of lower incidence of cancer compared with the general US population. Empirical evidence suggests that social support influences cancer outcomes, including adherence to screening guidelines and treatment recommendations. The purpose of this study is to examine the impact of social support on breast cancer screening patterns in a sample of rural Appalachian women.

Regular Mammography Screening Among African American (AA) Women: Qualitative Application of the PEN-3 Framework

Introduction: Breast cancer mortality rates among African American (AA) women are at 29.2 deaths per 100,000 persons compared with 20.6 deaths per 100,000 persons among Caucasian women. Regular mammography screening may significantly reduce breast cancer mortality and narrow this disparity. This study guided by PEN-3 model aims to explore the relationships and expectations domain and identify perceptions, enablers, and nurturers of regular mammography among AA women. Method: As part of an intervention study, in-depth interviews were conducted with 39 AA women recruited from the emergency department of a public university hospital. Results: Women’s perceptions included fear and limited knowledge. Enablers identified were cost, socioeconomic, and race-related discrimination, and health care previous experiences. Nurturers identified included observation of family experiences and lack of health-related social support. Discussion: Findings underscore the need to develop culturally tailored interventions to address the issues salient to this population.

Adolescents’ Perceptions of a Gardening Activity at a Juvenile Justice Center

Purpose: The purpose of this study was to elicit participants’ (N = 16) perceptions of a gardening activity at a juvenile justice center and to determine whether past exposure to gardening and farmers markets was associated with their perceptions of the gardening experience. Design: This cross-sectional, exploratory program evaluation was conducted in partnership with the Kentucky Department of Juvenile Justice. Adolescents completing the Cadet Leadership and Education Program participated in gardening in order to provide produce to a local farmers’ market. Method: After the growing season, participants were asked to complete a nine-item questionnaire about the gardening activity during one of their usual classes at the facility. The questionnaire assessed perception of the experience and past exposure to gardening and farmers’ markets. Findings: Participants reported favorably about their participation in the activity, knowledge gained from the activity, and their intent to garden in the future. Those who had previously gardened had more favorable perception of gardening than those who had never gardened. Gardening is an inexpensive means of teaching teamwork and delayed gratification and providing a sense of empowerment and may benefit at-risk adolescents during incarceration.

Training Community Health Workers in Motivational Interviewing to Promote Cancer Screening

Health disparities researchers attempting to engage and effectively deliver interventions to underserved populations often encounter a number of challenges ranging from geographical considerations to more complex issues of medical mistrust. While there are a number of strategies researchers may employ to address these challenges, one of the most successful of these has been the use of community health workers (CHWs). Despite the documented success of CHWs, little information exists on the use of theory-driven intervention strategies with these community partners. Researchers who have partnered with CHWs tend to provide brief descriptions of training strategies and provide little discussion of the challenges and barriers to training a lay population in the delivery of technical interventions, including ensuring fidelity to the intervention protocol. The purpose of this article is to describe the feasibility of training CHWs to deliver a motivational interviewing intervention to promote cancer screening in underserved populations. With this article we present an innovative way to use motivational interviewing delivered by CHWs. Specifically, we will detail the development of the training protocol, the implementation of that training in a variety of research settings, and the development and implementation of fidelity protocols. We will use examples from two research studies where CHWs were successfully trained to use MI to promote cancer screening in underserved communities to highlight the challenges and barriers faced in developing and implementing the training and strategies used to overcome these challenges during the refinement of the intervention.

Abstract C62: Sub-Saharan African immigrant men's knowledge and support related to cervical cancer screening: A qualitative descriptive study

Background: Cervical cancer screening disparity puts sub-Saharan African immigrant women at an increased risk for development of invasive cervical cancer. Several studies have identified various factors influencing cervical cancer screening use among sub-Saharan African immigrants in the United States. One of such factors is the role of spousal support; African men are often the gatekeepers of health for their families and have significant influence on the health-seeking behavior of their wives/female partners. However, limited research exists on men9s knowledge and support related to Pap screening. Thus, we conducted a qualitative descriptive study to assess knowledge and support related to Pap screening among sub-Saharan African immigrant men in Lexington, Kentucky. Method: In-depth individual interviews using semistructured guide were conducted with 21 sub-Saharan African immigrant men who were married or in committed relationships. Data were audio recorded, transcribed verbatim, and analyzed using content analysis. Results: The average age of the study participants was 36 ± 9; 53% have lived in the US for more than 5 years; 88% were college educated; 43% make more than

Abstract C65: Promoting colorectal cancer screening in rural Appalachian emergency department

50,000 annually; and 62% were married. General knowledge of Pap screening, cervical cancer, and HPV9s role in the etiology of cervical cancer was minimal. Men showed the desire to support their wives/female partners to have a Pap screening. All participants preferred to be carried along and informed about their wives9 decision to have a Pap screening in order to provide any support that might be needed. The narratives related to health care providers9 gender preference varied among men; several men showed preference for a female health care provider for Pap screening services for their wives/female partners while others showed no preference. Conclusions: These findings underscore the importance of men9s support in promoting Pap screening among sub-Saharan African immigrant women. Men should be included in cervical cancer prevention efforts to leverage their support. Thorough understanding of African family dynamics, cultural norms, and values related to preventive health care seeking is essential to the design and implementation of interventions for improving Pap screening among sub-Saharan African immigrant women. Citation Format: Adebola Adegboyega, Jennifer Hatcher. Sub-Saharan African immigrant men9s knowledge and support related to cervical cancer screening: A qualitative descriptive study [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 C62.

Abstract C57: Repeat mammography screening among African American women: Qualitative application of the PEN-3 framework

Objective: To provide a conceptual description of an Emergency Department (ED) placed randomized controlled trial designed to reduce the disproportionate burden of colorectal cancer (CRC) among rural Appalachian residents. Background: Residents of rural Appalachia have a higher incidence and mortality rate from CRC than residents of any other region of the country. The Centers for Disease estimate that as many as 60% of CRC deaths could be prevented if everyone aged 50 and up were screened regularly. One of the primary barriers to CRC screening for rural Appalachian residents is limited access to the health care system resulting in infrequent recommendations for screening and inadequate screening education. Given the propensity of rural Appalachians to accept health related information from trusted community members we designed an intervention to be delivered by local community health workers in the ED while individuals waited for non urgent care or waited with a family member. The ED provides services to a segment of the population that is traditionally hard to reach and at high risk for underutilization of preventive services. ED visits may be the sole point of contact with the health care system for these vulnerable individuals and provides a venue and opportunity for CRC screening promotion and education. Methods: This ED-placed RCT, designed and implemented in collaboration with community members and health care providers in rural Eastern Kentucky, is one of the first to use the ED as a site to promote colorectal cancer screening using a community health worker trained to deliver a motivational interviewing intervention to persons waiting for non urgent care or with a family member, in the ED of rural Appalachian hospitals. Results: We provide a conceptual overview to key elements of the intervention, including intervention development and refinement, theoretical foundations, intervention approach and implementation and evaluation procedures. Conclusion: This RCT has recruited more than 150 persons from rural Appalachian EDs who have not been screened for CRC in accordance with guidelines. It provides promise that CRC screening promotion activities are appropriately placed in rural EDs and provides a solid platform from which researchers and providers may launch efforts to develop targeted preventative health interventions in innovative public health settings. Citation Format: Jennifer Hatcher, Arica Brandford, Adaeze Aroh, Adebola Adegboyega, Brenda Combs, Nancy Schoenberg. Promoting colorectal cancer screening in rural Appalachian emergency department. [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 C65.

Rural Grandparent Headed Households: A Qualitative Description

Backgrounds: African American women have a higher mortality rate from breast cancer than any other ethnic group in the country, with an estimated 30,700 new cases of invasive breast cancer and 6,310 deaths expected to occur in 2016. In part the disparate breast cancer mortality rate suffered by African American women can be attributed to irregular mammography screening patterns, which contribute to later stages of diagnosis as compared with other racial ethnic groups. Regular mammography screening may significantly reduce breast cancer mortality and narrow this disparity; however, African American women underutilize mammography screening according to goals set by Healthy People 2020. The purpose of this paper is to identify factors influencing regular breast cancer screening among African American women. Method: In-depth individual interviews were conducted with 39 African-American women, ranging in age from 42 to 79, who visited the ED of a public hospital with non-urgent complaints and those who were seated in the waiting area. Using qualitative analysis we identified Perceptions (individually held knowledge, attitudes, values or beliefs), Enablers (societal, systematic or structural influences) and Nurturers (supportive or discouraging influences from significant others) that influenced screening decisions. The sample included women who had been screened in the past two years and those who had not. Using the PEN-3 as a theoretical guide we explored, from the perception of the women, the factors that influence screening behaviors. Findings: The themes that emerged were placed within the appropriate cells (perceptions, enablers or nurturers) in the PEN-3 framework. The findings indicated that women9s perceptions included fear of pain associated with mammography, fear of results, and fear of the unknown, fatalistic beliefs, and limited knowledge of personal risk for breast cancer. The only difference between the perceptions of women who had screened in the past two years and never screened women was knowledge. Women who had been screened in the past two years had more knowledge of mammography procedure and endorsed perceptions such as screening provides reassurance and maintenance of good health. Enablers identified included cost, access, gender and attitudes of the mammography provider, socioeconomic and race related discrimination, and previous experiences within the healthcare system. Previously screened women were more likely to have a source of insurance but both screened and unscreened women discussed financial burden associated with screening. Participants in both screened and unscreened groups emphasized the fact that their previous experiences within the healthcare influenced screening decisions. Nurturers identified included observations of family member9s experiences with cancer, lack of health-related social support and shared mammography experiences within participants9 social network. Women who receive encouraging feedback about mammography from their social network are more likely to have been screened. Conclusion: African American women suffer a significant disparity of breast cancer mortality as compared to other women in the U.S. Despite improvements in access, related to the enactment of the Affordable Care Act, this disparity persists. This study explores the influences on the decisions related to regular mammography screening from the perspective of African American women. The findings from this study underscore the critical need for development of culturally tailored interventions that address the issues salient to this population as well as interventions that leverage the powerful social networks that influence health care decisions in this population. Citation Format: Adebola Adegboyega, Arica Brandford, Jennifer Hatcher. Repeat mammography screening among African American women: Qualitative application of the PEN-3 framework. [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 C57.