Genoveva Ibarra

Educating Hispanic Women About Breast Cancer Prevention: Evaluation of a Home-Based Promotora-Led Intervention

OBJECTIVES Trained community health promoters (i.e., promotoras) conducted home-based group educational interventions (home health parties) to educate Hispanic women from the Lower Yakima Valley of Washington state about breast cancer and mammography screening. METHODS Women aged 40-79 participating in the parties completed baseline and follow-up surveys 6 months postintervention (n = 70). Changes in general cancer knowledge, breast cancer screening practices, and intentions to be screened among participants from baseline to follow-up were measured using McNemars test for marginal homogeneity to evaluate the effectiveness of the parties. RESULTS The average age of the sample was 50.0 years (standard deviation [SD] 10.0), 84% reported less than an eighth grade education, and 54% were covered by the states Basic Health Care Plan. Significant changes between baseline and follow-up were observed with respect to (1) believing that risk of cancer could not be reduced (41% vs. 15%, respectively, p = 0.001), (2) ever having a mammogram (83% vs. 91%, p = 0.014), (3) discussing a mammogram with a doctor (37% vs. 67%, p < 0.001), and (4) intending to have a mammogram within the next few months among women who did not report having a mammogram between baseline and follow-up (61% vs. 81%, p = 0.046). CONCLUSIONS Participation in home-based group educational interventions delivered by promotoras may be associated with improved breast cancer screening practices among Hispanic women.

A QUALITATIVE INVESTIGATION OF CANCER SURVIVORSHIP EXPERIENCES AMONG RURAL HISPANICS

Cancer survivorship experiences were explored among Hispanic men and women with cancer and family members of cancer survivors, recruited from two rural Washington communities in the Lower Yakima Valley. Five focus groups were conducted from February 2006 to October 2007 with 31 women and 10 men. Disbelief, fear, sadness, strength, courage, faith, and hope were common reactions to diagnosis. Concerns about family/children, losing medical coupons, and feelings of depression/isolation were identified as challenges faced after diagnosis. Participants identified smoking and environmental exposures as causes of cancer, but many believed operating on tumors caused cancer to spread. Participants used conventional treatments but identified herbal/natural remedies as cures. Most participants reported negative experiences with physicians and believed their community would benefit from language-appropriate information regarding prevention and treatment. The importance of linking survivors through support groups was emphasized and information elicited from sessions has been used to organize survivor support groups in these two communities.

Latinas’ Mammography Intention Following a Home-Based Promotores-Led Intervention

Abstract Despite increases in mammography rates among Latinas, screening rates remain lower than in non-Latina Whites and Latinas typically present with breast cancer at a later stage. Trained lay community workers (promotores) have been successfully used to increase screening mammography intention in Latinas. Little is known, however, about the potential mechanisms of these interventions, such as increased breast cancer knowledge (knowledge) and social interactions concerning mammography practices (social engagement). This prospective pre-post study examined this gap in the literature by (1) documenting changes in knowledge and social engagement after receipt of a promotores-based intervention; and (2) establishing if post-intervention knowledge and social engagement predicted mammography intention, after adjusting for socio-demographic and lifetime mammography history. There were significant increases in knowledge and social engagement about mammography. Finally, post-intervention social engagement was a significant predictor of mammography intention. Future promotores-based interventions should focus on enhancing social engagement to improve mammography intention and use.

The Promotora Explained Everything: Participant Experiences During a Household-Level Diabetes Education Program.

Purpose The purpose of this study is to describe participant experiences of a household-level, community health worker-led intervention to improve diabetes-related health behaviors and outcomes. Methods The Home Health Parties (HHP) aimed to improve diabetes self-management among Hispanics living in a rural, agricultural area in eastern Washington State. Trained promotores (community health workers) delivered a series of education sessions and distributed incentives to support diabetes-related behavior change. Open-ended, semi-structured questionnaires were administered to a random sample of 40 HHP participants. Qualitative methods were used to code and analyze the interview transcripts. Results Four primary themes emerged from interviews: (1) participants’ desire for improving knowledge about diabetes; (2) experiences of building skills for diabetes management; (3) developing social support; and (4) embracing household-level change. Conclusion This study shows that involving family members and increasing social support are effective strategies for improving health behaviors and chronic health outcomes among vulnerable Hispanics living with diabetes. Our findings demonstrate several important considerations regarding the design of diabetes management interventions for rural Hispanic populations including the following: (1) promotores are critical as they provide social support and encourage behavior change by building relationships based on trust and cultural understanding; (2) well-designed tools that provide step-by-step examples of healthy behaviors, such as cookbooks, and tools that aid participants to monitor behavior change, such as pedometers and glucose monitors, serve to build skills and improve confidence to achieve goals; and (3) targeting households is a promising strategy for individual and family lifestyle changes that benefit the entire family unit.

Diabetes prevention in Hispanics: report from a randomized controlled trial.

Introduction Hispanics are at increased risk of developing type 2 diabetes. Lifestyle interventions are effective in preventing diabetes and restoring glucose regulation. Methods We recruited Hispanic men and women (N = 320) who were residents of the Lower Yakima Valley, Washington, aged 18 years or older with hemoglobin A1c (HbA1c) levels higher than 6% to a parallel 2-arm randomized-controlled trial conducted from 2008 through 2012. The trial compared participants in the intervention arm, who received an immediate educational curriculum (n = 166), to participants in the control arm, who received a delayed educational curriculum (n = 154). The home-based curriculum consisted of 5 sessions led by community health workers and was designed to inform participants about diabetes, diabetes treatment, and healthy dietary and physical activity behaviors. Participants were randomly assigned to the intervention and control arms, and analysts were blinded as to participant arm. We evaluated intervention effects on HbA1c levels; frequency (times per week) of fruit and vegetable consumption; and frequency (times per week) of mild, moderate, and strenuous leisure-time physical activity. At baseline, 3 months, and 6 months after randomization, participants completed a questionnaire and provided a blood sample. Analysts were blinded to intervention arm. Results The immediate intervention group (−0.64% [standard error (SE) 0.10]) showed a significant improvement in HbA1c scores (–37.5%, P = .04) compared with the delayed intervention group (–0.44%, P = .14). No significant changes were seen for dietary end points or changes in physical activity. We did observe a trend of greater increases in frequency of moderate and vigorous physical activity and a smaller increase in mild physical activity in the immediate intervention group than in the delayed intervention group. Conclusion This home-based intervention delivered by CHWs was associated with a clinically and statistically significant reduction in HbA1c levels in Hispanic adults with HbA1c levels higher than 6%.

Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas

Latinas have the highest rates of cervical cancer in the United States and the second highest rate of cervical cancer mortality. One factor in the disparity is the relatively low rate of screening for cervical cancer in this population.

Type 2 Diabetes Among Rural Hispanics in Washington State: Perspectives From Community Stakeholders

During February-March 2006, elicitation interviews were conducted with 23 community stakeholders in the Yakima Valley, Washington State, to examine concerns about diabetes and to obtain recommendations for how to address concerns among Hispanics in this rural community. Using a snowball approach, stakeholders were identified from organizations providing care and outreach for Hispanics with diabetes. Interviews were guided by a social ecology approach and were conducted as part of a larger parent study using principles of community-based participatory research. Audiotaped interviews were transcribed and then coded by three staff members who identified common themes independently before meeting to reach consensus. Stakeholders represented health care delivery or social service organizations, churches, or local radio stations. Diabetes was perceived as an important problem among community members, who often underwent delayed diagnosis of the disease. Lack of disease knowledge, access to appropriate information or services, health insurance, and personal responsibility were perceived as barriers. Stakeholders recommended using exiting organizations and businesses as intervention channels, promoting cultural sensitivity of health professionals and volunteers, creating and distributing appropriate information, and organizing activities to promote awareness and disease management. Recommendations have informed the design of community interventions to lessen the impact of diabetes in the Yakima Valley.

WORKPLACE EXPOSURES AND PROTECTIVE PRACTICES OF HISPANIC WAREHOUSE WORKERS

Background This study was undertaken to assess workplace hazards and protective practices among Hispanic men and women working post-harvest in asparagus, apple and pear packaging warehouses. Methods Three focus groups were conducted in July 2003 with 25 workers (20 women, 5 men) recruited from communities in the Yakima Valley, Washington. Focus group content informed the design of an in-person structured interview administered to 50 additional warehouse workers from August to November 2006. Results Focus group participants reported difficult working conditions, exposure to chemicals, adverse health effects and use of work and home protective practices to minimize exposures for themselves and their families. Structured interview participants reported few workplace exposures to chemicals although many reported engaging in workplace and home protective practices. Discussion Findings from this research can direct initial efforts to determine if and how interventions for warehouse workers may be designed to protect against hazardous workplace exposures.

Abstract IA29: Overcoming barriers to screening in rural areas: No bus, no taxi, no services

Background: Cancer screening in rural areas is hampered by numerous barriers; among these are systemic factors such as access to care in the rural area, lack of culturally appropriate physicians, and lack of screening systems. These barriers are often accompanied by structural impediments such as lack of transportation to distant clinics and screening settings, lack of child care, and inconvenient times for appointments. New and innovative approaches to dealing with rural populations are needed to overcome some of these barriers. In Eastern Washington State, the many rural areas are served by a Federally Qualified Health Center (FQHC) system. A number of their clinics are spread throughout the region, and we collaborated with them to work on two innovative cancer prevention strategies in the rural area. Methods: Using a giant inflatable colon, we brought fecal occult blood test (FOBT) kits to 300 individuals who were over the age of 50 at regularly scheduled health fairs in the area. Individuals went through a brief educational tour of the colon, then received the kits, which were returned to us via mail or drop-off. A local hospital analyzed the kits and results were returned to participants. In a second study, women who were nonadherent with Pap testing were identified by the FQHC; after HIPAA consent, they were randomized to receive one of three intervention arms: a usual care arm, a video arm, or a promotora outreach arm. Adherence after seven months was assessed via medical records. Results: For the colon study, we received a return rate of 75.6%. Of these, seven were abnormal and those participants received free or low-cost colonoscopies. For the cervical cancer study, the rates of adherence after seven months were 34% (usual care), 38.7% (video arm), and 53.4% (promotora outreach). In both studies, knowledge and intention to be screened were significantly increased. Discussion: Rural areas suffer unique barriers to obtaining cancer prevention screening. Our approach of “meet the people where they are” has been positive in increasing screening rates. Whether it is participation at local community health fairs or collaboration with an FQHC, it is clear that “going to the people” is a method that works. More emphasis should be put on such methods in rural areas. Citation Format: Beti Thompson, Elizabeth Carosso, Kathy Briant, Genoveva Ibarra. Overcoming barriers to screening in rural areas: No bus, no taxi, no services [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 IA29.

Diabetes prevention in hispanics

Introduction Hispanics are at increased risk of developing type 2 diabetes. Lifestyle interventions are effective in preventing diabetes and restoring glucose regulation. Methods We recruited Hispanic men and women (N = 320) who were residents of the Lower Yakima Valley, Washington, aged 18 years or older with hemoglobin A1c (HbA1c) levels higher than 6% to a parallel 2-arm randomized-controlled trial conducted from 2008 through 2012. The trial compared participants in the intervention arm, who received an immediate educational curriculum (n = 166), to participants in the control arm, who received a delayed educational curriculum (n = 154). The home-based curriculum consisted of 5 sessions led by community health workers and was designed to inform participants about diabetes, diabetes treatment, and healthy dietary and physical activity behaviors. Participants were randomly assigned to the intervention and control arms, and analysts were blinded as to participant arm. We evaluated intervention effects on HbA1c levels; frequency (times per week) of fruit and vegetable consumption; and frequency (times per week) of mild, moderate, and strenuous leisure-time physical activity. At baseline, 3 months, and 6 months after randomization, participants completed a questionnaire and provided a blood sample. Analysts were blinded to intervention arm. Results The immediate intervention group (−0.64% [standard error (SE) 0.10]) showed a significant improvement in HbA1c scores (–37.5%, P = .04) compared with the delayed intervention group (–0.44%, P = .14). No significant changes were seen for dietary end points or changes in physical activity. We did observe a trend of greater increases in frequency of moderate and vigorous physical activity and a smaller increase in mild physical activity in the immediate intervention group than in the delayed intervention group. Conclusion This home-based intervention delivered by CHWs was associated with a clinically and statistically significant reduction in HbA1c levels in Hispanic adults with HbA1c levels higher than 6%.