Javiera Martinez-Gutierrez

Cancer Screening at a Federally Qualified Health Center: A Qualitative Study on Organizational Challenges in the Era of the Patient-Centered Medical Home

Federally Qualified Health Centers (FQHCs) serve uninsured and minority populations, who have low cancer screening rates. The patient-centered medical home (PCMH) model aims to provide comprehensive preventive services, including cancer screening, to these populations. Little is known about organizational factors influencing the delivery of cancer screening in this context. We conducted 18 semi-structured interviews with clinic personnel at four FQHC clinics in Washington State. All interviews were recorded and transcribed verbatim and analyzed by two bilingual coders to identify salient themes. We found that screening on-site, scheduling separate visits for preventive care, and having non-provider staff recommend and schedule screening services facilitated the delivery of cancer screening. We found work overload to be a barrier to screening. To successfully implement screening strategies within the PCMH model, FQHCs must enhance facilitators and address organizational gaps in their cancer screening processes.

Plans to obtain a mammogram among Chilean women: the roles of recommendations and self-efficacy

Social factors may heavily influence cancer screening decisions and practices among Latinas, given the importance their culture places on close, interpersonal relationships. Recommendations by healthcare providers, family and friends have been associated with early detection strategies among US-based Latina populations, but little is known about other Latin American populations. Furthermore, less is known about mechanisms underlying this relationship. In this study, we sought to (i) understand if different types of recommendations were associated with subsequent plans to obtain a mammogram and (ii) assess the potential mediating roles of perceived importance of these recommendations and self-efficacy. Our sample included 250 women residing in a low-income, urban area of Santiago, Chile, and who had participated in a 6-month intervention to increase mammography screening, but remained non-compliant. Women who received family recommendations were more likely to indicate they planned to receive a mammogram in the next 6 months. Perceived self-efficacy mediated this relationship, such that women who received a family recommendation appeared to be more likely to plan to get a mammogram because of increased perceived capabilities to do so. Future research should consider the cultural context of family and self-efficacy in the development of screening interventions for Latinas.

Perceived and Objective Breast Cancer Risk Assessment in Chilean Women Living in an Underserved Area

Background: Breast cancer is the most frequently diagnosed malignancy among Chilean women and an increasingly significant public health threat. This study assessed the accuracy of breast cancer risk perception among underserved, Chilean women. Methods: Women aged 50 to 70 years, with no mammogram during the last 2 years, were randomly selected from a community clinic registry in Santiago, Chile (n = 500). Perceived risk was measured using three methods: absolute risk, comparative risk, and numerical risk. Risk comprehension was measured by comparing womens perceived and objective risk estimates. Multivariate logistic regression was used to assess overestimation of perceived risk. Results: Women at high risk of breast cancer were more likely than average risk women to perceive themselves at high or higher risk, using absolute and comparative risk approaches (P < 0.001). The majority of participants (67%) overestimated their breast cancer risk, on the basis of risk comprehension; although, participants achieved higher accuracy with comparative risk (40%) and absolute risk (31.6%) methods. [Age, breast cancer knowledge and Breast Cancer Risk Assessment Tool (BCRAT) 5-year risk were significantly associated (P < 0.01) with accuracy of perceived risk]. Conclusion: Chilean women residing in an underserved community may not accurately assess their breast cancer risk, although risk perception and level of accuracy differed between perceived risk measures. Comparative and absolute risk methods may better reflect womens interpretation and accuracy of risk perception. Impact: Improving our understanding of Chilean womens perceptions of developing breast cancer may lead to the development of culturally relevant efforts to reduce the breast cancer burden in this population. Cancer Epidemiol Biomarkers Prev; 21(10); 1716–21. ©2012 AACR.

Diplomado de salud y humanización: el valor de la reflexión y el aprendizaje presencial

BACKGROUND In a rapidly changing culture like ours, with emphasis on productivity, there is a strong need to find the meaning of health care work using learning instances that privilege reflection and face to face contact with others. The Diploma in Health and Humanization (DSH), was developed as an interdisciplinary space for training on issues related to humanization. AIM To analyze the experience of DSH aiming to identify the elements that students considered key factors for the success of the program. MATERIAL AND METHODS We conducted a focus group with DSH graduates, identifying factors associated with satisfaction. Transcripts were coded and analyzed by two independent reviewers. RESULTS DSH graduates valued a safe space, personal interaction, dialogue and respect as learning tools of the DSH. They also appreciates the opportunity to have emotional interactions among students and between them and the teacher as well as the opportunity to share personal stories and their own search for meaning. DISCUSSION DSH is a learning experience in which their graduates value the ability to think about their vocation and the affective interaction with peers and teachers. We hope to contribute to the development of face to face courses in the area of humanization. Face to face methodology is an excellent teaching technique for contents related to the meaning of work, and more specifically, to a group of learners that require affective communication and a personal connection of their work with their own values and beliefs.Background: In a rapidly changing culture like ours, with emphasis on productivity, there is a strong need to find the meaning of health care work using learning instances that privilege reflection and face to face contact with others. The Diploma in Health and Humanization (DSH), was developed as an interdisciplinary space for training on issues related to humanization. Aim: To analyze the experience of DSH aiming to identify the elements that students considered key factors for the success of the program. Material and Methods: We conducted a focus group with DSH graduates, identifying factors associated with satisfaction. Transcripts were coded and analyzed by two independent reviewers. Results: DSH graduates valued a safe space, personal interaction, dialogue and respect as learning tools of the DSH. They also appreciates the opportunity to have emotional interactions among students and between them and the teacher as well as the opportunity to share personal stories and their own search for meaning. Discussion: DSH is a learning experience in which their graduates value the ability to think about their vocation and the affective interaction with peers and teachers. We hope to contribute to the development of face to face courses in the area of humanization. Face to face methodology is an excellent teaching technique for contents related to the meaning of work, and more specifically, to a group of learners that require affective communication and a personal connection of their work with their own values and beliefs.

Examining Barriers for Mammography Screening Compliance Within a Private Hospital and an Underserved Primary Care Clinic in Santiago, Chile

INTRODUCTION Breast cancer is the most commonly diagnosed cancer and the leading cause of death in Latin American women [1]. Although differences in incidence exist, mortality rates remain proportionally higher (approximately 10%) in Latin America compared with the mortality rates in United States and Canada. Late stage detection in these countries is believed to be a major contributing factor to decreased survival [2]. Globally, increasing adherence to screening mammography guidelines has led to a significant improvement in early detection. Mammography screening compliance rates throughout Latin America are estimated around 8% to 34% [3]. Alternatively, compliance is estimated at an average of 66% in the United States, though it varies from 38% to 75%, dependent on various cultural and socioeconomic factors [4]. Many lowand middle-income Latin American countries struggle to implement screening programs because of limited resources. In many cases, mammographic exams remain opportunistic rather than compulsory. For example, the

Its Still Personal: Preferences of Underserved Chilean Women on a Mobile Technology Intervention for Cervical Cancer Screening. (Preprint)

Background In Chile and Latin America, cervical cancer disproportionately affects women of low socioeconomic status. Mobile technology (mobile health, mHealth) may be able to address this disparity by targeting women in underserved populations. However, there is a lack of information regarding barriers to the implementation of mHealth interventions in underserved populations. Objective The objective of this study was to investigate the use of cell phones and text messaging (short message service, SMS) in Latina women from disadvantaged communities to design an mHealth intervention for improving cervical cancer screening rates. Methods We conducted 9 focus groups among women aged 25-64 years to better understand the implementation barriers and perceptions of a text message (SMS)–based intervention designed to improve cervical cancer screening rates. We used the PRECEDE-PROCEED model to categorize identified themes using template analysis. Results Focus group results indicated that older women use mobile phones to receive calls from family and friends but seldom send text messages. Furthermore, they prefer personal contact with their health care providers regarding Papanicolaou (Pap) testing. Younger women, on the other hand, find text messaging easy to use and frequently send texts to family and friends. Importantly, women of all ages mentioned they would like to receive text messages about Pap tests. Factors that facilitate the uptake of the intervention include ease of access to Pap testing, inclusion of family members, and reminder messaging. Potential barriers include cost and the impersonal nature of messaging. Health team members support an mHealth intervention even though they acknowledge the potential barriers to this strategy. Overall, these results support the implementation of an mHealth intervention to increase cervical cancer screening rates. Conclusions This study describes the opinions of women nonadherent to Pap testing on the potential use of mobile technologies for cervical cancer screening. Although the overall acceptance was positive, older women prefer personal contact and phone calls over text messaging. Information surrounding these preferences will aid in the implementation of effective strategies to improve cancer screening in underserved populations.

Abstract B77: “Messages for your health”: Mobile use and cancer prevention for underserved Latinas in Santiago, Chile

Background: Mobile technology uptake has increased exponentially in the past years; in 2009, mobile telephones could be found in more than 90% of Chilean homes and are widely distributed across all socioeconomic levels. Because of this technological explosion, mobile health (mHealth), or medical and public health practice supported by mobile devices, has gained potential in many health areas such as cancer prevention. Chile has a very well organized Cervical Cancer Prevention Program, with universal coverage, and a centralized registry. Despite all efforts, more than 500 Chilean women die of cervical cancer each year and Papanicolau (Pap) adherence is lower than 60%. Like many other cancers sites, cervical cancer affects the most vulnerable and under-served women. An intervention based on mobile health might be able to narrow this gap by increasing cervical cancer screening in vulnerable Latinas. The aim of this study is to assess mobile use and barriers, facilitators and acceptability to an intervention based on text messaging to increase cervical cancer-screening rates in three health care centers of Santiago Chile. Methods: We held 9 focus groups at 3 under-served health care centers in Santiago Chile; 6 focus groups among 27 women between 25-64 years old and 3 among 11 midwifes working at the health care centers. Focus groups were conducted in Spanish, recorded, and transcribed verbatim. Our research team analyzed and coded the data grouping findings into relevant themes. Results: Regarding mobile use, older women (44 to 65 years) in our study used their phones mainly to keep in touch and receive news from family and friends. Most women did not call or send messages for two main reasons: a. Most women owned prepaid phones and did not have the money to be able perform such tasks. b. Some women did not know how to check or answer a text message. Younger women (25 to 44 years) were more prone to use cell phones for different tasks such as navigating the Internet, using chat apps and making calls through Wi-Fi if they did not have the money to pay for their calls. Acceptability: Most women mentioned liking the idea of receiving messages regarding their health. They mentioned they would have to be written in simple language and the content be general enough to respect confidentiality. They would like the messages to have information regarding cervical cancer and days and hours for them to be able to get the Pap at their health care centers. They would also like to receive reminders of their scheduled Pap appointments. Older women mentioned they preferred to get phone calls from their provider or even automated calls rather than text messages. Providers were also very prone to the idea of a text message intervention since it would increase cervical cancer screening rates and would make their jobs easier. Facilitators to the implementation of a strategy based on text messages were easy access to the technology and better communication with the health care team. Potentials barriers were: Switching cell phone number rather frequently. They find it easier to buy prepaid cell phones each time rather than keep their number and get a cell phone plan. Also, male providers and the need to schedule an appointment for their Pap rather than getting it instantly whenever they arrive at the health care center were mentioned as organizational barriers. Conclusions: Cell phone use is widely spread in the Chilean population. An intervention based on text messaging might help increase cervical cancer-screening rates in Santiago, Chile. Women and providers were prone to accept an intervention using mHealth. Facilitators and barriers described such as availability of cell phones, difficulty to operate messages and use of prepaid phones need to be considered when planning an mHealth intervention for cancer prevention. Citation Format: Javiera Martinez-Gutierrez, Mauricio Soto, McKenzie Momany, Francis Ciampi, Daniel Capurro, Emilia Cea, Klaus Puschel. “Messages for your health”: Mobile use and cancer prevention for underserved Latinas in Santiago, Chile. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B77.

Cancer Screening at a Federally Qualified Health Center: A qualitative study on organizational challenges in the era of health care reform

Federally Qualified Health Centers (FQHCs) serve uninsured and minority populations, who have low cancer screening rates. The patient-centered medical home (PCMH) model aims to provide comprehensive preventive services, including cancer screening, to these populations. Little is known about organizational factors influencing the delivery of cancer screening in this context. We conducted 18 semi-structured interviews with clinic personnel at four FQHC clinics in Washington State. All interviews were recorded and transcribed verbatim and analyzed by two bilingual coders to identify salient themes. We found that screening on-site, scheduling separate visits for preventive care, and having non-provider staff recommend and schedule screening services facilitated the delivery of cancer screening. We found work overload to be a barrier to screening. To successfully implement screening strategies within the PCMH model, FQHCs must enhance facilitators and address organizational gaps in their cancer screening processes.

Cancer screening at a federally qualified health center

Federally Qualified Health Centers (FQHCs) serve uninsured and minority populations, who have low cancer screening rates. The patient-centered medical home (PCMH) model aims to provide comprehensive preventive services, including cancer screening, to these populations. Little is known about organizational factors influencing the delivery of cancer screening in this context. We conducted 18 semi-structured interviews with clinic personnel at four FQHC clinics in Washington State. All interviews were recorded and transcribed verbatim and analyzed by two bilingual coders to identify salient themes. We found that screening on-site, scheduling separate visits for preventive care, and having non-provider staff recommend and schedule screening services facilitated the delivery of cancer screening. We found work overload to be a barrier to screening. To successfully implement screening strategies within the PCMH model, FQHCs must enhance facilitators and address organizational gaps in their cancer screening processes.