Kimberly K. Engelman

Impact of Geographic Barriers on the Utilization of Mammograms by Older Rural Women

OBJECTIVES: To examine whether geographic proximity to mammography facilities influences mammogram utilization.

Colorectal cancer screening, perceived discrimination, and low-income and trust in doctors: a survey of minority patients

BackgroundCompletion of colorectal cancer (CRC) screening testing is lower among low-income and minority groups than the population as a whole. Given the multiple cancer screening health disparities known to exist within the U.S., this study investigated the relationship between perceived discrimination, trust in most doctors, and completion of Fecal Occult Blood Testing (FOBT) among a low-income, minority primary care population in an urban setting.MethodsWe recruited a convenience sample of adults over age 40 (n = 282) from a federally qualified community health center (70% African American). Participants completed a survey which included measures of trust in most doctors, perceived discrimination, demographics and report of cancer screening.ResultsParticipants reported high levels of trust in most doctors, regardless of sex, race, education or income. High trust was associated with low perceived discrimination (p < 0.01). The trend was for older participants to express more trust (p = 0.09) and less perceived discrimination (p < 0.01). Neither trust nor discrimination was associated with race or education. Trust was higher among participants over 50 who were up-to-date on FOBT screening vs. those who were not (31 vs. 29 (median), p < 0.05 by T-test). Among those over 50, up-to-date FOBT screening was nearly associated with high trust (p < 0.06; 95% CI 0.99, 1.28) and low perceived discrimination (p < 0.01; 95% CI 0.76, 0.96). Nevertheless, in multivariate-modeling, age and income explained FOBT completion better than race, trust and discrimination.ConclusionPerceived discrimination was related to income, but not race, suggesting that discrimination is not unique to minorities, but common to those in poverty. Since trust in most doctors trended toward being related to age, FOBT screening could be negatively influenced by low trust and perceived discrimination in health care settings. A failure to address these issues in middle-aged, low income individuals could exacerbate future disparities in CRC screening.

Effective Recruitment Strategies and Community-Based Participatory Research: Community Networks Program Centers' Recruitment in Cancer Prevention Studies

Background: Community-based participatory research (CBPR) approaches that involve community and academic partners in activities ranging from protocol design through dissemination of study findings can increase recruitment of medically underserved and underrepresented racial/ethnic minority populations into biomedical research. Methods: Five cancer screening and prevention trials in three National Cancer Institute (Bethesda, MD)–funded Community Networks Program Centers (CNPC), in Florida, Kansas, and South Carolina, were conducted across diverse populations. Data were collected on total time period of recruitment, ratios of participants enrolled over potential participants approached, selected CBPR strategies, capacity-building development, and systematic procedures for community stakeholder involvement. Results: Community-engaged approaches used included establishing colearning opportunities, participatory procedures for community–academic involvement, and community and clinical capacity building. A relatively large proportion of individuals identified for recruitment was actually approached (between 50% and 100%). The proportion of subjects who were eligible among all those approached ranged from 25% to more than 70% (in the community setting). Recruitment rates were very high (78%–100% of eligible individuals approached) and the proportion who refused or who were not interested among those approached was very low (5%–11%). Conclusions: Recruitment strategies used by the CNPCs were associated with low refusal and high enrollment ratios of potential subjects. Adherence to CBPR principles in the spectrum of research activities, from strategic planning to project implementation, has significant potential to increase involvement in biomedical research and improve our ability to make appropriate recommendations for cancer prevention and control programming in underrepresented diverse populations. Impact: CBPR strategies should be more widely implemented to enhance study recruitment. See all articles in this CEBP Focus section, “Community Network Program Centers.” Cancer Epidemiol Biomarkers Prev; 23(3); 416–23. ©2014 AACR.

Cancer Information Needs in Rural Areas

ABSTRACT Although cancer presents obstacles for all who experience it, persons in rural communities must negotiate additional challenges. This study determined the cancer information (CI) needs and the CI-seeking behavior and preferences among rural-dwelling persons. Patients (N = 801) ≥ 50 years of age seen in 36 rural Kansas primary care practices completed a Cancer Care Information Needs Survey (CCINS); physicians completed a cancer resource knowledge and preference survey. Of the 801 patients, 184 (23%) reported a CI need. Of these 184 patients, 45% reported either not discussing cancer or having insufficient discussion time with their physicians; 44% needed more information after consulting their physician. Patients more likely to report a CI need were young, female, Internet users, persons with a prior cancer diagnosis, and persons seeing male physicians or physicians in group/multispecialty practices. Patients and physicians were unfamiliar with services provided by national cancer organizations. Physicians are a primary CI source; however, patients who need CI report insufficient cancer discussion time with their physician and need more CI after consulting their physician. Promoting access to national CI sources could bridge the CI needs gap that exists in rural areas currently.

Restoring dressing independence in persons with Alzheimer's disease: A pilot study:

Purpose: Well meaning nursing facility staff may compromise the independence of older adults with dementia by performing activities of daily living for residents. We assessed the impact of teaching certified nursing assistants (CNAs) to use a graduated prompting procedure to increase dressing independence of persons with dementia. Design and methods: This study was conducted in a seven-bed dementia care unit. Three residents and two CNAs participated in the study. We used a repeatedmeasures experimental design to evaluate the effect of a training workshop for CNAs on a strategy for increasing resident engagement in self-care activities. Results: During a series of baseline observations, we found that CNAs typically dressed residents with minimal resident involvement. Results showed that, following the training workshop for CNAs, resident independence in dressing increased and range of motion improved. Implications: CNAs can provide restorative care that increases dressing independence and range of motion of older adults with dementia.

Direct observation of counseling on colorectal cancer in rural primary care practices

To better understand colorectal cancer (CRC) screening practices in primary care, medical students directly observed physician-patient encounters in 38 physician offices. CRC was discussed with 14% of patients ≥50 years of age; 87% of discussions were initiated by the physician. The rate of discussions varied among the practices from 0% to 41% of office visits. Discussions were more common for new patient visits, with younger patients, and in the 24% of offices that utilized flow sheets. The frequency of CRC discussions in physician offices varies widely. More widespread implementation of simple office systems, such as flow sheets, is needed to improve CRC screening rates.

Understanding the Role of Violence in Incarcerated Women's Cervical Cancer Screening and History

In this exploratory study the authors investigated characteristics, including reported experiences of violence, related to incarcerated womens self-report of cervical cancer screening and cancer history and treatment. During a four month period in 2010, 204 women in Kansas City jails were surveyed. Multiple logistic regression models were used to examine the relations of socio-demographic and community characteristics and history of violence among the women to their cervical cancer screening, diagnosis, and treatment histories. Forty percent of the women in the current sample reported abnormal Pap histories, though only 6% of all Pap smears done in the U.S. are abnormal. Women who reported abuse histories in this study were found to be more likely to report having ever had an abnormal Pap smear (for physical abuse Odds Ratio [OR] = 6.05; CI 2.36, 15.54 and for past year intimate partner violence OR = 2.41; CI 1.09, 5.31). Participants who did not fear neighborhood violence were less likely to report an abnormal Pap history (OR = 0.57; CI 0.34, 0.96) and more likely to visit a family doctor for their Pap screenings (OR = 1.91; CI 1.01, 3.60). Women who perceived greater neighborhood violence had increased odds of reporting that they received Pap screenings in a hospital setting (OR = 1.47; CI 1.08, 2.00). Frequency of Pap screening did not differ in women who did and did not have fear of neighborhood violence. This study highlights the heightened cervical cancer risk experienced by women with criminal justice histories and suggests that violence at several levels has implications for cervical cancer prevention for these women.

Fatalistic Cancer Beliefs and Information Sources Among Rural and Urban Adults in the USA

Fatalistic beliefs about cancer prevention can be a significant deterrent to one’s likelihood of engaging in cancer prevention behaviors. Lower education and less access to cancer information among rural residents may influence their level of cancer fatalism. The purpose of this study was to examine rural–urban differences in fatalistic beliefs about cancer prevention and cancer information sources using data from the 2007 Health Information National Trends Survey (n = 1,482 rural and 6,192 urban residents). Results showed that rural residents were more likely to endorse multiple fatalistic beliefs about cancer prevention than urban residents even after controlling for other significant demographic correlates. Urban residents were more likely to use the internet as their primary cancer information source, whereas rural residents were more likely to rely on print material and healthcare providers. Future educational work to communicate relevant and accurate cancer prevention information to rural residents should consider not only information access but also rural culture and fatalistic perspectives.

Finding a practical method to increase engagement of residents on a dementia care unit

Previous research has shown that it is possible to increase the engagement of residents with dementia in daily activities by making changes in institutional care practices. However, these changes often require expensive and cumbersome staff training programs that longterm care facilities may be unlikely to adopt and maintain. This study evaluates a simple, inexpensive recording and feedback procedure to increase resident engagement in a way that may be more amenable to adoption by long-term care facilities. Nursing assistants working in a locked dementia care unit were asked to complete a daily activity record on which they recorded the amount and quality of resident engagement. The facilitys activity director was asked to read these activity records each day and give immediate, positive feedback to the nursing assistants. This procedure was evaluated by using a control series design. Results revealed baseline engagement observations with a mean of 11 percent, which increased to a mean of 44 percent during observations under treatment conditions. This study suggests that simple, inexpensive changes in institutional practices can make meaningful improvements in the level of engagement of residents with dementia.

Perceptions of the Screening Mammography Experience by Hispanic and Non-Hispanic White Women

PURPOSE To uncover perceptive differences in mammography experiences (from scheduling the mammography appointment to receipt and reporting of mammography results) between women from two different racial/ethnic groups. METHODS Focus groups (n = 9) were conducted with Hispanic, and non-Hispanic White women (n = 88) who were aged 40 years or older and had a mammogram within the preceding 36 months. We used a qualitative ethnographic approach with content analysis to identify key categories present in the transcripts and domain analysis to discover domains of meaning. A matrix was designed to determine which domains differed by racial/ethnic group. The primary mammography-related topics of focus group discussion included 1) the scheduling process, 2) the day of the mammogram, 3) receipt of results, and 4) recommendations to improve the mammography process. MAIN FINDINGS Six domains uniquely described issues women of the differing racial/ethnic groups experience and perceive as important. Hispanic women highlighted embarrassment surrounding the examination and fear of negative news about their mammography results. Non-Hispanic White women focused on instructions given before or during the examination as a critical process feature. CONCLUSIONS Perceptions of the mammography experience vary by race/ethnicity. Mammography experiences might be improved through enhanced sensitivity of healthcare personnel to cultural differences in perceptions of mammogram testing. Future research to investigate the extent to which the domains of meanings uncovered in this study influence a womens decision to return for routine mammograms would be of great value.