Mondi Mason

A Structural Approach to Examining Prostate Cancer Risk for Rural Southern African American Men

Physical, cultural, and social factors influence health risk and behavior, but few have explored how the environmental context affects African American mens prostate cancer screening and treatment. This paper describes a structural analysis of data from eight focus groups of rural, southern African American men (n=66). A structural approach highlights the interrelationships between individuals, the health service system, and community factors that directly and indirectly affect screening and treatment for prostate cancer. The availability of accurate and timely health information and health services, social norms regarding health and professional help-seeking, and the sociopolitical context shaped mens screening and treatment behaviors. These proximal and distal health factors affected mens prostate cancer knowledge, perceived risk, willingness to seek care and trust in the health service system. The findings suggest that prostate cancer screening and treatment occurs in a larger structural context that has important implications for help-seeking and health promotion.

Salud es vida: development of a cervical cancer education curriculum for promotora outreach with Latina farmworkers in rural Southern Georgia.

We developed and evaluated a lay health worker curriculum intended to educate Hispanic farmworker women on cervical cancer, human papillomavirus (HPV), and the HPV vaccine. We pilot tested the curriculum in 2010 with 7 volunteer promotoras for readability, attractiveness, content, comprehension, cultural appropriateness, persuasion, structure and organization of lessons, balance between didactic and participatory activities, and ease of diffusion to community members. Peer-led cervical cancer prevention education is a practical option for low-income, Hispanic farmworker women in newer immigrant-receiving areas of the United States with fewer Spanish-speaking health professionals.

Refinement of an educational toolkit to promote cervical cancer screening among Hispanic immigrant women in rural southern Georgia.

Cervical cancer incidence and mortality continue to affect Hispanic women in the U.S. disproportionately. Our project sought to refine a cervical cancer intervention designed for use by community health workers, or promotoras, in rural southern Georgia. We collaborated with Hispanic promotoras to refine a Spanish language educational flipchart featuring cervical cancer topic areas for use in screening promotion.

Considering Organizational Factors in Addressing Health Care Disparities: Two Case Examples

Policy makers and practitioners have yet to successfully understand and eliminate persistent racial differences in health care quality. Interventions to address these racial health care disparities have largely focused on increasing cultural awareness and sensitivity, promoting culturally competent care, and increasing providers’ adherence to evidence-based guidelines. Although these strategies have improved some proximal factors associated with service provision, they have not had a strong impact on racial health care disparities. Interventions to date have had limited impact on racial differences in health care quality, in part, because they have not adequately considered or addressed organizational and institutional factors. In this article, we describe an emerging intervention strategy to reduce health care disparities called dismantling (undoing) racism and how it has been adapted to a rural public health department and an urban medical system. These examples illustrate the importance of adapting interventions to the organizational and institutional context and have important implications for practitioners and policy makers.

A community-based approach to translational research addressing breast cancer disparities

Disparities in breast cancer survival rates suggest that biological processes contribute. Translational research addressing health disparities would benefit from using a community-based participatory approach (CBPR) to examine biological processes commonly seen as the proximal causes of illness as well as behavioral and social-ecological “causes of the causes” within an integrated conceptual framework. This paper describes a CBPR study that explored perceptions regarding breast cancer relevant behaviors, and the application of the study’s results to develop translational research. Data from eight focus groups of African American (n = 29) and Caucasian women (n = 27) were analyzed, using the framework of the social-ecological model. Nutrition and physical activity were valued over screening and research participation. Treatment of illness was emphasized over prevention. Women’s perspectives are presented within a framework that facilitated the collaborative development of translational research to examine associations among biological, behavioral, and societal processes contributing to disparities.

Eliminating Inequities in Health Care: Understanding Perceptions and Participation in an Antiracism Initiative

Antiracism training for staff of health care institutions is a promising intervention strategy to address racial and ethnic disparities in health care. In 2001, Southern County Public Health Department (SCPHD) staff completed a mandatory Dismantling Racism (DR) training, and some continued with an optional DR process to challenge institutional racism within their agency. To explore factors influencing participation in optional DR activities (i.e., caucuses and Change Team), a process evaluation was conducted involving in-depth interviews with 28 SCPHD administrators and staff members, whose participation in the DR process varied. Findings demonstrate that familiarity with and receptiveness to the relationship between racism and health care inequities influenced participation in DR activities. Perceived relevance and impact of the DR process on the organization and staff were also major factors affecting participation. Improvements for implementing such efforts including the consideration of institutional power and other implications for addressing racial health care inequities through antiracism initiatives are discussed.

Training Child Care Inspectors to Deliver Health Messaging: A Quality Improvement Pilot Project

Early childhood obesity is at epidemic proportions. Early child care providers have a unique opportunity to instill healthy eating and active living behaviors in children that can foster lifelong health. Academic–community partnerships that involve collaborations between child care centers, local public health departments, and universities provide one avenue to strengthening healthy eating and active living–related knowledge and skills among early child care providers. This quality improvement pilot intervention, titled Healthy Child Care Makes a Healthy Start, is one example of this type of collaboration. This quality improvement pilot project consisted of two complementary intervention components. Inspectors were trained to cofacilitate a strategic planning process with university researchers to help providers implement healthy eating and active living–related policy, system, and environment changes in their child care homes and centers. An average of five changes were implemented in participating child care locations. Inspectors also received training on health-related best practices and delivered 1-minute health messages to child care providers during routine inspection visits. This type of innovative partnership has the potential to leverage a currently existing relationship between child care providers and licensing and regulation inspectors and shift the relationship to include dissemination and implementation of health messaging in child care center and home settings.

Abstract B27: Developing promotora curriculum modules for cervical cancer prevention and control

Aim: Cervical cancer is a disease characterized by health disparities in incidence and mortality, disproportionately affecting Hispanic women compared to whites. This research presents the initial findings of the second phase of a two-phase, multi-year study to gain a better understanding of knowledge, risk perceptions, and cultural attitudes among different Hispanic subethnicities in order to develop pilot curriculum modules on HPV and cervical cancer for promotora (lay health advisor) programs. The aim of phase 2 is to develop and evaluate pilot curriculum modules on cervical cancer and HPV using feedback from a group of promotoras in southern Georgia. The development of the pilot modules was designed and conceptualized by a multidisciplinary team with expertise in health literacy, health communication, and Spanish/English translation. The curriculum will be further modified after pilot testing and analysis of the evaluation findings. Methods: In partnership with a Hispanic-serving nonprofit agency in southern Georgia, the team developed pilot curriculum modules, guided by promotora curricula developed for Hispanic populations in Texas, as well as survey results from phase 1 with Mexican and Honduran farm worker women in Florida, and added the most recent information on cervical cancer, HPV, and the HPV vaccine. Six Spanish-speaking promotoras have been recruited to pilot test curriculum modules to ensure comprehensibility, and cultural and literacy-level appropriateness. The curriculum will be evaluated both quantitatively through a pretest/posttest instrument and qualitatively through a post-training focus group and written evaluations. Results: Survey results from phase 1 found that Mexican and Honduran farm worker women were less likely to have heard of HPV or the HPV vaccine than Puerto Rican or Anglo American women recruited from similar low-income clinic settings. Based on this finding, when designing the curriculum for Mexican farm worker women in Georgia, a separate module was developed on HPV and the HPV vaccine. The curriculum is divided into two lessons of three hours instruction each. The curriculum is delivered by a female, native Spanish speaker trained in pedagogical techniques. The first lesson covers cervical cancer screening, and the second lesson covers HPV and the HPV vaccine. Each lesson contain five topics, with accompanying slide presentations, vocabulary cards, problem cards for discussion, and list of local and national resources to facilitate access to cervical cancer screening. The curriculum modules are designed with a Popular Education framework and coded throughout with cues for listening, dialogue, and action. Each lesson begins with icebreakers and includes interactive exercises to facilitate co-learning. The curriculum is also coded by constructs from Social Cognitive Theory, with activities and lessons linked to the appropriate construct. Conclusion: Future cervical cancer educational interventions should address distinct cultural belief factors about cervical cancer in order to target materials to Hispanic farm worker women. This project is distinguished for its focus on community collaboration with the goal of building sustainable outreach programs to reduce barriers to cervical cancer screening, while addressing both culture and literacy in the development of educational materials to reduce cancer disparities. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B27.