Nerida Berrios

A Qualitative Evaluation of a Faith-Based Breast and Cervical Cancer Screening Intervention for African American Women

This article presents a formative evaluation of a CDC Racial and Ethnic Approaches to Community Health (REACH) 2010 faith-based breast and cervical cancer early detection and prevention intervention for African American women living in urban communities. Focus groups were conducted with a sample of women (N = 94) recruited from each church participating in the intervention. One focus group was conducted in each of the nine participating churches following completion of the 6-month REACH 2010 intervention. Transcribed data were coded to identify relevant themes. Key findings included (a) the acceptability of receiving cancer education within the context of a faith community, (b) the importance of pastoral input, (c) the effectiveness of personal testimonies and lay health advocates, (d) the saliency of biblical scripture in reinforcing health messages, (e) the effectiveness of multimodal learning aids, and (f) the relationship between cervical cancer and social stigma. Study findings have implications for enhancing faith-based breast and cervical cancer prevention efforts in African American communities.

Using Multilevel, Multisource Needs Assessment Data for Planning Community Interventions:

African Americans and Latinos share higher rates of cardiovascular disease (CVD) and diabetes compared with Whites. These diseases have common risk factors that are amenable to primary and secondary prevention. The goal of the Chicago REACH 2010–Lawndale Health Promotion Project is to eliminate disparities related to CVD and diabetes experienced by African Americans and Latinos in two contiguous Chicago neighborhoods using a community-based prevention approach. This article shares findings from the Phase 1 participatory planning process and discusses the implications these findings and lessons learned may have for programs aiming to reduce health disparities in multiethnic communities. The triangulation of data sources from the planning phase enriched interpretation and led to more creative and feasible suggestions for programmatic interventions across the four levels of the ecological framework. Multisource data yielded useful information for program planning and a better understanding of the cultural differences and similarities between African Americans and Latinos.

Patient Navigation Improves Subsequent Breast Cancer Screening After a Noncancerous Result: Evidence from the Patient Navigation in Medically Underserved Areas Study

BACKGROUND Past efforts to assess patient navigation on cancer screening utilization have focused on one-time uptake, which may not be sufficient in the long term. This is partially due to limited resources for in-person, longitudinal patient navigation. We examine the effectiveness of a low-intensity phone- and mail-based navigation on multiple screening episodes with a focus on screening uptake after receiving noncancerous results during a previous screening episode. METHODS The is a secondary analysis of patients who participated in a randomized controlled patient navigation trial in Chicago. Participants include women referred for a screening mammogram, aged 50-74 years, and with a history of benign/normal screening results. Navigation services focused on identification of barriers and intervention via shared decision-making processes. A multivariable logistic regression intent-to-treat model was used to examine differences in odds of obtaining a screening mammogram within 2 years of the initial mammogram (yes/no) between navigated and non-navigated women. Sensitivity analyses were conducted to explore patterns across subsets of participants (e.g., navigated women successfully contacted before the initial appointment; women receiving care at Hospital C). RESULTS The final sample included 2,536 women (741 navigated, 1,795 non-navigated). Navigated women exhibited greater odds of obtaining subsequent screenings relative to women in the standard care group in adjusted models and analyses including women who received navigation before the initial appointment. CONCLUSIONS Our findings suggest that low-intensity navigation services can improve follow-up screening among women who receive a noncancerous result. Further investigation is needed to confirm navigations impacts on longitudinal screening.

Abstract C78: The effect of navigation on mammography uptake among Latinas: Effect modification by facility and neighborhood characteristics

Purpose. Improving mammography among Latinas may improve ethnic disparities in stage at diagnosis, morbidity, and quality of life. In response, multiple interventions have been developed and assessed, including patient navigation. Little is known about how efficacy varies across socioenvironmental contexts. Such work is warranted for future comparative effectiveness research and clinical implementation. Objective. The study examined the interactive effects of patient navigation with contextual factors (facility and residential neighborhood characteristics) on mammography uptake among a Chicago-based sample of Latinas. Methods. The larger trial, “Patient Navigation in Medically Underserved Areas”, is a five year project to assess the effectiveness of primarily phone-based navigation services within 3 hospitals in South Chicago. The current study9s analytic sample includes 715 women who: 1) identified as Latina; 2) were referred for mammography; and 3) had age, insurance status, type of mammogram, and zipcode information documented in their medical records. We classified participants using an as-treated operationalization (navigated or not). The facility variable of interest was accreditation as a Breast Imaging Center of Excellence (BICOE; 1 yes and 2 no). The two neighborhood characteristics of interest were median household income and percent of Latino residents (%Latino) based on American Community Survey 2007-2011 data. The outcome of interest was days to mammography uptake, defined as days between randomization and attendance at the referred mammography appointment. Results. First, Cox regression survival models were conducted that adjusted for patient age, insurance status, and type of mammogram (screening or diagnostic) and incorporated main effects of facility and neighborhood characteristics. There were significant interaction effects of navigation with neighborhood %Latino (p The analysis next conducted models, wherein we stratified by tertiles for %Latino and by facility BICOE status (yes/no). For these models, it included covariates and the main effects of non-stratified contextual variables (e.g., neighborhood median income). Among residents of neighborhoods with the least %Latino, non-navigated women had a greater number of days to mammography uptake relative to navigated women, HR =2.8, 95%CI[1.6, 4.9], p Conclusions. The study suggests navigation may be particularly effective within more resourced facility settings and for Latinos living outside of ethnic enclaves. Future studies are warranted to confirm our findings and assess the potential of these services across diverse clinical settings. Citation Format: Yamile Molina, Yazmin San Miguel, Sage Kim, Anne Elizabeth Glassglow, Nerida Berrios, Julie S. Darnell, Elizabeth A. Calhoun. The effect of navigation on mammography uptake among Latinas: Effect modification by facility and neighborhood characteristics. [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 C78.

Abstract B76: Effects of navigation on initial and repeat mammography screening among medically underserved women

Purpose: Despite its increasing popularity to address breast cancer disparities, existing efforts to assess the effect of patient navigation on regular breast cancer screening utilization among medically underserved groups have been cross-sectional or ecological in nature. Such work is warranted to examine the longitudinal benefits of patient navigation, given one-time utilization of cancer screening is not sufficient strategy for improving early detection of breast cancer. Objective: Our study had two objectives. First, we test the effectiveness of navigation on adherence to initial recommended screening mammography appointments among a population of medically underserved, largely African American women. Second, for women with normal screening results, we test the effectiveness of navigation on attainment of subsequent screening mammograms. Methods: The larger trial, Patient Navigation in Medically Underserved Areas, is a five year project to assess the effectiveness of multimodal, primarily phone-based, navigation services to timely diagnostic resolution after an abnormal screening result within three hospitals located in South Chicago. The current study focuses on secondary outcomes concerning the effectiveness of navigation for mammography screening. Our analytic sample includes 4185 women referred for mammography screening with available medical record data concerning demographic (age, race, insurance, miles to clinic, neighborhood median income) and healthcare information (insurance, screening patterns). Participants were classified by their assignment from randomization, which was focused on the primary outcome (diagnostic follow-up), and whether they interacted with staff prior to the initial appointment: navigated with contact; control with contact; navigated without contact; and control without contact. Results: After adjusting for demographic and healthcare insurance, navigated with contact, women obtained the initial screening mammogram within fewer days relative to other groups, HR= 0.7, 95%CI [0.6, 0.9], p = .001 and greater odds of obtaining screening mammograms, OR = 1.6, 95%CI [1.3, 1.9], p Conclusions: Our study adds to a growing body of work demonstrating the usefulness of patient navigation, including the impact of delivering services outside of in-person interaction. Future studies are warranted to confirm our findings and assess the potential of these services in real life settings. Citation Format: Yamile Molina, Sage Kim, Anne L. Glassgow, Nerida M. Berrios, Julie Darnell, Heather Pauls, Ganga Vijayasiri, Richard Warnecke, Elizabeth A. Calhoun. Effects of navigation on initial and repeat mammography screening among medically underserved women. [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 B76.

Abstract IA38: Patient navigation in medically underserved areas

Purpose: The Chicago Patient Navigation in Medically Underserved Areas Study, a large scale randomized trial of patient navigation, involving women who made appointments at one of three Chicago-area medical centers for either screening or diagnostic mammograms/services. The principal outcome measure is the time required to come to diagnostic resolution for women whose initial mammograms results in BIRAD values of 0,3,4 or 5. Our goal was to evaluate the effectiveness of patient navigation but also to investigate the effect of living in an officially designated Medically Underserved Area (MUA). Background: MUAs are designated by the Health Research Services Administration (HRSA). Areas to be considered for designation are defined as rational service areas (RSA), which in urban areas are composed of contiguous census tracts. Four elements are considered (1) the ratio of primary medical care physicians per 1,000 population, (2) the infant mortality rate, (3) the percentage of the population with income below the poverty level, and (4) the percent of the population 65 years and older. Each of the four elements is scored separately and then summed; the resulting score can range from 0 to 100. Areas with an IMU below 62 qualify for designation. Consideration for MUA status must be requested by representatives from the population of the eligible areas. Thus, designation requires that a local community organization advocates for establishment of the MUA. As a result, in Chicago, many census tracts are eligible for MUA status but are not so designated. Methods: All women who had an initial referral from a physician for screening or for diagnostic mammography following a clinical breast exam were randomly assigned to either the control or navigation arm of the study. Randomization was balanced by age group. Women assigned to navigation were recruited if they had a working telephone and gave informed consent. Electronic medical record (EMR) data were made available by the cooperating medical centers for all women. All women in the navigation arm and a small subsample of women in the control arm also responded to a series of questionnaires collecting background data and tracking their progress through the breast care cycle. Each woman9s address was geocoded and the census tract was coded for MUA status: (1) not eligible, (2) old MUA designated before the year 2000, (3) new MUA designated in 2000 or after and (4) eligible but not designated. For this analysis, the primary outcome variable is the number of days ensuing between the date of the initial examination and the date on which a firm diagnosis of cancer or no cancer was obtained. The analysis sample consisted of all women with initial BIRAD values of 0, 3, 4 or 5. Women with BIRAD 3 are normally asked to return for re-examination in six months and in their case the number of days till resolution was adjusted to count the number of days following the suggested return date. Over the course of the study some women were observed over several exam cycles. This analysis focuses on the first cycle only. All analysis were conducted using the Cox proportional hazard model. Analyses were stratified by the initial BIRAD value. Results: After excluding a small number of women with missing clinical data, 5660 cases were available for analysis. Of these, 3567 cases were excluded because their initial BIRAD value was 1 or 2. For the remaining 2093 cases involving 223022 person-days at risk we obtained resolution dates for 1810 and the remainder were lost to follow up in that we did not observe a diagnostic resolution date. These cases were considered to be censored. The maximum number of days observed was 741. Variables in the Cox model were indicator variables for navigated versus control and screening versus diagnostic, a set of indicator variables for MUA status (reference group New MUA), a set of indicator variables for insurance status (private, Medicare, Medicaid or uninsured, reference group private) and marital status (single, married, divorced/separated and widowed, reference group single). Age was found to be unrelated to the rate of resolution and was not included in the final model. Women who were navigated obtained diagnostic resolution more quickly (HR 1.13; CI 1.02, 1.24; p .017) than women in the control arm. Women seen for diagnostic mammography had much faster resolution times (HR 1.88, CI 1.67, 2.09; p . Conclusion: Despite years of gains in cancer screening, diagnosis, and treatment, certain populations continue to disproportionally suffer with poor outcomes and higher mortality. Patient navigation is a strategy to improve the equity in outcomes across populations. The field of navigation is maturing and solidifying the evidence for the efficacy pf patient navigation. There needs to be more efforts aimed at understanding which populations benefit the most from navigation. In addition, determining what type of navigation models works best in certain settings and with certain populations is still ripe for study. This study provides evidence supporting navigation as an effective tool to help women reach diagnostic resolution. Additionally analyses will be conducted to examine more fully the impact on how living in an MUA, having a medical home, and being actively engaged in your health care has on the patients9 ability to navigate themselves more effectively and help provide evidence to help deploy navigation in a sustainable and cost efficient manner. Citation Format: Elizabeth A. Calhoun, Heather Pauls, Ganga Vijayasiri, Julie S. Darnell, Yamile Molina, Nerida Berrios, Richard Warnecke, Richard Campbell. Patient navigation in medically underserved areas. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA38.