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Molina Y, Tsai E, Enqubahry Y, Lee E, Siddiqi F, Gottesman A, Boylan E, Paz K, Wright ME, Abrol E, Lofton S, Kim SJ, Patel A. Equity in Cancer and Chronic Disease Prevention through a Multi-Pronged Network Intervention: Works-in-Progress. Int J Environ Res Public Health 2024; 21:213. [PMID: 38397702 PMCID: PMC10888495 DOI: 10.3390/ijerph21020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
The increasing rates of cancer incidence are disproportionately borne by populations that are ineligible for screening and historically marginalized populations. To address this need, our community-centered model seeks to catalyze the widespread diffusion of evidence-based information and resources (e.g., community-based organizations, federally qualified health centers) to reduce the risks of cancer, chronic disease, and other conditions. In this study, we tested whether improving personal health literacy (i.e., confidence in seeking information) and enabling successful information transfer (i.e., intention to share the specific information learned through the program) among community residents could contribute to greater diffusion intention (i.e., number of network members with whom residents plan to share information and resources). The current study used post-intervention surveys, which were administered to Chicago residents who were 18 years or older and had participated in the program. Among the 1499 diverse Chicago residents, improved personal health literacy was associated with greater diffusion intention (ORs = 2.00-2.68, 95% CI [1.27-4.39], p ≤ 0.003). Successful information transfer was associated with greater diffusion, especially for cancer and other chronic disease risk reductions (ORs = 3.43-3.73, 95% CI [1.95-6.68], p < 0.001). The findings highlight the potential gains for health equity through sustainable, scalable, multi-sectoral partnerships.
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Affiliation(s)
- Yamilé Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Edward Tsai
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (E.T.); (M.E.W.); (E.A.)
| | - Yalemzewod Enqubahry
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Eunhye Lee
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Faria Siddiqi
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Anna Gottesman
- School of Public Health, George Washington Milkin Institute, Washington, DC 20037, USA;
| | - Emma Boylan
- Chicago Department of Public Health, Chicago, IL 60612, USA; (E.B.); (K.P.); (A.P.)
| | - Kate Paz
- Chicago Department of Public Health, Chicago, IL 60612, USA; (E.B.); (K.P.); (A.P.)
| | - Margaret E. Wright
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (E.T.); (M.E.W.); (E.A.)
| | - Ekas Abrol
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (E.T.); (M.E.W.); (E.A.)
| | - Saria Lofton
- Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Sage J. Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Ajanta Patel
- Chicago Department of Public Health, Chicago, IL 60612, USA; (E.B.); (K.P.); (A.P.)
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Molina Y, Kao SY, Bergeron NQ, Strayhorn-Carter SM, Strahan DC, Asche C, Watson KS, Khanna AS, Hempstead B, Fitzpatrick V, Calhoun EA, McDougall J. The Integration of Value Assessment and Social Network Methods for Breast Health Navigation Among African Americans. Value Health 2023; 26:1494-1502. [PMID: 37301367 PMCID: PMC10530024 DOI: 10.1016/j.jval.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 05/10/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES A major strategy to reduce the impact of breast cancer (BC) among African Americans (AA) is patient navigation, defined here as individualized assistance for reducing barriers to healthcare use. The primary focus of this study was to estimate the added value of incorporating breast health promotion by navigated participants and the subsequent BC screenings that network members may obtain. METHODS In this study, we compared the cost-effectiveness of navigation across 2 scenarios. First, we examine the effect of navigation on AA participants (scenario 1). Second, we examine the effect of navigation on AA participants and their networks (scenario 2). We leverage data from multiple studies in South Chicago. Our primary outcome (BC screening) is intermediate, given limited available quantitative data on the long-term benefits of BC screening for AA populations. RESULTS When considering participant effects alone (scenario 1), the incremental cost-effectiveness ratio was $3845 per additional screening mammogram. When including participant and network effects (scenario 2), the incremental cost-effectiveness ratio was $1098 per additional screening mammogram. CONCLUSION Our findings suggest that inclusion of network effects can contribute to a more precise, comprehensive assessment of interventions for underserved communities.
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Affiliation(s)
- Yamilé Molina
- University of Illinois at Chicago, Chicago, IL, USA.
| | - Szu-Yu Kao
- University of Minnesota, Minneapolis, MN, USA
| | | | | | | | - Carl Asche
- University of Illinois at Chicago, Chicago, IL, USA; Huntsman Cancer Institute, Salt Lake City, UT, USA
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Gong AJ, Lee EE, Visvanathan K, Oluyemi ET. Impact of Patient Navigation on Reducing Breast Imaging Disparities and Applications in the COVID-19 Era. J Breast Imaging 2023; 5:346-350. [PMID: 38416882 DOI: 10.1093/jbi/wbac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 03/01/2024]
Abstract
The coronavirus (COVID-19) pandemic has impacted breast cancer screening with concerns that this may lead to increased overall breast cancer mortality and worsened racial and ethnic disparities in breast cancer survival. As pandemic recovery efforts are underway, we must be prepared to address barriers to timely access of breast imaging services, including those that existed prior to the pandemic, as well as any new barriers that may arise as a result of the pandemic. Patient navigation is an important tool that has been shown to address barriers to timely breast imaging access and help reduce disparities. Patient navigation programs can serve as a key part of the strategy to mitigate the impact of the COVID-19 pandemic on timely breast cancer diagnosis. These programs have been shown to be successful in promoting adherence to breast cancer screening guidelines as well as encouraging timely diagnostic follow-up, particularly in underserved communities. Further research is needed to explore the role of using a telehealth platform for patient navigation and evaluate the cost-effectiveness of patient navigator programs as well as more randomized controlled trials to further explore the impact of patient navigation programs.
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Affiliation(s)
- Anna J Gong
- Johns Hopkins University, Department of Radiology, Baltimore, MD, USA
| | - Emerson E Lee
- Johns Hopkins University, Department of Radiology, Baltimore, MD, USA
| | - Kala Visvanathan
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Eniola T Oluyemi
- Johns Hopkins University, Department of Radiology, Baltimore, MD, USA
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Alsbrook KE, Donovan HS, Wesmiller SW, Hagan Thomas T. Oncology Nurses' Role in Promoting Patient Self-Advocacy. Clin J Oncol Nurs 2022; 26:239-243. [PMID: 35604742 DOI: 10.1188/22.cjon.239-243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Teaching patients with cancer the skill of self-advocacy shifts the focus of their cancer care onto what is important to them, leading to optimized patient-centered care. As oncology nurses, providing support to patients as they self-advocate to get their needs met fosters a collaborative relationship, creating an environment in which patients feel comfortable verbalizing their needs and concerns.
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Henderson V, Strayhorn SM, Bergeron NQ, Strahan DC, Ganschow PS, Khanna AS, Watson K, Hoskins K, Molina Y. Healthcare Predictors of Information Dissemination About Genetic Risks. Cancer Control 2022; 29:10732748221104666. [PMID: 35658635 PMCID: PMC9174561 DOI: 10.1177/10732748221104666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives Despite the benefits of genetic counseling and testing (GCT), utilization is
particularly low among African American (AA) women who exhibit breast cancer
features that are common in BRCA-associated cancer. Underutilization is
especially problematic for AA women who are more likely to die from breast
cancer than women from any other race or ethnicity. Due to medical mistrust,
fear, and stigma that can be associated with genetic services among
racial/ethnic minorities, reliance on trusted social networks may be an
impactful strategy to increase dissemination of knowledge about hereditary
cancer risk. Informed by the social cognitive theory, the purpose of this
study is to determine: 1) which AA patients diagnosed with breast cancer and
with identified hereditary risk are sharing information about hereditary
risk with their networks; 2) the nature of the information dissemination;
and 3) if personal GCT experiences is associated with dissemination of
information about hereditary risk. Methods Among consented participants (n = 100) that completed an interview
administered using a 202-item questionnaire consisting of open- and
closed-ended questions, 62 patients were identified to be at higher risk for
breast cancer. Descriptive statistics, bivariable chi-square, Pearson’s
exact tests, and regression analyses were conducted to examine differences
in characteristics between high-risk participants who disseminated
hereditary risk information and participants who did not. Results Among high-risk participants, 25 (40%) indicated they had disseminated
information about hereditary risk to at least one member in their
family/friend network and 37 (60%) had not. Receipt of both provider
recommendations and receipt of GCT services was associated with greater odds
of disseminating information about hereditary risk with networks, OR = 4.53,
95%CI [1.33, 15.50], p = .02. Conclusion Interventions that increase self-efficacy gained through additional
personalized knowledge and experience gained through provider
recommendations and by undergoing GCT may facilitate information
dissemination among social/familial networks.
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Affiliation(s)
- Vida Henderson
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA, USA.,14681Community Health Sciences Division, University of Illinois Chicago, Chicago, IL, USA
| | - Shaila M Strayhorn
- 14621School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Nyahne Q Bergeron
- 14681Community Health Sciences Division, University of Illinois Chicago, Chicago, IL, USA
| | - Desmona C Strahan
- 14681Community Health Sciences Division, University of Illinois Chicago, Chicago, IL, USA
| | - Pamela S Ganschow
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA.,Cancer Center, University of Illinois Chicago, Chicago, IL, USA
| | - Aditya S Khanna
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Karriem Watson
- All of Us Program, National Institutes of Health, Bethesda, MD, USA
| | - Kent Hoskins
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA.,Cancer Center, University of Illinois Chicago, Chicago, IL, USA
| | - Yamile Molina
- 14681Community Health Sciences Division, University of Illinois Chicago, Chicago, IL, USA.,Cancer Center, University of Illinois Chicago, Chicago, IL, USA
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