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Melkonian SC, Chen L, Jim MA, Haverkamp D, King JB. Disparities in incidence and trends of colorectal, lung, female breast, and cervical cancers among non-Hispanic American Indian and Alaska Native people, 1999-2018. Cancer Causes Control 2023; 34:657-670. [PMID: 37126144 PMCID: PMC10951714 DOI: 10.1007/s10552-023-01705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE This study is the first to comprehensively describe incidence rates and trends of screening-amenable cancers (colorectal, lung, female breast, and cervical) among non-Hispanic AI/AN (NH-AI/AN) people. METHODS Using the United States Cancer Statistics AI/AN Incidence Analytic Database, we, calculated incidence rates for colorectal, lung, female breast, and cervical cancers for NH-AI/AN and non-Hispanic White (NHW) people for the years 2014-2018 combined. We calculated age-adjusted incidence rates (per 100,000), total percent change in incidence rates between 1999 and 2018, and trends over this time-period using Joinpoint analysis. Screening prevalence by region was calculated using Behavioral Risk Factor Surveillance System data. RESULTS Rates of screening-amenable cancers among NH-AI/AN people varied by geographic region and age at diagnosis. Over half of all lung and colorectal cancers in NH-AI/AN people were diagnosed at later stages. Rates of lung and colorectal cancers decreased significantly between 1999-2018 among NH-AI/AN men, but no significant changes were observed in rates of screening-amenable cancers among NH-AI/AN women. CONCLUSION This study highlights disparities in screening-amenable cancers between NH-AI/AN and NHW people. Culturally informed, community-based interventions that increase access to preventive health services could reduce cancer disparities among AI/AN people.
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Affiliation(s)
- Stephanie C Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 500 Gold Ave SW, 9th Floor, Suite 9222, Albuquerque, New Mexico 87102, USA.
| | | | - Melissa A Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 500 Gold Ave SW, 9th Floor, Suite 9222, Albuquerque, New Mexico 87102, USA
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 500 Gold Ave SW, 9th Floor, Suite 9222, Albuquerque, New Mexico 87102, USA
| | - Jessica B King
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Roh S, Lee YS, Kenyon DB, Elliott AJ, Petereit DG, Gaba A, Lee HY. Mobile Web App Intervention to Promote Breast Cancer Screening Among American Indian Women in the Northern Plains: Feasibility and Efficacy Study. JMIR Form Res 2023; 7:e47851. [PMID: 37471115 PMCID: PMC10401399 DOI: 10.2196/47851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. OBJECTIVE This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. METHODS Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants' satisfaction with and acceptance of the intervention. RESULTS A significantly higher proportion of women who received the wMammogram intervention (26/62, 42%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=-5.22; P<.001), increase in knowledge (t120=-4.75; P<.001), and satisfaction with the intervention (t120=-3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100% vs 51/60, 85%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4% vs 54/60, 90%) with statistically significant differences. CONCLUSIONS This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. TRIAL REGISTRATION ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603.
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Affiliation(s)
- Soonhee Roh
- Department of Social Work, University of South Dakota, Sioux Falls, SD, United States
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, CA, United States
| | - DenYelle B Kenyon
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States
| | - Amy J Elliott
- Avera Research Institute, Avera Health, Sioux Falls, SD, United States
| | - Daniel G Petereit
- Monument Health Cancer Care Institute, Rapid City, SD, United States
| | - Anu Gaba
- Sanford Roger Maris Cancer Center, University of North Dakota, Fargo, ND, United States
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, AL, United States
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Chando S, Howell M, Young C, Craig JC, Eades SJ, Dickson M, Howard K. Outcomes reported in evaluations of programs designed to improve health in Indigenous people. Health Serv Res 2021; 56:1114-1125. [PMID: 33748978 PMCID: PMC8586489 DOI: 10.1111/1475-6773.13653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the outcomes reported and measured in evaluations of complex health interventions in Indigenous communities. DATA SOURCES We searched all publications indexed in MEDLINE, PreMEDLINE, EMBASE, PsycINFO, EconLit, and CINAHL until January 2020 and reference lists from included papers were hand-searched for additional articles. STUDY DESIGN Systematic review. DATA COLLECTION/EXTRACTION METHODS We included all primary studies, published in peer-reviewed journals, where the main objective was to evaluate a complex health intervention developed specifically for an Indigenous community residing in a high-income country. Only studies published in English were included. Quantitative and qualitative data were extracted and summarized. PRINCIPAL FINDINGS Of the 3523 publications retrieved, 62 evaluation studies were included from Australia, the United States, Canada, and New Zealand. Most studies involved less than 100 participants and were mainly adults. We identified outcomes across 13 domains: clinical, behavioral, process-related, economic, quality of life, knowledge/awareness, social, empowerment, access, environmental, attitude, trust, and community. Evaluations using quantitative methods primarily measured outcomes from the clinical and behavioral domains, while the outcomes reported in the qualitative studies were mostly from the process-related and empowerment domains. CONCLUSION The outcomes from qualitative evaluations, which better reflect the impact of the intervention on participant health, remain different from the outcomes routinely measured in quantitative evaluations. Measuring the outcomes from qualitative evaluations alongside outcomes from quantitative evaluations could result in more relevant evaluations to inform decision making in Indigenous health.
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Affiliation(s)
- Shingisai Chando
- University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Martin Howell
- University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | | | - Jonathan C. Craig
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
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Patel SH, Ebrahimi S, Northfelt DW, Mathews TE, Omar FM, Martinez ED, DeWees TA, Okamoto JM. Understanding American Indian Perceptions Toward Radiation Therapy. Cancer Control 2020; 27:1073274820945991. [PMID: 32735143 PMCID: PMC7658722 DOI: 10.1177/1073274820945991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022] Open
Abstract
Many American Indian (AI) and Alaska native (AN) patients do not complete guideline-concordant cancer care for the 4 most common cancers. Our aim was to better understand AI/AN attitudes toward radiation therapy (RT). Patients eligible for this survey study were AI/AN patients with cancer at the Phoenix Indian Medical Center who either received previous RT or were recommended to receive RT. An 18-item questionnaire was administered to each of the 50 participants from October 1, 2018, through February 15, 2019. Willingness to travel for RT was compared to respondent characteristics, concerns regarding RT, and obstacles to obtain RT. Duration of RT was important to 78% of patients: 24% would consider traveling 25 miles or more for a standard course, and 48% would travel that distance for a shorter course (P < .001). The top-ranked barriers to RT were transportation, cost of treatment, and insurance compatibility. The top-ranked concerns about RT were adverse effects, cost of treatment, and fear of RT. Concerns about adverse effects were associated with the radiation team's inability to explain the treatment (P = .05). Transportation concerns were significantly associated with accessibility (P = .02), communication with the RT team (P = .02), and fear of RT (P = .04). AI/AN patients are concerned about the adverse effects of RT and the logistics of treatment, particularly costs, transportation, and insurance compatibility. Use of culturally specific education and hypofractionation regimens may increase acceptance of RT for AI/AN patients with cancer, and this hypothesis will be tested in a future educational intervention-based study.
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Affiliation(s)
- Samir H. Patel
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Sasha Ebrahimi
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Donald W. Northfelt
- Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Timothy E. Mathews
- Oncology Center of Excellence, Phoenix Indian Medical Center, Phoenix, AZ, USA
| | - Farhia M. Omar
- Office of Health Disparities Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Erika D. Martinez
- Office of Health Disparities Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Todd A. DeWees
- Health Services Research, Mayo Clinic Scottsdale, AZ, USA
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Hiratsuka VY, Avey JP, Beans JA, Dirks LG, Caindec K, Dillard DA. Approach and Methods of the 2016 Alaska Native Research Forum. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2018; 25:19-29. [PMID: 29671855 PMCID: PMC6392196 DOI: 10.5820/aian.2501.2018.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Southcentral Foundation, a tribal health organization serving Alaska Native and American Indian (AN/AI) people in southcentral Alaska, convened the Alaska Native Health Research Forum (Forum) for AN/AI people in May 2016. The purpose of the Forum was to obtain AN/AI community member feedback about sharing health research results. This article describes the funding mechanism that provided resources for the Forum and other factors that were considered when designing the Forum. This is followed by a description of how attendees were invited, the audience response system, and process used to collect quantitative data on participants and qualitative feedback from small group discussions with Forum attendees. Finally, we describe the quantitative and qualitative data analysis processes used to evaluate responses.
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Hiratsuka VY, Avey JP, Beans JA, Dirks LG, Caindec K, Dillard DA. Approach and Methods of the 2016 Alaska Native Research Forum. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2018. [PMID: 29671855 DOI: 10.5820/aian.2501.2018.19018.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Southcentral Foundation, a tribal health organization serving Alaska Native and American Indian (AN/AI) people in southcentral Alaska, convened the Alaska Native Health Research Forum (Forum) for AN/AI people in May 2016. The purpose of the Forum was to obtain AN/AI community member feedback about sharing health research results. This article describes the funding mechanism that provided resources for the Forum and other factors that were considered when designing the Forum. This is followed by a description of how attendees were invited, the audience response system, and process used to collect quantitative data on participants and qualitative feedback from small group discussions with Forum attendees. Finally, we describe the quantitative and qualitative data analysis processes used to evaluate responses.
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McBride K, Gesink D. Increasing Cancer Screening Among Old Order Anabaptist Women Through Specialized Women's Health and Integrated Cancer Screening Interventions. J Immigr Minor Health 2017; 20:465-478. [PMID: 28239755 DOI: 10.1007/s10903-017-0551-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our objective was to develop, deliver, and evaluate a cancer screening intervention focused on rural Anabaptist communities in Ontario, Canada, to increase routine cancer screenings among women. We carried out three cancer prevention and screening interventions with Old Order Anabaptist women. Each intervention consisted of: transportation to the site, pre-arranged screening services, health teachings, fellowship and shopping, and an evaluative survey. Seventy five women total participated over three interventions. 85% of participants were under or never screened for cancer. This was the first breast screen for 26% of those who completed a mammogram and the first colon screen for 29% of the women who took home an FOBT collection kit. Reviews of the intervention were positive. Integration and community based planning were the primary reasons for the success of this cancer screening intervention. Intervention days were best timed in the early spring before planting or late fall after canning.
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Affiliation(s)
- Kate McBride
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.
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Martin DN, Lam TK, Brignole K, Ashing KT, Blot WJ, Burhansstipanov L, Chen JT, Dignan M, Gomez SL, Martinez ME, Matthews A, Palmer JR, Perez-Stable EJ, Schootman M, Vilchis H, Vu A, Srinivasan S. Recommendations for Cancer Epidemiologic Research in Understudied Populations and Implications for Future Needs. Cancer Epidemiol Biomarkers Prev 2017; 25:573-80. [PMID: 27196089 DOI: 10.1158/1055-9965.epi-15-1297] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/10/2016] [Indexed: 11/16/2022] Open
Abstract
Medically underserved populations in the United States continue to experience higher cancer burdens of incidence, mortality, and other cancer-related outcomes. It is imperative to understand how health inequities experienced by diverse population groups may contribute to our increasing unequal cancer burdens and disparate outcomes. The National Cancer Institute convened a diverse group of scientists to discuss research challenges and opportunities for cancer epidemiology in medically underserved and understudied populations. This report summarizes salient issues and discusses five recommendations from the group, including the next steps required to better examine and address cancer burden in the United States among our rapidly increasing diverse and understudied populations. Cancer Epidemiol Biomarkers Prev; 25(4); 573-80. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".
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Affiliation(s)
- Damali N Martin
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland.
| | - Tram Kim Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Katy Brignole
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Kimlin T Ashing
- Center for Community Alliance for Research and Education, City of Hope Cancer Center, Duarte, California
| | - William J Blot
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee. International Epidemiology Institute, Rockville, Maryland
| | - Linda Burhansstipanov
- Native American Cancer Research Corporation, Denver, Colorado. Native American Cancer Initiatives, Incorporated, Colorado
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark Dignan
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Alicia Matthews
- School of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Eliseo J Perez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Mario Schootman
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Hugo Vilchis
- Burrell College of Osteopathic Medicine/Burrell Institute for Health Policy & Research, Las Cruces, New Mexico
| | - Alexander Vu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
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Culture: The missing link in health research. Soc Sci Med 2016; 170:237-246. [DOI: 10.1016/j.socscimed.2016.07.015] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/14/2016] [Accepted: 07/17/2016] [Indexed: 12/21/2022]
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Lin Y, Gong X, Mousseau R. Barriers of Female Breast, Colorectal, and Cervical Cancer Screening Among American Indians-Where to Intervene? AIMS Public Health 2016; 3:891-906. [PMID: 29546202 PMCID: PMC5690412 DOI: 10.3934/publichealth.2016.4.891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022] Open
Abstract
Female breast, colorectal, and cervical cancer are three common cancers among people in the United States. Both their incidence and mortality rates can be dramatically reduced if effective prevention and intervention programs are developed and implemented, because these cancers are preventable through regular screenings. American Indians in the United States especially in the Northern Plains have a disproportionally high burden of these cancers. As a hard-to-reach population group, less attention has been paid to American Indians regarding cancer screening compared with other population groups. This study examined barriers experienced by American Indians residing in South Dakota regarding three cancer sites: female breast, colorectal, and cervical cancer through a community-based survey. A total of 199 participants were recruited and factors significantly associated with cancer screening included knowledge about cancer screening, geographic access to PCPs, encouragement by doctors, as well as socioeconomic barriers. Meanwhile, integrating geographic access, socioeconomic deprivation, and geographic distribution of American Indians, the study identified geographic areas of low access to cancer screening where hard-to-reach populations resided. Results from the study will provide crucial information for the development of targeted intervention programs to increase the acceptability and uptake of cancer screening among American Indians.
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Affiliation(s)
- Yan Lin
- Department of Geography & Environmental Studies, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Xi Gong
- Department of Geography & Environmental Studies, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Richard Mousseau
- Community Health Department, The Great Plains Tribal Chairmen's Health Board, Rapid City, South Dakota 57702, USA
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Zehbe I, Wakewich P, Wood B, Sameshima P, Banning Y, Little J. Engaging Canadian First Nations Women in Cervical Screening through Education. INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 2016; 54:255-264. [PMID: 29321717 PMCID: PMC5758335 DOI: 10.1080/14635240.2016.1169942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recognition of the need to decrease cervical cancer rates in Indigenous populations has been ongoing-yet few successful interventions have been reported. In addition, literature addressing the challenges and barriers associated with designing screening programs aimed to specifically reach Indigenous women is limited. Here, we report findings from a mixed methods cervical cancer research project conducted in partnership with 10 First Nations communities in northwest Ontario, Canada. Individual interviews with community health professionals (the majority of whom identified as First Nations) stressed that awareness of cervical screening benefits is lacking. In contrast, focus group participants (women with no formal health education) emphasized the desire to learn more about the science of human papillomavirus (HPV), and that a positive HPV or abnormal Papanicolaou test need not mean a woman will undoubtedly develop cervical cancer. Both the health professionals and the focus group participants highlighted that sexual health education must start early, in schools, preferably before girls are sexually active and that it has to continue throughout life to create a screening culture with a focus on women's wellbeing. Both interview and focus group participants highlighted that sexual health education must start early, in schools, preferably before girls are sexually active and that it has to continue throughout life to create a screening culture with a focus on women's wellbeing. Health professionals elaborated mainly on special events for community women whereas focus group participants also recognized the need to include community men in health education particularly for de-stigmatizing the sexually-transmitted HPV infection.
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Affiliation(s)
- Ingeborg Zehbe
- Scientist, Thunder Bay Regional Research Institute, and Associate Professor, Health Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Pamela Wakewich
- Professor, Sociology and Women’s Studies, Lakehead University; Professor, Human Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Brianne Wood
- PhD student, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pauline Sameshima
- Associate Director, Centre for Place & Sustainability Studies, Lakehead University, Thunder Bay, ON, Canada
| | - Yvonne Banning
- Nursing Student, Lakehead University, Fort William First Nation, Fort William First Nation, Ontario, Canada
| | - Julian Little
- Professor and Chair, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Langdon SE, Golden SL, Arnold EM, Maynor RF, Bryant A, Freeman VK, Bell RA. Lessons Learned From a Community-Based Participatory Research Mental Health Promotion Program for American Indian Youth. Health Promot Pract 2016; 17:457-63. [PMID: 27009131 DOI: 10.1177/1524839916636568] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background American Indian (AI) youth have the highest rates of suicide among racial/ethnic minority groups in the United States. Community-based strategies are essential to address this issue, and community-based participatory research (CBPR) offers a model to engage AI communities in mental health promotion programming. Objectives This article describes successes and challenges of a CBPR, mixed-method project, The Lumbee Rite of Passage (LROP), an academic-community partnership to develop and implement a suicide prevention program for Lumbee AI youth in North Carolina. Method LROP was conducted in two phases to (1) understand knowledge and perceptions of existing mental health resources and (2) develop, implement, and evaluate a cultural enrichment program as a means of suicide prevention. Discussion/Results LROP implemented an effective community-academic partnership by (1) identifying and understanding community contexts, (2) maintaining equitable partnerships, and (3) implementing a culturally tailored research design targeting multilevel changes to support mental health. Strategies formed from the partnership alleviated challenges in each of these key CBPR concept areas. Conclusions LROP highlights how a CBPR approach contributes to positive outcomes and identifies opportunities for future collaboration in a tribal community. Using culturally appropriate CBPR strategies is critical to achieving sustainable, effective programs to improve mental health of AI youth.
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Affiliation(s)
| | | | | | | | - Alfred Bryant
- University of North Carolina, Pembroke, Pembroke, NC, USA
| | | | - Ronny A Bell
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Lin Y, Wimberly MC. Geographic Variations of Colorectal and Breast Cancer Late-Stage Diagnosis and the Effects of Neighborhood-Level Factors. J Rural Health 2016; 33:146-157. [DOI: 10.1111/jrh.12179] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/11/2016] [Accepted: 02/06/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Yan Lin
- Department of Geography; South Dakota State University; Brookings South Dakota
| | - Michael C. Wimberly
- Geospatial Sciences Center of Excellence; South Dakota State University; Brookings South Dakota
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Filippi MK, Perdue DG, Hester C, Cully A, Cully L, Greiner KA, Daley CM. COLORECTAL CANCER SCREENING PRACTICES AMONG THREE AMERICAN INDIAN COMMUNITIES IN MINNESOTA. JOURNAL OF CULTURAL DIVERSITY 2016; 23:21-27. [PMID: 27188017 PMCID: PMC4990452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality. Effective prevention and early detection may be achieved through screening, but screening rates are low, especially in American Indian (AI) populations. We wanted to understand perceptions of CRC screening among AI located in the Great Lakes region. Focus groups were recorded and transcribed verbatim (N = 45). Data were analyzed using qualitative text analysis. Themes that deterred CRC screening were low CRC knowledge, fear of the procedure and results, cost and transportation issues, and a lack of quality and competent care. Suggestions for improvement included outreach efforts and culturally-tailored teaching materials.
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Gesink D, Nattel L. A qualitative cancer screening study with childhood sexual abuse survivors: experiences, perspectives and compassionate care. BMJ Open 2015; 5:e007628. [PMID: 26246075 PMCID: PMC4538265 DOI: 10.1136/bmjopen-2015-007628] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The childhood sexual abuse (CSA) survivor population is substantial and survivors have been identified as part of the population who were under-screened or never-screened for breast, cervical and colon cancer. Our objective was to learn CSA survivor perspectives on, and experiences with, breast, cervical and colon cancer screening with the intention of generating recommendations to help healthcare providers improve cancer screening participation. DESIGN A pragmatic constructivist qualitative study involving individual, semistructured, in-depth interviews was conducted in January 2014. Thematic analysis was used to describe CSA survivor perspectives on cancer screening and identify potential facilitators for screening. PARTICIPANTS A diverse purposive sample of adult female CSA survivors was recruited. The inclusion criteria were: being a CSA survivor, being in a stable living situation, where stable meant able to meet one's financial needs independently, able to maintain supportive relationships, having participated in therapy to recover from past abuse, and living in a safe environment. 12 survivors were interviewed whose ages ranged from the early 40s to mid-70s. Descriptive saturation was reached after 10 interviews. SETTING Interviews were conducted over the phone or Internet. CSA survivors were primarily from urban and rural Ontario, but some resided elsewhere in Canada and the USA. RESULTS The core concept that emerged was that compassionate care at every level of the healthcare experience could improve cancer screening participation. Main themes included: desire for holistic care; unique needs of patients with dissociative identity disorder; the patient-healthcare provider relationship; appointment interactions; the cancer screening environment; and provider assumptions about patients. CONCLUSIONS Compassionate care can be delivered by: building a relationship; practising respect; focusing attention on the patient; not rushing the appointment; keeping the environment positive and comfortable; maintaining patient dignity; sharing control whenever possible; explaining procedures; and using laughter to reduce power imbalance through shared humanity.
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Affiliation(s)
- Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Wong RSL, Vikram B, Govern FS, Petereit DG, Maguire PD, Clarkson MR, Heron DE, Coleman CN. National Cancer Institute's Cancer Disparities Research Partnership Program: Experience and Lessons Learned. Front Oncol 2014; 4:303. [PMID: 25405101 PMCID: PMC4217306 DOI: 10.3389/fonc.2014.00303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/14/2014] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To increase access of underserved/health disparities communities to National Cancer Institute (NCI) clinical trials, the Radiation Research Program piloted a unique model - the Cancer Disparities Research Partnership (CDRP) program. CDRP targeted community hospitals with a limited past NCI funding history and provided funding to establish the infrastructure for their clinical research program. METHODS Initially, 5-year planning phase funding was awarded to six CDRP institutions through a cooperative agreement (U56). Five were subsequently eligible to compete for 5-year implementation phase (U54) funding and three received a second award. Additionally, the NCI Center to Reduce Cancer Health Disparities supported their U56 patient navigation programs. RESULTS Community-based hospitals with little or no clinical trials experience required at least a year to develop the infrastructure and establish community outreach/education and patient navigation programs before accrual to clinical trials could begin. Once established, CDRP sites increased their yearly patient accrual mainly to NCI-sponsored cooperative group trials (~60%) and Principal Investigator/mentor-initiated trials (~30%). The total number of patients accrued on all types of trials was 2,371, while 5,147 patients received navigation services. CONCLUSION Despite a historical gap in participation in clinical cancer research, underserved communities are willing/eager to participate. Since a limited number of cooperative group trials address locally advanced diseases seen in health disparities populations; this shortcoming needs to be rectified. Sustainability for these programs remains a challenge. Addressing these gaps through research and public health mechanisms may have an important impact on their health, scientific progress, and efforts to increase diversity in NCI clinical trials.
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Affiliation(s)
- Rosemary S L Wong
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute , Rockville, MD , USA
| | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute , Rockville, MD , USA
| | - Frank S Govern
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute , Rockville, MD , USA
| | - Daniel G Petereit
- Walking Forward Program, Rapid City Regional Hospital , Rapid City, SD , USA
| | | | | | - Dwight E Heron
- University of Pittsburgh Medical Center McKeesport , McKeesport, PA , USA
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute , Rockville, MD , USA
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Gesink D, Mihic A, Antal J, Filsinger B, Racey CS, Perez DF, Norwood T, Ahmad F, Kreiger N, Ritvo P. Who are the under- and never-screened for cancer in Ontario: a qualitative investigation. BMC Public Health 2014; 14:495. [PMID: 24885998 PMCID: PMC4229738 DOI: 10.1186/1471-2458-14-495] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/14/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Observed breast, cervical and colon cancer screening rates are below provincial targets for the province of Ontario, Canada. The populations who are under- or never-screened for these cancers have not been described at the Ontario provincial level. Our objective was to use qualitative methods of inquiry to explore who are the never- or under-screened populations of Ontario. METHODS Qualitative data were collected from two rounds of focus group discussions conducted in four communities selected using maps of screening rates by dissemination area. The communities selected were archetypical of the Ontario context: urban, suburban, small city and rural. The first phase of focus groups was with health service providers. The second phase of focus groups was with community members from the under- and never-screened population. Guided by a grounded theory methodology, data were collected and analyzed simultaneously to enable the core and related concepts about the under- and never-screened to emerge. RESULTS The core concept that emerged from the data is that the under- and never-screened populations of Ontario are characterized by diversity. Group level characteristics of the under- and never-screened included: 1) the uninsured (e.g., Old Order Mennonites and illegal immigrants); 2) sexual abuse survivors; 3) people in crisis; 4) immigrants; 5) men; and 6) individuals accessing traditional, alternative and complementary medicine for health and wellness. Under- and never-screened could have one or multiple group characteristics. CONCLUSION The under- and never-screened in Ontario comprise a diversity of groups. Heterogeneity within and intersectionality among under- and never-screened groups adds complexity to cancer screening participation and program planning.
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Affiliation(s)
- Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
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Petereit DG, Guadagnolo BA, Wong R, Coleman CN. Addressing Cancer Disparities Among American Indians through Innovative Technologies and Patient Navigation: The Walking Forward Experience. Front Oncol 2011; 1:11. [PMID: 22649752 PMCID: PMC3355933 DOI: 10.3389/fonc.2011.00011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 06/09/2011] [Indexed: 12/03/2022] Open
Abstract
Purpose/Objective(s): American Indians (AIs) present with more advanced stages of cancer and, therefore, suffer from higher cancer mortality rates compared to non-AIs. Under the National Cancer Institute (NCI) Cancer Disparities Research Partnership (CDRP) Program, we have been researching methods of improving cancer treatment and outcomes since 2002, for AIs in Western South Dakota, through the Walking Forward (WF) Program. Materials/Methods: This program consists of (a) a culturally tailored patient navigation program that facilitated access to innovative clinical trials in conjunction with a comprehensive educational program encouraging screening and early detection, (b), surveys to evaluate barriers to access, (c) clinical trials focusing on reducing treatment length to facilitate enhanced participation using brachytherapy and intensity modulated radiotherapy (IMRT) for breast and prostate cancer, as AIs live a median of 140 miles from the cancer center, and (d) a molecular study (ataxia telangiectasia mutated) to address whether there is a specific profile that increases toxicity risks. Results: We describe the design and implementation of this program, summary of previously published results, and ongoing research to influence stage at presentation. Some of the critical outcomes include the successful implementation of a community-based research program, development of trust within tribal communities, identification of barriers, analysis of nearly 400 navigated cancer patients, clinical trial accrual rate of 10%, and total enrollment of nearly 2,500 AIs on WF research studies. Conclusion: This NCI funded pilot program has achieved some initial measures of success. A research infrastructure has been created in a community setting to address new research questions and interventions. Efforts underway to promote cancer education and screening are presented, as well as applications of the lessons learned to other health disparity populations – both nationally and internationally.
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Affiliation(s)
- Daniel G Petereit
- Department of Oncology, John T. Vucurevich Cancer Care Institute Rapid City, SD, USA
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