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Christie V, Riley L, Green D, Amin J, Skinner J, Pyke C, Gwynne K. Improving Breast Cancer Outcomes for Indigenous Women in Australia. Cancers (Basel) 2024; 16:1736. [PMID: 38730687 PMCID: PMC11083011 DOI: 10.3390/cancers16091736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
In Australia, the incidence rate of breast cancer is lower in Indigenous* women than non-Indigenous women; however, the mortality rate is higher, with Indigenous women 1.2 times more likely to die from the disease. This paper provides practical and achievable solutions to improve health outcomes for Indigenous women with breast cancer in Australia. This research employed the Context-Mechanism-Outcome (CMO) framework to reveal potential mechanisms and contextual factors that influence breast cancer outcomes for Indigenous women, stratified into multiple levels, namely, micro (interpersonal), meso (systemic) and macro (policy) levels. The CMO framework allowed us to interpret evidence regarding Indigenous women and breast cancer and provides nine practical ways to improve health outcomes and survival rates.
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Affiliation(s)
- Vita Christie
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Heart Research Institute, Sydney, NSW 2042, Australia; (J.S.); (K.G.)
| | - Lynette Riley
- Sydney School of Education & Social Work, The University of Sydney, Camperdown, NSW 2006, Australia;
| | - Deb Green
- Armajun Aboriginal Health Service, Armidale, NSW 2350, Australia;
| | - Janaki Amin
- Department of Health Sciences, Macquarie University, Sydney, NSW 2109, Australia;
| | - John Skinner
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Heart Research Institute, Sydney, NSW 2042, Australia; (J.S.); (K.G.)
| | - Chris Pyke
- Royal Australasian College of Surgeons, Melbourne, VIC 3002, Australia;
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Heart Research Institute, Sydney, NSW 2042, Australia; (J.S.); (K.G.)
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2
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Welch AC, London SM, Wilshire CL, Gilbert CR, Buchwald D, Ferguson G, Allick C, Gorden JA. Access to Lung Cancer Screening Among American Indian and Alaska Native Adults: A Qualitative Study. Chest 2024; 165:716-724. [PMID: 37898186 DOI: 10.1016/j.chest.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer mortality among American Indian and Alaska Native populations. American Indian and Alaska Native people use commercial tobacco products at higher rates compared with all other races and ethnicities. Moreover, they show lower adherence to cancer screening guidelines. RESEARCH QUESTION How do American Indian and Alaska Native adults perceive and use lung cancer screening? STUDY DESIGN AND METHODS We conducted a study in which we recorded and transcribed data from three focus groups consisting of American Indian and Alaska Native adults. Participants were recruited through convenience sampling at a national health conference. Transcripts were analyzed by inductive coding. RESULTS Participants (n = 58) of 28 tribes included tribal Elders, tribal leaders, and non-Native volunteers who worked with tribal communities. Limited community awareness of lung cancer screening, barriers to lung cancer screening at health care facilities, and health information-seeking behaviors emerged as key themes in discussions. Screening knowledge was limited except among people with direct experiences of lung cancer. Cancer risk factors such as multigenerational smoking were considered important priorities to address in communities. Limited educational and diagnostic resources are significant barriers to lung cancer screening uptake in addition to limited discussions with health care providers about cancer risk. INTERPRETATION Limited access to and awareness of lung cancer screening must be addressed. American Indian and Alaska Native adults use several health information sources unique to tribal communities, and these should be leveraged in designing screening programs. Equitable partnerships between clinicians and tribes are essential in improving knowledge and use of lung cancer screening.
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Affiliation(s)
- Allison C Welch
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA
| | - Sara M London
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Candice L Wilshire
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA
| | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Gary Ferguson
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Cole Allick
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Jed A Gorden
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA.
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3
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Mishra SI, Adsul P, Leekity S, Rodman J, Sussman AL, Kelly K, Sheche J, Faber T, Shah V. A culturally informed model to enhance breast, cervical, and colorectal cancer screenings: perspectives of American Indian adults and healthcare providers in rural New Mexico. Cancer Causes Control 2023; 34:855-871. [PMID: 37277513 PMCID: PMC10460346 DOI: 10.1007/s10552-023-01721-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: 07/05/2022] [Accepted: 05/16/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE American Indian/Alaska Native (AI/AN) populations have some of the lowest cancer screening rates compared to other racial/ethnic populations. Using community-based participatory research methods, we sought to characterize knowledge, attitudes, beliefs, and approaches to enhance breast, colorectal, and cervical cancer screening. METHODS We conducted 12 focus groups between October 2018 and September 2019 with 96 eligible AI adults and healthcare providers, recruited using non-probability purposive sampling methods from the Zuni Pueblo in rural New Mexico. We used the Multi-level Health Outcomes Framework (MHOF) to conduct a qualitative content analysis identifying mutable systems- and individual- level constructs important for behavior change that we crosslinked with the Community Preventive Services Task Force (CPSTF) recommended evidence-based interventions (EBIs) or approaches. RESULTS Salient systems-level factors that limited uptake of cancer screenings included inflexible clinic hours, transportation barriers, no on-demand service and reminder systems, and brief doctor-patient encounters. Individual-level barriers included variable cancer-specific knowledge that translated into fatalistic beliefs, fear, and denial. Interventions to enhance community demand and access for screening should include one-on-one and group education, small media, mailed screening tests, and home visitations by public health nurses. Interventions to enhance provider delivery of screening services should include translation and case management services. CONCLUSIONS The MHOF constructs crosslinked with CPSTF recommended EBIs or approaches provided a unique perspective to frame barriers and promoters of screening utilization and insights for intervention development. Findings inform the development of culturally tailored, theoretically informed, multi-component interventions concordant with CPSTF recommended EBIs or approaches aimed at improving cancer screening.
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Affiliation(s)
- Shiraz I. Mishra
- Departments of Pediatrics and Family and Community Medicine, and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Prajakta Adsul
- Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Samantha Leekity
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Andrew L. Sussman
- Department of Family and Community Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5040, Albuquerque, NM 87131 USA
| | - Keith Kelly
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Judith Sheche
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Thomas Faber
- Albuquerque Area Indian Health Service, 4101 Indian School Rd, NE, Albuquerque, NM 87110 USA
| | - Vallabh Shah
- Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
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Roh S, Lee YS. Developing Culturally Tailored Mobile Web App Education to Promote Breast Cancer Screening: Knowledge, Barriers, and Needs Among American Indian Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023:10.1007/s13187-022-02252-x. [PMID: 36631714 PMCID: PMC10366295 DOI: 10.1007/s13187-022-02252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
American Indian (AI) women face disproportionate rates of breast cancer mortality and cancer disparities. This study conducted qualitative research to assess perspectives of AI women towards breast cancer screening, knowledge, barriers, and needs about mobile web app-based education to promote breast cancer screening. This study, in collaboration with the Yankton Sioux Tribe (YST), followed a community-based participatory research approach and conducted two focus groups with a total of 22 YST women aged 40-70 years living on reservation in rural South Dakota. Each group consisted of 11 local professionals working in healthcare and social services and community members. A grounded theory was used for the qualitative analysis. A large portion of participants reported having prior knowledge about breast cancer and screening methods, yet lacked awareness of the detailed procedure and recommended guidelines. Competing priorities and cost of mammograms were noted as major barriers to screening. Participants wanted to learn-in a convenient and easy-to-understand manner-more about breast cancer and prevention from a credible source. Both groups were favorable toward novel educational tools, such as the mobile web app education, and cited potential health benefits, particularly for women aged 40s to 60s. Our findings highlighted the importance of creating effective, culturally tailored educational interventions built into programs specific to AIs to increase understanding about breast cancer screening and promote screening behaviors among AI women. Particular attention to how AIs' culture, beliefs, and barriers are implicated in screening behaviors could help with developing culturally tailored health education tools for this population.
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Affiliation(s)
- Soonhee Roh
- Department of Social Work, University of South Dakota-Sioux Falls, 4801 North Career Ave, 145C, Sioux Falls, SD, 57107, USA.
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, 1600 Holloway Avenue, HSS 216, San Francisco, CA, 94132, USA
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Lau J, Shrestha P, Shaina Ng J, Jianlin Wong G, Legido-Quigley H, Tan KK. Qualitative factors influencing breast and cervical cancer screening in women: A scoping review. Prev Med Rep 2022; 27:101816. [PMID: 35656228 PMCID: PMC9152777 DOI: 10.1016/j.pmedr.2022.101816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/04/2022] [Accepted: 04/30/2022] [Indexed: 11/28/2022] Open
Abstract
Breast and cervical are top cancers for women globally, but few studies have summarised how gender norms influence screening uptake, given sexual connotations and physical exposure. These beliefs may play a central role in decision-making, and understanding them is crucial to improving screening rates and services. This review scopes international literature for gender-based qualitative factors influencing women’s screening uptake. A systematic search of peer-reviewed English articles in PubMed, Scopus, and CINAHL was conducted from inception until December 2019. Articles were included if they were about breast or cervical cancer screening, had mixed or qualitative methodology, and sampled women from the general population. 72 studies spanning 34 countries were analysed. Eight studies also included healthcare providers’ views. Our narrative thematic analysis summarised primary themes extracted from each study into first-level subthemes, then synthesising second-level and third-level themes: (I) gender socialisation of women, (II) gender inequality in society, and (III) lack of empowerment to women in making screening decisions. Women tended to face sociocultural/role-based constraints, were expected to prioritise family, and keep bodily exposure to their husbands. Women showed low awareness and had fewer opportunities for health education compared to men. Male relations were often gatekeepers to financial resources needed to pay for screening tests. Screening risked community norms about women’s or husbands’ perceived embarrassing sexual behaviours. These findings suggest that interventions targeting unhelpful stigmatising beliefs about women’s cancer screening must concurrently address community general norms, familial role-based beliefs, as well as at male relations who hold the purse-strings.
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Affiliation(s)
- Jerrald Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Janelle Shaina Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gretel Jianlin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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6
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Comparison of Study Quality as Determined by Standard Research and Community Engagement Metrics: A Pilot Study on Breast Cancer Research in Urban, Rural, and Remote Indigenous Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095008. [PMID: 35564401 PMCID: PMC9102080 DOI: 10.3390/ijerph19095008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023]
Abstract
The purpose of this review is to compare research evaluation tools to determine whether the tools typically used for assessing the quality of research adequately address issues of Indigenous health and culture, particularly when the studies are intended to benefit Indigenous peoples in urban, regional, rural, and remote settings. Our previously published systematic review evaluated studies about breast cancer using a modified Indigenous community engagement tool (CET). In this study, we evaluated the same studies using two commonly used tools: the Critical Appraisal Skills Programme (CASP) for qualitative research; and the Effective Public Health Practice Project (EPHPP) for quantitative research. The results were then compared to ascertain whether there was alignment between performances in terms of engagement and the CASP/EPHPP metrics. Of the 15 papers, 3 papers scored weakly on both metrics, and are therefore the least likely to offer reliable findings, while 2 papers scored strongly on both metrics, and are therefore the most likely to offer reliable findings. Beyond this summation, it was clear that the results did not align and, therefore, could not be used interchangeably when applied to research findings intended to benefit Indigenous peoples. There does not appear to be a pattern in the relationship between the reliability of the studies and the study settings. In order to address disparities in health outcomes, we must assess research through a typical research quality and cultural engagement and settings lens, ensuring that there is rigour in all aspects of the studies.
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7
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Redvers N, Wilkinson M, Fischer C. Colorectal cancer community engagement: a qualitative exploration of American Indian voices from North Dakota. BMC Cancer 2022; 22:158. [PMID: 35139807 PMCID: PMC8827199 DOI: 10.1186/s12885-021-09119-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background American Indians (AI) in North Dakota present with higher rates of advanced-stage disease for screening detectable colorectal cancers and have lower overall baseline colorectal cancer screening rates than non-AIs. We sought to identify the perceived barriers and facilitators for the engagement with colorectal cancer prevention within North Dakota tribal communities. Methods Twelve semi-structured interviews were carried out across four tribal reservation communities in the state of North Dakota with American Indian adults between the ages of 30 and 75 years. We utilized purposive sampling to ensure maximum variation in age, sex, and tribal community until data saturation was achieved. The interviews were transcribed, and thematic analysis was carried out to identify consistent themes rooted within the data. Ethical approval was gained for this project from all relevant institutional review boards. Results Four main themes were identified as barriers for the engagement with colorectal cancer prevention, including: colorectal cancer screening barriers, focused on other health problems, lack of colorectal cancer tailored health promotion, and socio-cultural factors affecting colorectal cancer prevention. Three main themes were identified as facilitators for the engagement with colorectal cancer prevention, including: reasons for getting colorectal cancer screening, role of culture, and getting out into the community. Conclusion There is need for more community-rooted, strengths-based approaches to colorectal cancer prevention activities in AI communities in North Dakota. Socio-cultural factors, such as the use of storytelling, and the use of traditional knowledge have been demonstrated to be an important element of consideration for colorectal cancer tribal community engagement and prevention planning in the state. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09119-2.
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Affiliation(s)
- Nicole Redvers
- Department of Family & Community Medicine, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA. .,Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA.
| | - Mia Wilkinson
- Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA
| | - Courtney Fischer
- Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA
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Thompson JA, Chollet-Hinton L, Keighley J, Chang A, Mudaranthakam DP, Streeter D, Hu J, Park M, Gajewski B. The need to study rural cancer outcome disparities at the local level: a retrospective cohort study in Kansas and Missouri. BMC Public Health 2021; 21:2154. [PMID: 34819024 PMCID: PMC8611913 DOI: 10.1186/s12889-021-12190-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Rural residence is commonly thought to be a risk factor for poor cancer outcomes. However, a number of studies have reported seemingly conflicting information regarding cancer outcome disparities with respect to rural residence, with some suggesting that the disparity is not present and others providing inconsistent evidence that either urban or rural residence is associated with poorer outcomes. We suggest a simple explanation for these seeming contradictions: namely that rural cancer outcome disparities are related to factors that occur differentially at a local level, such as environmental exposures, lack of access to care or screening, and socioeconomic factors, which differ by type of cancer. Methods We conducted a retrospective cohort study examining ten cancers treated at the University of Kansas Medical Center from 2011 to 2018, with individuals from either rural or urban residences. We defined urban residences as those in a county with a U.S. Department of Agriculture Urban Influence Code (UIC) of 1 or 2, with all other residences defines a rural. Inverse probability of treatment weighting was used to create a pseudo-sample balanced for covariates deemed likely to affect the outcomes modeled with cumulative link and weighted Cox-proportional hazards models. Results We found that rural residence is not a simple risk factor but rather appears to play a complex role in cancer outcome disparities. Specifically, rural residence is associated with higher stage at diagnosis and increased survival hazards for colon cancer but decreased risk for lung cancer compared to urban residence. Conclusion Many cancers are affected by unique social and environmental factors that may vary between rural and urban residents, such as access to care, diet, and lifestyle. Our results show that rurality can increase or decrease risk, depending on cancer site, which suggests the need to consider the factors connected to rurality that influence this complex pattern. Thus, we argue that such disparities must be studied at the local level to identify and design appropriate interventions to improve cancer outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12190-w.
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Affiliation(s)
- Jeffrey A Thompson
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA. .,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Lynn Chollet-Hinton
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - John Keighley
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Audrey Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - David Streeter
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Jinxiang Hu
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Michele Park
- University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Byron Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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Ablordeppey EA, Powell B, McKay V, Keating S, James A, Carpenter C, Kollef M, Griffey R. Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter insertion. BMJ Open Qual 2021; 10:bmjoq-2020-001222. [PMID: 34663588 PMCID: PMC8524291 DOI: 10.1136/bmjoq-2020-001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/02/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Avoiding low value medical practices is an important focus in current healthcare utilisation. Despite advantages of point-of-care ultrasound (POCUS) over chest X-ray including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation has slow rate of adoption. This demonstrates a gap that is ripe for the development of an intervention. Methods The intervention is a deimplementation programme called DRAUP (deimplementation of routine chest radiographs after adoption of ultrasound-guided insertion and confirmation of central venous catheter protocol) that will be created to address one unnecessary imaging modality in the acute care environment. We propose a three-phase approach to changing low-value practices. In phase 1, we will be guided by the Consolidated Framework for Implementation Research framework to explore barriers and facilitators of POCUS for CVC confirmation in a single centre, large tertiary, academic hospital via focus groups. The qualitative methods will inform the development and adaptation of strategies that address identified determinants of change. In phase 2, the multifaceted strategies will be conceptualised using Morgan’s framework for understanding and reducing medical overuse. In phase 3, we will locally implement these strategies and assess them using Proctor’s outcomes (adoption, deadoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on the programme. Secondary outcomes will include POCUS-guided CVC confirmation efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS confirmation after CVC insertion. With limited data available to inform interventions that use concurrent implementation and deimplementation strategies to substitute chest X-ray for POCUS using the DRAUP programme, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that will expand the knowledge of implementation approaches to replacing low value or unnecessary care in acute care environments. Ethics and dissemination Approval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means. Trial registration number ClinicalTrials.gov Identifier, NCT04324762, registered on 27 March 2020.
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Affiliation(s)
- Enyo A Ablordeppey
- Department of Anesthesiology and Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Byron Powell
- Brown School at Washington University in St Louis, St Louis, Missouri, USA
| | - Virginia McKay
- Brown School at Washington University in St Louis, St Louis, Missouri, USA
| | - Shannon Keating
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Aimee James
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Christopher Carpenter
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Marin Kollef
- Department of Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Richard Griffey
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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Charaka H, Khalis M, Elfakir S, Huybrechts I, Khazraji YC, Lyoussi B, Soliman AS, Nejjari C. Knowledge, Perceptions, and Satisfaction of Moroccan Women Towards a New Breast Cancer Screening Program in Morocco. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:657-663. [PMID: 31873856 DOI: 10.1007/s13187-019-01680-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to evaluate the knowledge, perceptions, and satisfaction of Moroccan women who resided the Meknes-Tafilalt region regarding a newly implemented breast cancer screening program in the region. The study was conducted in 24 randomly selected health centers from Meknes-Tafilalt region, Morocco. We targeted all women who resided in the region of the program and who met the inclusion criteria to participate in the screening program. Data was collected through a face-to-face questionnaire. In this study, 318 women were included. Results revealed moderate knowledge of breast cancer and the screening program. Most of the participants (90.5%) had heard of the breast cancer screening program. Only 33.6% of women declared that they are well informed about the program. Fear emotions related to breast cancer were reported by 93.1% of participants. About 82% of women accept to repeat a screening test every 2 years. Recommending the breast cancer screening test to their family and friends was stated by nearly 90% of women. The majority of women (94.9%) expressed their satisfaction about the screening test activities provided by health centers. Our results showed a moderate level of knowledge about breast cancer, a very positive attitude, and high overall satisfaction towards the breast cancer screening program in the Meknes-Tafilalt region. These results can guide development of appropriate breast cancer prevention strategies and sensibilisation campaigns in Morocco.
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Affiliation(s)
- Hafida Charaka
- Department of Research and Development, Hassan II University Hospital of Fez, Fez, Morocco
| | - Mohamed Khalis
- School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco.
| | - Samira Elfakir
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, B.P. 1893, Km 2.2 Route Sidi Harazem, 30 000, Fez, Morocco
| | - Inge Huybrechts
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | | | - Badiaa Lyoussi
- Laboratory of Physiology, Pharmacology and Environmental Health, Faculty of Science, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Amr S Soliman
- Department of Community Health and Social Medicine, City University of New York, School of Medicine, New York, USA
| | - Chakib Nejjari
- International School of Public health, Mohammed VI University of Health Sciences, Casablanca, Morocco
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11
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Christie V, Green D, Amin J, Pyke C, Littlejohn K, Skinner J, McCowen D, Gwynne K. What Is the Evidence Globally for Culturally Safe Strategies to Improve Breast Cancer Outcomes for Indigenous Women in High Income Countries? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6073. [PMID: 34199955 PMCID: PMC8200222 DOI: 10.3390/ijerph18116073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Abstract
The aim was to systematically assess the evidence on whether cultural safety affects breast cancer outcomes with regards to care for Indigenous women in high income countries. We conducted a systematic review in accordance with PRISMA guidelines of peer-reviewed articles in Medline, EMBASE, CINAHL, Scopus, Web of Science, Proquest Sociology and Informit Rural health database and Indigenous collection databases. Key inclusion criteria were: adult female patients with breast cancer; high income country setting; outcome measure, including screening, diagnosis, treatment and follow up care. A total of 15 were selected. We developed a Community Engagement assessment tool in consultation with aboriginal researchers, based on the National Health and Medical Research Councils' community engagement guidelines, against which studies were appraised. This novel element allowed us to evaluate the literature from a new and highly relevant perspective. Thematic analysis of all 15 studies was also undertaken. Despite limited literature there are evidence-based strategies that are likely to improve outcomes for Indigenous women with breast cancer in high income countries and indicate that culture makes a positive difference. It is also clear that strong Indigenous community leadership and governance at all stages of the research including design is an imperative for feasibility.
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Affiliation(s)
- Vita Christie
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (J.A.); (K.G.)
- Poche Centre for Indigenous Health, The University of Sydney, Sydney 2006, Australia;
| | - Debbie Green
- Armajun Aboriginal Health Service, Armidale 2350, Australia; (D.G.); (D.M.)
| | - Janaki Amin
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (J.A.); (K.G.)
| | - Christopher Pyke
- Foundation for Breast Cancer Care, South Brisbane 4101, Australia; (C.P.); (K.L.)
| | - Karen Littlejohn
- Foundation for Breast Cancer Care, South Brisbane 4101, Australia; (C.P.); (K.L.)
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Sydney 2006, Australia;
| | - Deb McCowen
- Armajun Aboriginal Health Service, Armidale 2350, Australia; (D.G.); (D.M.)
| | - Kylie Gwynne
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (J.A.); (K.G.)
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Zahrieh D, Golafshar MA, Patel SH, DeWees TA. Quantification of Potential Inequities in Breast Cancer Incidence in New Mexico Through Bayesian Disease Mapping. Prev Chronic Dis 2021; 18:E23. [PMID: 33705303 PMCID: PMC7986972 DOI: 10.5888/pcd18.200468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The incidence of breast cancer among non-Hispanic American Indian and Alaska Native (AI/AN) women varies across the United States. We applied county-level Bayesian disease mapping to quantify potential inequities in 10-year breast cancer incidence in New Mexico to better inform health equity initiatives among its non-Hispanic at-risk AI/AN population. METHODS We used data from the Surveillance, Epidemiology, and End Results (SEER) program from 2005 through 2014 to identify new cases of breast cancer in New Mexico's 33 counties. To account for spatial variation, a county-level Area Deprivation Index, and the small area estimation problem inherent in these data, we borrowed strength globally and locally by applying Bayesian disease mapping to the counts of age-adjusted county-level breast cancer incidence. We quantified the disparity effect, as measured by the age-adjusted rate ratio, comparing the incidence of breast cancer between at-risk non-Hispanic AI/AN and non-Hispanic White women and assessed whether the ratio differed among counties. RESULTS Accounting for over-dispersion and spatial correlation among the 33 counties and a county-level Area Deprivation Index, the posterior mean of the overall age-adjusted rate ratio was 0.384 (95% credible interval, 0.253--0.546). The age-adjusted rate of breast cancer in non-Hispanic AI/AN women was 0.38 times the corresponding age-adjusted rate for non-Hispanic White women; however, a significant reduction in breast cancer incidence was observed in 16 of the 33 counties. CONCLUSION The application of Bayesian disease mapping to these data provided substantial evidence of an overall disparity in breast cancer incidence between at-risk non-Hispanic AI/AN and non-Hispanic White women in New Mexico, which was more marked than previously reported and limited to certain counties. Targeted statewide and county-level health-equity initiatives may lead to a reduction in these disparities.
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Affiliation(s)
- David Zahrieh
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic, Department of Quantitative Health Sciences, 200 First St SW, Rochester, MN 55905.
| | | | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Todd A DeWees
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
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Mouslim MC, Johnson RM, Dean LT. Healthcare system distrust and the breast cancer continuum of care. Breast Cancer Res Treat 2020; 180:33-44. [PMID: 31983018 DOI: 10.1007/s10549-020-05538-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/14/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE To identify and synthesize the literature on healthcare system distrust across the breast cancer continuum of care. METHODS We searched CINAHL, Cochrane, EMBASE, PubMed, PsycINFO, and Web of Science from January 1, 1990 to December 31, 2018 for all peer-reviewed publications addressing the role of healthcare system trust, distrust or mistrust in the breast cancer continuum of care. RESULTS We identified a total of 20 studies, seven qualitative studies and thirteen quantitative studies. Two studies assessed genetic testing, eleven assessed screening and seven assessed treatment and follow-up. Twelve studies evaluated mistrust, five evaluated distrust, and three evaluated trust. Study populations included African American, American Indian, Latina, Hispanic, and Asian American participants. CONCLUSION Healthcare system distrust is prevalent across many different racial and ethnic groups and operates across the entire breast cancer continuum of care. It is an important yet understudied barrier to cancer. We hope that the knowledge garnered by this study will enable researchers to form effective and targeted interventions to reduce healthcare system distrust mediated disparities in breast cancer outcomes.
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Affiliation(s)
- Morgane C Mouslim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Lee YS, Roh S, Moon H, Lee KH, McKinley C, LaPlante K. Andersen's Behavioral Model to Identify Correlates of Breast Cancer Screening Behaviors among Indigenous Women. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:117-135. [PMID: 32211512 PMCID: PMC7092411 DOI: 10.1080/26408066.2019.1650316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
This study examined predictive models of utilization of mammograms among Indigenous women adapting Andersen's behavioral model. Using a sample of 285 Indigenous women residing in South Dakota, nested logistic regression analyses were conducted to assess predisposing (age and marital status), need (personal and family cancer history), and enabling factors (education, monthly household income, mammogram screening awareness, breast cancer knowledge, self-rated health, and cultural practice to breast cancer screening). Results indicated that only 55.5% of participants reported having had a breast cancer screening within the past 2 years. After controlling for predisposing and need factors, higher education, greater awareness of mammogram, and higher utilization of traditional Native American approaches were significant predictors of mammogram uptake. The results provide important implications for intervention strategies aimed at improving breast cancer screening and service use among Indigenous women.
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Affiliation(s)
- Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, California, USA
| | - Soonhee Roh
- Department of Social Work, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Heehyul Moon
- Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Kyoung Hag Lee
- School of Social Work, Wichita State University, Wichita, Kansas, USA
| | | | - Kathy LaPlante
- Department of Social Work, University of South Dakota, Sioux Falls, South Dakota, USA
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Barriers to mammography screening among racial and ethnic minority women. Soc Sci Med 2019; 239:112494. [PMID: 31513931 DOI: 10.1016/j.socscimed.2019.112494] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 07/04/2019] [Accepted: 08/13/2019] [Indexed: 11/21/2022]
Abstract
RATIONALE Breast cancer is the second leading cause of cancer death among women. Disparities in breast cancer mortality rates adversely affect racial/ethnic minority women. Mammography screening is the most effective early detection method and means of reducing mortality rates. Yet, barriers prevent racial/ethnic minority women from participating in regular screening. OBJECTIVE This review aimed to summarize self-reported barriers to mammography screening in racial/ethnic minority women in studies using open-ended assessments and closed-ended assessments. METHOD Literature searches were conducted in two databases, PsycINFO and PubMed. Barriers were detailed in full by barrier type (psychological/knowledge-related, logistical, cultural/immigration-related, and social/interpersonal) and summarized briefly by race/ethnicity (African American/Black, Asian/Pacific Islander, Hispanic, American Indian/Native American, and Middle Eastern). RESULTS Twenty-two open-ended and six closed-ended studies were identified as eligible for this review. Overall, racial/ethnic minority women identified common logistical and psychological/knowledge-related barriers. Additionally, women reported cultural/immigration-related and social/interpersonal barriers that were closely tied to their racial/ethnic identities. CONCLUSIONS It was concluded that cultural/immigration-related barriers may be the only barrier type that is unique to racial/ethnic minority women. Thus, designing studies of barriers around race and ethnicity is not always appropriate, and other demographic factors are sometimes a more important focus. The variability in 'barrier' definitions, how data were collected and reported, and the appropriateness of closed-ended measures were also examined. This literature may benefit from detailed and strategically designed studies that allow more clear-cut conclusions and better comparison across studies as well as improving closed-ended measures by incorporating insights from investigations using open-ended inquiry.
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Jerome-D’Emilia B, Gachupin FC, Suplee PD. A Systematic Review of Barriers and Facilitators to Mammography in American Indian/Alaska Native Women. J Transcult Nurs 2018; 30:173-186. [DOI: 10.1177/1043659618793706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The purpose of this systematic review was to synthesize the current knowledge of factors that enable or impede American Indian and Alaska Native (AI/AN) women from accessing breast cancer screening. Methodology: A systematic search of MEDLINE and CINAHL databases identified relevant research studies published from 2007 to 2017. Results: Consistent with other low-income populations, socioeconomic factors were related to lower rates of screening in AI/AN women. However, some factors, such as reliance on the Indian Health Service, cultural issues, and traditionality were unique to this population. Discussion: AI/AN women appear to face many of the difficulties that other low-income minority women face in accessing preventive care; however, they may face unique challenges and circumstances in accessing care. Efforts to work with tribes in the development of interventions framed by community-based participatory research are needed to tackle the disparities in the AI/AN community.
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Okuhara T, Ishikawa H, Okada M, Kato M, Kiuchi T. Beliefs Underlying Messages of Anti-Cancer-Screening
Websites in Japan: A Qualitative Analysis. Asian Pac J Cancer Prev 2018; 19:427-433. [PMID: 29479993 PMCID: PMC5980930 DOI: 10.22034/apjcp.2018.19.2.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Cancer screening rates are lower in Japan than in Western countries. Meanwhile, anti-cancer-screening activists take to the internet to spread their messages that cancer screening has little or no efficacy, poses substantial health risks such as side effects from radiation exposure, and that people should forgo cancer screening. We applied a qualitative approach to explore the beliefs underlying the messages of anti-cancer-screening websites, by focusing on perceived value the beliefs provided to those who held them. Methods: We conducted online searches using Google Japan and Yahoo! Japan, targeting websites we classified as “pro,” “anti,” or “neutral” depending on their claims. We applied a dual analytic approach- inductive thematic analysis and deductive interpretative analysis- to the textual data of the anti websites. Results: Of the 88 websites analyzed, five themes that correspond to beliefs were identified: destruction of common knowledge, denial of standard cancer control, education about right cancer control, education about hidden truths, and sense of superiority that only I know the truth. Authors of anti websites ascribed two values (“safety of people” and “self-esteem”) to their beliefs. Conclusion: The beliefs of authors of anti-cancer-screening websites were supposed to be strong. It would be better to target in cancer screening promotion not outright screening refusers but screening hesitant people who are more amenable to changing their attitudes toward screening. The possible means to persuade them were discussed.
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Affiliation(s)
- Tsuyoshi Okuhara
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Falk D. A Mixed Methods Review of Education and Patient Navigation Interventions to Increase Breast and Cervical Cancer Screening for Rural Women. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:173-186. [PMID: 29412063 DOI: 10.1080/19371918.2018.1434583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Reviews have assessed studies of breast and cervical cancer screening access and utilization for rural women, but none analyze interventions to increase screening rates. A mixed methods literature search identified studies of breast and/or cervical cancer prevention education and patient navigation interventions for rural women. Rural areas need greater implementation and evaluation of screening interventions as these services address the challenges of delivering patient-centered cancer care to un-/underserved communities. The lack of intervention studies on breast and cervical cancer education and patient navigation programs compared to urban studies highlights the need for validation of these programs among diverse, rural populations.
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Affiliation(s)
- Derek Falk
- a School of Social Work , The University of Texas at Austin , Austin , Texas USA
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Harris R, Van Dyke ER, Ton TGN, Nass CA, Buchwald D. Assessing Needs for Cancer Education and Support in American Indian and Alaska Native Communities in the Northwestern United States. Health Promot Pract 2016; 17:891-898. [PMID: 26507742 DOI: 10.1177/1524839915611869] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
American Indians and Alaska Natives (AI/ANs) experience significant cancer disparities. To inform future public health efforts, a web-based needs assessment survey collected quantitative and qualitative data from AI/AN community health workers and cancer survivors in the northwestern United States. Content analysis of qualitative responses identified themes to contextualize quantitative results. Seventy-six AI/AN respondents (93% female) described substantial unmet needs for education and resources to assist cancer survivors, including a shortage of patient navigators, support groups, and home health care workers. Fear of negative outcomes, a culturally rooted avoidance of discussing illness, and transportation difficulties were cited as major barriers to participation in cancer education and receipt of health services. Face-to-face contact was overwhelmingly preferred for community education and support, but many respondents were receptive to other communication channels, including e-mail, social media, and webinars. Survey results highlight the importance of culturally sensitive approaches to overcome barriers to cancer screening and education in AI/AN communities. Qualitative analysis revealed a widespread perception among respondents that available financial and human resources were insufficient to support AI/AN cancer patients' needs.
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Affiliation(s)
| | | | | | | | - Dedra Buchwald
- College of Medical Sciences, Washington State University, Seattle, WA
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20
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Breast cancer knowledge, attitudes and screening behaviors among Indian-Australian women. Eur J Oncol Nurs 2015; 19:701-6. [PMID: 26051075 DOI: 10.1016/j.ejon.2015.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE OF RESEARCH The aims of the study were to report breast cancer screening practices among Indian-Australian women and to examine the relationship between demographic characteristics, cultural beliefs and women's breast cancer screening (BCS) behaviors. METHOD A descriptive and cross-sectional method was used. Two hundred and forty two Indian-Australian women were recruited from several Indian organizations. English versions of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ) were administered. The main research variables are BCS practices, demographic characteristics and total scores on each of the BCSBQ subscales. RESULT The majority of participants (72.7%-81.4%) had heard of breast awareness, clinical breast examination (CBE) and mammograms. Only 28.9% performed a BSE monthly and although 60% had practiced CBE, only 27.3% of women within the targeted age group had annual CBE. Only 23.6% of women within the targeted age group reported they had a mammogram biennial. Marital status and length of stay in Australia were positively associated with women's screening behaviors. In terms of BCSBQ score, women who had the three screening practices regularly as recommended obtained significantly higher scores on the "attitude towards general health check-ups" and "barriers to mammographic screening" subscales. There was a significant difference in the mean score of the "knowledge and perceptions about breast cancer" between women who did and who did not engage in breast awareness. CONCLUSIONS Our study reveals that attitudes toward health check-ups and perceived barriers to mammographic screening were influential in determining compliance with breast cancer screening practices among Indian-Australian women.
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Padela AI, Murrar S, Adviento B, Liao C, Hosseinian Z, Peek M, Curlin F. Associations between religion-related factors and breast cancer screening among American Muslims. J Immigr Minor Health 2015; 17:660-9. [PMID: 24700026 PMCID: PMC4646415 DOI: 10.1007/s10903-014-0014-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
American Muslims have low rates of mammography utilization, and research suggests that religious values influence their health-seeking behaviors. We assessed associations between religion-related factors and breast cancer screening in this population. A diverse group of Muslim women were recruited from mosques and Muslim organization sites in Greater Chicago to self-administer a survey incorporating measures of fatalism, religiosity, discrimination, and Islamic modesty. 254 surveys were collected of which 240 met age inclusion criteria (40 years of age or older). Of the 240, 72 respondents were Arab, 71 South Asian, 59 African American, and 38 identified with another ethnicity. 77% of respondents had at least one mammogram in their lifetime, yet 37% had not obtained mammography within the past 2 years. In multivariate models, positive religious coping, and perceived religious discrimination in healthcare were negatively associated with having a mammogram in the past 2 years, while having a PCP was positively associated. Ever having a mammogram was positively associated with increasing age and years of US residency, and knowing someone with breast cancer. Promoting biennial mammography among American Muslims may require addressing ideas about religious coping and combating perceived religious discrimination through tailored interventions.
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Affiliation(s)
- Aasim I Padela
- Initiative on Islam and Medicine, Program on Medicine and Religion, Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA,
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Breast Cancer Among Special Populations: Disparities in Care Across the Cancer Control Continuum. IMPROVING OUTCOMES FOR BREAST CANCER SURVIVORS 2015; 862:39-52. [DOI: 10.1007/978-3-319-16366-6_4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Strickland CJ, Hillaire E. Conducting a Feasibility Study in Women's Health Screening Among Women in a Pacific Northwest American Indian Tribe. J Transcult Nurs 2014; 27:42-8. [PMID: 24848352 DOI: 10.1177/1043659614526251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Breast and cervical cancers continue to contribute to high cancer mortality rates in American Indian/Alaska Native women; culturally appropriate interventions are needed to influence screening behaviors and to reduce delays in obtaining care. In a pilot feasibility study designed to influence Pacific Northwest American Indian/Alaska Native women's health screening knowledge and behaviors (breast and cervical), we employed a community-based participatory research approach. Data from interviews with study participants, those involved in implementation of the study and observations were included in the analysis. Study questions focused on training of staff, recruitment of participants, and implementation of the protocol and data management. The complexities of translational, transcultural research and the importance of reporting pilot feasibility studies to the advancement of transcultural research are highlighted in the findings of this research effort.
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Ndikum-Moffor FM, Braiuca S, Daley CM, Gajewski BJ, Engelman KK. Assessment of mammography experiences and satisfaction among American Indian/Alaska Native women. Womens Health Issues 2014; 23:e395-402. [PMID: 24183414 DOI: 10.1016/j.whi.2013.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/19/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND American Indian/Alaska Native (AI/AN) women have lower breast cancer (BCA) screening and 5-year survival rates than non-Hispanic Whites. Understanding reasons for low screening rates is important to combatting later stage diagnoses. The purpose of this study was to assess mammography experiences and satisfaction among AI/AN women. METHODS Nine focus groups were held with rural (N = 15) and urban (N = 38) AI/AN women 40 years and older in Kansas and Kansas City, Missouri, living both near and far from Indian Health Service (IHS) and tribal facilities, to examine experiences and satisfaction with mammography. Transcripts were coded and themes identified using a community-based participatory research approach. FINDINGS Themes were classified under knowledge, communication, and awareness of BCA; barriers to mammography; mammogram facility size; impressions of mammogram technologist; motivations for getting a mammogram; and how to improve the mammogram experience. Participants had knowledge of prevention, but described cultural reasons for not discussing it and described better experiences in smaller facilities. Participants indicated having a mammogram technologist who was friendly, knowledgeable, respectful, competent, and explained the test was a determining factor in satisfaction. Other factors included family history, physician recommendation, and financial incentives. Barriers included transportation, cost, perceptions of prejudice, and time constraints. Participants on reservations or near IHS facilities preferred IHS over mainstream providers. Suggestions for improvement included caring technologists, better machines with less discomfort, and education. CONCLUSIONS Interventions to enhance the professionalism, empathy, and cultural awareness of mammogram technologists; reduce barriers; and provide positive expectations and incentives could improve satisfaction and compliance with screening mammography.
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Affiliation(s)
- Florence M Ndikum-Moffor
- Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, Kansas; University of Kansas Cancer Center, Kansas City, Kansas; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas.
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Morris NS, Field TS, Wagner JL, Cutrona SL, Roblin DW, Gaglio B, Williams AE, Han PJK, Costanza ME, Mazor KM. The association between health literacy and cancer-related attitudes, behaviors, and knowledge. JOURNAL OF HEALTH COMMUNICATION 2013; 18 Suppl 1:223-41. [PMID: 24093358 PMCID: PMC3815140 DOI: 10.1080/10810730.2013.825667] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Using a multidimensional assessment of health literacy (the Cancer Message Literacy Test-Listening, the Cancer Message Literacy Test-Reading, and the Lipkus Numeracy Scale), the authors assessed a stratified random sample of 1013 insured adults (40-70 years of age). The authors explored whether low health literacy across all 3 domains (n =111) was associated with sets of variables likely to affect engagement in cancer prevention and screening activities: (a) attitudes and behaviors relating to health care encounters and providers, (b) attitudes toward cancer and health, (c) knowledge of cancer screening tests, and (d) attitudes toward health related media and actual media use. Adults with low health literacy were more likely to report avoiding doctor's visits, to have more fatalistic attitudes toward cancer, to be less accurate in identifying the purpose of cancer screening tests, and more likely to avoid information about diseases they did not have. Compared with other participants, those with lower health literacy were more likely to say that they would seek information about cancer prevention or screening from a health care professional and less likely to turn to the Internet first for such information. Those with lower health literacy reported reading on fewer days and using the computer on fewer days than did other participants. The authors assessed the association of low health literacy with colorectal cancer screening in an age-appropriate subgroup for which colorectal cancer screening is recommended. In these insured subjects receiving care in integrated health care delivery systems, those with low health literacy were less likely to be up to date on screening for colorectal cancer, but the difference was not statistically significant.
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Affiliation(s)
- Nancy S. Morris
- University of Massachusetts Worcester, Graduate School of Nursing, Worcester, Massachusetts, USA
- Address correspondence to Nancy S. Morris, University of Massachusetts Worcester, GSN S1-853, 55 Lake Avenue North, Worcester, MA 01655, USA. E-mail:
| | - Terry S. Field
- University of Massachusetts Medical School, Worcester, Massachusetts, and Meyers Primary Care Institute, Worcester, Massachusetts, USA
| | - Joann L. Wagner
- Meyers Primary Care Institute, Worcester, Massachusetts, USA
| | - Sarah L. Cutrona
- University of Massachusetts Medical School, Worcester, Massachusetts, and Meyers Primary Care Institute, Worcester, Massachusetts, USA
| | | | - Bridget Gaglio
- Mid-Atlantic Permanente Research Institute/Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | | | - Paul J. K. Han
- Center for Outcomes Research and Evaluation, Portland, Maine, USA
| | - Mary E. Costanza
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kathleen M. Mazor
- University of Massachusetts Medical School, Worcester, Massachusetts, and Meyers Primary Care Institute, Worcester, Massachusetts, USA
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