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Dignan M, Dwyer S, Cromo M, Geertz M, Bardhan R, Stockton E. Development and Evaluation of Patient Navigation Training for Rural and Appalachian Populations. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1077-1083. [PMID: 36396832 DOI: 10.1007/s13187-022-02234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 06/02/2023]
Abstract
The Appalachian region of the USA includes 423 counties in 13 states positioned along the spine of the Appalachian Mountains stretching from New York to Mississippi. Approximately 42% of Appalachia is rural, and while the economy of Appalachia has diversified over the past two decades from reliance on agriculture and coal mining, 176 (41.6%) of the 423 counties are classified as economically distressed or at-risk. Patient navigation (PN) has been shown to be effective as an approach to address multiple barriers and enhance access to healthcare services, and yet there are no known PN programs focusing on the Appalachian population. This project was designed to develop, implement, and evaluate a curriculum and training program for PN for cancer prevention and control in Appalachia. The training program was developed through formative evaluation and offered daylong workshops that provided instruction in 60-90-min modules. Workshop topics included an introduction to PN, Appalachian culture, community needs assessment, communication, financial navigation, and navigation for screening and diagnostic follow-up for breast, cervical, and colorectal cancers. A total of 20 workshops were conducted with 334 attendees. The workshops were evaluated using a mixed-method approach using pre- and posttests and participant evaluations. The overall mean posttest scores increased by 4% from pretest (p < 0.05). Evaluation also showed that attendees valued the focus on Appalachian culture and judged the content relevant and useful. Attendees also expressed interest in additional opportunities for similar workshops that expanded upon current topics and allowed for exploration of Appalachian health-related issues.
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Affiliation(s)
- Mark Dignan
- College of Medicine, Prevention Research Center, University of Kentucky, 760 Press Avenue, Room 335, Lexington, KY, 40536-0679, USA.
| | - Sharon Dwyer
- College of Medicine, Prevention Research Center, University of Kentucky, 760 Press Avenue, Room 335, Lexington, KY, 40536-0679, USA
| | - Mark Cromo
- College of Medicine, Prevention Research Center, University of Kentucky, 760 Press Avenue, Room 335, Lexington, KY, 40536-0679, USA
| | - Margaret Geertz
- Kentucky College of Osteopathic Medicine, Pikeville, KY, USA
| | | | - Eric Stockton
- Grantmakers in Health, (Formerly Appalachian Regional Commission, Washington, DC, USA), Washington, DC, USA
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Salyer C, Lee J, Lorvick J, Comfort M, Cropsey K, Smith S, Emerson A, Ramaswamy M. Cervical Cancer Prevention Behaviors Among Criminal-Legal Involved Women from Three U.S. Cities. J Womens Health (Larchmt) 2021; 31:533-545. [PMID: 34652231 PMCID: PMC9063145 DOI: 10.1089/jwh.2021.0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: This study aims to understand how criminal-legal involved women from three U.S. cities navigate different health resource environments to obtain cervical cancer screening and follow-up care. Methods: We conducted a cross-sectional study of women with criminal-legal histories from Kansas City KS/MO; Oakland, CA; and Birmingham, AL. Participants completed a survey that explored influences on cervical cancer prevention. Responses from all women with/without up-to-date cervical cancer screening and women with abnormal Pap testing who did/did not obtain follow-up care were compared. Proportions and associations were tested with chi-square or analysis of variance tests. Multivariable regression was performed to identify variables independently associated with up-to-date cervical cancer screening and reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: There were n = 510 participants, including n = 164 Birmingham, n = 108 Kansas City, and n = 238 Oakland women. Criminal-legal involved women in Birmingham (71.3%) and Kansas City (68.9%) were less likely to have up-to-date cervical cancer screening than women in Oakland (84.5%, p = 0.01). More women in Birmingham (14.6%) and Kansas City (16.7%) needed follow-up for abnormal Pap than women in Oakland (6.7%, p = 0.003), but there were no differences in follow-up rates. Predictors for up-to-date cervical cancer screening included access to a primary care provider (OR: 3.3, 95% CI: 1.4-7.7), health literacy (OR: 0.3, 95% CI: 0.2-0.7), and health behaviors, including avoiding tobacco (OR: 0.4, 95% CI: 0.1-0.9) and HPV vaccination (OR: 3.4, 95% CI: 1.0-10.9). Conclusions: Cervical cancer screening and follow-up varied by study site. The results suggest that patient level factors coupled with the complexity of accessing care in different health resource environments impact criminal-legal involved women's cervical cancer prevention behaviors.
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Affiliation(s)
- Chelsea Salyer
- Division of Gynecologic Oncology, University of Kansas, Kansas City, Kansas, USA
| | - Jaehoon Lee
- Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, Texas, USA
| | - Jennifer Lorvick
- Community Health and Implementation Research Program, RTI International, Berkeley, California, USA
| | - Megan Comfort
- Applied Justice Research Program, RTI International, Berkeley, California, USA
| | - Karen Cropsey
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sharla Smith
- Department of Population Health, University of Kansas, Kansas City, Kansas, USA
| | - Amanda Emerson
- School of Nursing, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas, Kansas City, Kansas, USA
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Robertson NM, Hudson L, Attia SL, Porterfield JZ, Vanderford NL. Assessing the Effectiveness of Cancer Screening Interventions Targeting Appalachian Populations: A Systematic Review. J Rural Health 2021; 37:602-623. [PMID: 33305886 PMCID: PMC9838639 DOI: 10.1111/jrh.12550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Appalachian residents have higher cancer prevalence and invasive cancer incidence in almost all cancer types relative to non-Appalachian residents. Public health interventions have been carried out to increase preventive cancer screening participation. However, no studies have evaluated the effectiveness of existing interventions targeting cancer screening uptake in this high-risk population. The main objective of this study is to assess the effectiveness of interventions aimed at increasing uptake and/or continuing participation in screened cancers (breast, cervical, colorectal, lung, and prostate) in Appalachia. METHODS We conducted a systematic review of electronic databases and gray literature using a combination of MeSH and free-text search terms related to breast, cervical, colorectal, lung, and prostate cancer; mass screening; health promotion; and Appalachia. We identified 3,014 articles of which 15 articles were included. We assessed methodological quality using validated tools and analyzed findings using narrative synthesis. FINDINGS Fifteen studies reported uptake and/or continued participation in screening interventions; these focused on cervical (n = 7), colorectal (n = 5), breast (n = 2), and lung (n = 1) cancers in Appalachia. Interventions included diverse components: mass media campaigns, community outreach events, community health workers, interpersonal counseling, and educational materials. We found that multi-strategy interventions had higher screening uptake relative to interventions employing 1 intervention strategy. Studies that targeted noncompliant populations and leveraged existing community-based organization partnerships had a substantial increase in screening participation versus others. CONCLUSIONS There is an urgent need for further research and implementation of effective cancer prevention and screening interventions to reduce disparities in cancer morbidity and mortality in Appalachian populations.
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Affiliation(s)
| | - Lauren Hudson
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Suzanna Labib Attia
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Kentucky College of Medicine, Lexington, Kentucky
| | - J. Zachary Porterfield
- Department of Internal Medicine, Division of Infectious Diseases, University of Kentucky College of Medicine, Lexington, Kentucky,Department of Otolaryngology-Head & Neck Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Nathan L. Vanderford
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky,Department of Toxicology & Cancer Biology, University of Kentucky College of Medicine, Lexington, Kentucky,Center of Health Equity Transformation, University of Kentucky College of Medicine, Lexington, Kentucky
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Kruse-Diehr AJ, Oliveri JM, Vanderpool RC, Katz ML, Reiter PL, Gray DM, Pennell ML, Young GS, Huang B, Fickle D, Cromo M, Rogers M, Gross D, Gibson A, Jellison J, Sarap MD, Bivens TA, McGuire TD, McAlearney AS, Huerta TR, Rahurkar S, Paskett ED, Dignan M. Development of a multilevel intervention to increase colorectal cancer screening in Appalachia. Implement Sci Commun 2021; 2:51. [PMID: 34011410 PMCID: PMC8136225 DOI: 10.1186/s43058-021-00151-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of "Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia," a 5-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics. METHODS Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs. RESULTS Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components. CONCLUSIONS Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years. TRIAL REGISTRATION Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020.
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Affiliation(s)
- Aaron J Kruse-Diehr
- University of Kentucky College of Public Health, Lexington, KY, USA.
- University of Kentucky Markey Cancer Center, Lexington, KY, USA.
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Mira L Katz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Paul L Reiter
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Darrell M Gray
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Michael L Pennell
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Gregory S Young
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Bin Huang
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - Darla Fickle
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Cromo
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - Melinda Rogers
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - David Gross
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Ashley Gibson
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | | | | | - Tonia A Bivens
- Lewis County Primary Care Center, Inc. dba PrimaryPlus, Vanceburg, KY, USA
| | - Tracy D McGuire
- Lewis County Primary Care Center, Inc. dba PrimaryPlus, Vanceburg, KY, USA
| | - Ann Scheck McAlearney
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Timothy R Huerta
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Saurabh Rahurkar
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Dignan
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
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Fuzzell LN, Perkins RB, Christy SM, Lake PW, Vadaparampil ST. Cervical cancer screening in the United States: Challenges and potential solutions for underscreened groups. Prev Med 2021; 144:106400. [PMID: 33388330 DOI: 10.1016/j.ypmed.2020.106400] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/09/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
Cervical cancer screening rates in the United States are generally high, yet certain groups demonstrate disparities in screening and surveillance. Individuals at greatest risk for cervical cancer are often from marginalized or underserved groups who do not participate in regular screening for a variety of reasons. Using the Population-based Research to Optimize the Screening Process (PROSPR) Trans-Organ Conceptual Model, including concepts of individual-, provider-, facility-, system-, or policy-level factors, we provide a commentary to highlight reasons for low screening participation among subgroups in the U.S. These include racial and ethnic minorities, rural residents, sexual and gender minorities, those with limited English proficiency, those with particular religious beliefs, and various health conditions. We describe barriers and offer potential solutions for each group. In addition, we discuss cross-cutting barriers to screening including difficulty interacting with the healthcare system (limited knowledge and health literacy, lack of provider recommendation/contact), financial (cost, lack of insurance), and logistical barriers (e.g., lack of usual source of care, competing demands, scheduling issues). Solutions to address these barriers are needed to improve screening rates across all underscreened groups. Changes at state and national policy levels are needed to address health insurance coverage. Mobile screening, ensuring that interpreters are available for all visits, and targeted in reach at non-gynecological visits can further overcome barriers. Employing community outreach workers can increase community demand for screening, and patient navigators can improve adherence to both screening and follow-up diagnostic evaluation. HPV self-sampling can address multiple barriers to cervical cancer screening.
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Affiliation(s)
- Lindsay N Fuzzell
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America.
| | - Rebecca B Perkins
- Boston University School of Medicine, 85 E. Concord St., Boston, MA 02118, United States of America
| | - Shannon M Christy
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America
| | - Paige W Lake
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America
| | - Susan T Vadaparampil
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America.
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Mboineki JF, Wang P, Chen C. Fundamental Elements in Training Patient Navigators and Their Involvement in Promoting Public Cervical Cancer Screening Knowledge and Practices: A Systematic Review. Cancer Control 2021; 28:10732748211026670. [PMID: 34169777 PMCID: PMC8236772 DOI: 10.1177/10732748211026670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/23/2021] [Accepted: 05/30/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical cancer screening remains unsatisfactory in some regions due to hindrances. This study aims to explore fundamental elements in training patient navigators and their involvement in promoting screening knowledge and practices. METHODS This systematic review study included only English published articles between 2014 and 2019 from PubMed/Medline, EBSCO, Science Direct, and Wiley online library. RESULTS Healthcare professionals trained patient navigators in 3 days regarding screening basics, along with group discussions and role-plays. They delivered effective health education and navigation assistance. CONCLUSION The group education session facilitated by patient navigators, coupled with navigation care, resulted in a high screening rate.
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Affiliation(s)
- Joanes Faustine Mboineki
- First Affiliated Teaching Hospital of Zhengzhou University, Zhengzhou, Henan, China
- School of Nursing, Zhengzhou University, Zhengzhou, China
- College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Panpan Wang
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Changying Chen
- First Affiliated Teaching Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Zoellner J, Porter K, Thatcher E, Kennedy E, Werth JL, Grossman B, Roatsey T, Hamilton H, Anderson R, Cohn W. A Multilevel Approach to Understand the Context and Potential Solutions for Low Colorectal Cancer (CRC) Screening Rates in Rural Appalachia Clinics. J Rural Health 2020; 37:585-601. [PMID: 33026682 DOI: 10.1111/jrh.12522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To explore system/staff- and patient-level opportunities to improve colorectal cancer (CRC) screening within an 11-clinic Federally Qualified Health Center (FQHC) in rural Appalachia with CRC screening rates around 22%-30%. METHODS Using a convergent parallel mixed-methods design, staff (n = 26) and patients (n = 60, age 50-75, 67% female, 83% <college, 47% Medicare, 23% Medicaid) were interviewed about CRC-related screening practices. Staff and patient interviews were guided by the Consolidated Framework for Implementation Research and Health Belief Model, respectively, and analyzed using a hybrid inductive-deductive approach. RESULTS Among staff, inner setting factors that could promote CRC screening included high workplace satisfaction, experiences tracking other cancer screenings, and a highly active Performance Improvement Committee. Inner setting hindering factors included electronic medical record inefficiencies and requiring patients to physically return fecal tests to the clinic. Outer setting CRC screening promoting factors included increased Medicaid access, support from outside organizations, and reporting requirements to external regulators, while hindering factors included poor social determinants of health, inadequate colonoscopy access, and lack of patient compliance. Among patients, perceived screening benefits were rated relatively higher than barriers. Top barriers included cost, no symptoms, fear, and transportation. Patients reported high likelihood of getting a stool-based test and colonoscopy if recommended, yet self-efficacy to prevent CRC was considerably lower. CONCLUSIONS Contextualized perceptions of barriers and practical opportunities to improve CRC screening rates were identified among staff and patients. To optimize multilevel CRC screening interventions in rural Appalachia clinics, future quality improvement, research, and policy efforts are needed to address identified challenges.
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Affiliation(s)
- Jamie Zoellner
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Kathleen Porter
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Esther Thatcher
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Erin Kennedy
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - James L Werth
- Stone Mountain Health Services, Damascus, Virginia.,Tri-Area Community Health, Laurel Fork, Virginia
| | - Betsy Grossman
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | | | | | - Roger Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
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Elewonibi B, Nkwonta C. The association of chronic diseases and mammography among Medicare beneficiaries living in Appalachia. ACTA ACUST UNITED AC 2020; 16:1745506520933020. [PMID: 32538325 PMCID: PMC7297020 DOI: 10.1177/1745506520933020] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study assessed the relationship between presence and number of chronic disease and reception of mammogram in women 65 years and older, and how this relationship is influenced by primary care provider visits. METHODS A total of 3306 women diagnosed with breast cancer from 2006 to 2008 from cancer registries in four Appalachian states were analyzed. RESULTS Having a mammogram within the past 2 years was associated with having at least one chronic disease. The presence of a chronic disease was associated with an increased likelihood of breast cancer screening adherence but was not a strong predictor when demographic variables were added. CONCLUSION This study supports the findings that women with more primary care provider visits were more likely to adhere to breast cancer screening guidelines but having several chronic diseases presents a barrier to achieving guideline-concordant mammography screening, highlighting the importance of preventive screening for patients managing chronic diseases.
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Affiliation(s)
- Bilikisu Elewonibi
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chigozie Nkwonta
- Smart State Center for Heathcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Mitchell EM, Lothamer H, Garcia C, Marais AD, Camacho F, Poulter M, Bullock L, Smith JS. Acceptability and Feasibility of Community-Based, Lay Navigator-Facilitated At-Home Self-Collection for Human Papillomavirus Testing in Underscreened Women. J Womens Health (Larchmt) 2019; 29:596-602. [PMID: 31532298 DOI: 10.1089/jwh.2018.7575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective: Women without regular health care providers or a medical home routinely fail to complete recommended cervical cancer screening. At-home self-collection of samples to test for high-risk strains of human papillomavirus (hrHPV) can improve screening rates. This study documents acceptability and feasibility of community lay navigator (LN)-facilitated at-home self-collection for underscreened women in Appalachian Virginia. Materials and Methods: This study used mixed methods in three phases. Phase I involved focus groups of LNs to ensure cultural acceptability of self-collection, and to enhance recruitment of medically underserved women. An environmental scan of community resources and climate was created in Phase II. During Phase III, underscreened women in Appalachian Virginia (the far southwest corner of Virginia) were recruited to complete hrHPV testing using LN-provided self-collection kits. Results: LN-facilitated at-home self-collection for HPV testing was deemed culturally acceptable and feasible to participants in this community-based pilot study. Self-kit training included 64 LNs, of which 35 engaged in the study and were provided 77 kits and instructions. A total of 59 self-kits were returned, of which 42 were correctly completed with valid HPV results, yielding a 16.6% hrHPV rate. Conclusions: Over a quarter of the women LNs recruited had no medical home, indicating this delivery model may have potential to reach women at increased risk of being underscreened for cervical cancer. Research is needed to identify optimal approaches to increase LN participation in outreach self-collection interventions.
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Affiliation(s)
| | - Heather Lothamer
- Office of Clinical Research, UVA Cancer Center, University of Virginia Health System, Charlottesville, Virginia
| | - Christine Garcia
- Gynecologic Oncology Department, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Andrea Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill North Carolina
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Melinda Poulter
- Clinical Microbiology, Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - Linda Bullock
- University of Virginia School of Nursing, Charlottesville, Virginia
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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10
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Cerentini TM, Schlöttgen J, Viana da Rosa P, La Rosa VL, Vitale SG, Giampaolino P, Valenti G, Cianci S, Macagnan FE. Clinical and Psychological Outcomes of the Use of Vaginal Dilators After Gynaecological Brachytherapy: a Randomized Clinical Trial. Adv Ther 2019; 36:1936-1949. [PMID: 31209699 PMCID: PMC6822871 DOI: 10.1007/s12325-019-01006-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the dimensions of the vaginal canal in patients undergoing gynaecological brachytherapy and the effect of the use of vaginal dilators (VD) used in the follow-up of pelvic physiotherapy. METHODS A total of 88 patients were randomly allocated to the control group (CG) and intervention group (IG). Three evaluations were performed: pre-brachytherapy, post-brachytherapy and follow-up of 3 months. The CG received standard guidance from the health team while the IG was instructed to use VD for 3 months. The dimensions of the vaginal canal (main outcome) were defined by the length of the vagina (centimetres), width (number of full clockwise turns of the opening thread of a gynaecological speculum) and area (defined by the size of the VD). Quality of life and pelvic floor (PF) functionality were also evaluated. RESULTS There was no effect of the VD on vaginal length, width and area among the intention-to-treat (ITT) population. However, in the analysis stratified by adhesion, the CG had a significant decrease in the vaginal area. PF was predominantly hypoactive throughout the follow-up. Quality of life improved in both groups, but the reduction of constipation, vaginal dryness and stress urinary incontinence manifested only in the IG. CONCLUSION The use of VD did not alter the dimensions of the vaginal canal within the first 3 months after the end of radiotherapy treatment. However, there was a large sample loss during follow-up so studies with a larger sample number and longer follow-up time need to be conducted. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03090217.
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Affiliation(s)
| | - Júlia Schlöttgen
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | | | - Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Stefano Cianci
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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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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Community-Based Screening for Cervical Cancer: A Feasibility Study of Rural Appalachian Women. Sex Transm Dis 2016; 42:607-11. [PMID: 26462184 DOI: 10.1097/olq.0000000000000365] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe women's comfort levels and perceptions about their experience self-collecting cervicovaginal swabs for human papillomavirus (HPV) testing, to determine whether nurse-guided patient navigation increases the odds of women receiving a traditional Papanicolaou (Pap) test after HPV screening, and to test the hypothesis that women testing positive for oncogenic HPV would be more likely to have a subsequent Pap test than those testing negative. METHODS A total of 400 women were recruited from 8 rural Appalachian counties, in 2013 and 2014. After completing a survey, women were provided instructions for self-collecting a cervicovaginal swab. Specimens were tested for 13 oncogenic HPV types. Simultaneously, women were notified of their test results and offered initial navigation for Pap testing. Chart-verified Pap testing within the next 6 months served as the end point. RESULTS Comfort levels with self-collection were high: 89.2% indicated that they would be more likely to self-collect a specimen for testing, on a regular basis, compared with Pap testing. Thirty women (7.5%) had a follow-up Pap test. Women receiving added nurse-guided navigation efforts were significantly less likely to have a subsequent test (P = 0.01). Women testing positive for oncogenic HPV were no more likely than those testing negative to have a subsequent Pap test (P = 0.27). Data were analyzed in 2014. CONCLUSIONS Rural Appalachian women are comfortable self-collecting cervicovaginal swabs for HPV testing. Furthermore, efforts to recontact women who have received an oncogenic HPV test result and an initial navigation contact may not be useful. Finally, testing positive for oncogenic HPV may not be a motivational factor for subsequent Pap testing.
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Schoenberg NE, Eddens K, Jonas A, Snell-Rood C, Studts CR, Broder-Oldach B, Katz ML. Colorectal cancer prevention: Perspectives of key players from social networks in a low-income rural US region. Int J Qual Stud Health Well-being 2016; 11:30396. [PMID: 26905402 PMCID: PMC4764956 DOI: 10.3402/qhw.v11.30396] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 12/26/2022] Open
Abstract
Social networks influence health behavior and health status. Within social networks, “key players” often influence those around them, particularly in traditionally underserved areas like the Appalachian region in the USA. From a total sample of 787 Appalachian residents, we identified and interviewed 10 key players in complex networks, asking them what comprises a key player, their role in their network and community, and ideas to overcome and increase colorectal cancer (CRC) screening. Key players emphasized their communication skills, resourcefulness, and special occupational and educational status in the community. Barriers to CRC screening included negative perceptions of the colonoscopy screening procedure, discomfort with the medical system, and misinformed perspectives on screening. Ideas to improve screening focused on increasing awareness of women's susceptibility to CRC, providing information on different screening tests, improving access, and the key role of health-care providers and key players themselves. We provide recommendations to leverage these vital community resources.
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Affiliation(s)
- Nancy E Schoenberg
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA;
| | - Kathryn Eddens
- Department of Health Behavior, University of Kentucky, Lexington, KY, USA
| | - Adam Jonas
- Gatton School of Business and Economics, University of Kentucky, Lexington, KY, USA
| | - Claire Snell-Rood
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Christina R Studts
- Department of Health Behavior, University of Kentucky, Lexington, KY, USA
| | | | - Mira L Katz
- College of Public Health, The Ohio State University, Columbus, OH, USA
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Collins T, Stradtman LR, Vanderpool RC, Neace DR, Cooper KD. A Community-Academic Partnership to Increase Pap Testing in Appalachian Kentucky. Am J Prev Med 2015; 49:324-30. [PMID: 26190807 PMCID: PMC4753790 DOI: 10.1016/j.amepre.2015.04.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Appalachian Kentucky is recognized for elevated rates of cervical cancer, which exerts an undue burden in this medically underserved region. The purpose of this study was to examine the impact of an academic-community partnership, specifically a regional health department and a CDC Prevention Research Center, in conducting outreach aimed at improving Pap testing rates and examining barriers among under-screened women in Appalachian Kentucky. Differences between women with abnormal and negative results were also examined. METHODS The Prevention Research Center provided technical assistance to the district health department that, in turn, hosted "Women's Health Day" events at county health departments, providing incentives to women who had never had a Pap test or those who had not received one in at least 3 years to receive guideline-recommended screening. RESULTS From 2011 to 2014, 317 women were screened for cervical cancer; data were analyzed in 2014. The mean age was 42.1 (SD=13.6) years. More than half (54.5%) of the sample reported high school as their highest level of education, and 57.7% had an annual household income of <$25,000. The most commonly reported barriers to Pap testing were cost (28.4%) and lack of a perceived need for screening (25.6%). Approximately one in five (21.7%) women received abnormal Pap results. CONCLUSIONS As a result of this community-academic public health partnership and its shared resources, Appalachian Kentucky women received needed cervical cancer screening and appropriate follow-up for abnormal results, thereby increasing this population's compliance with guideline-recommended screening.
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Affiliation(s)
- Tom Collins
- Rural Cancer Prevention Center, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Lindsay R Stradtman
- Rural Cancer Prevention Center, University of Kentucky College of Public Health, Lexington, Kentucky.
| | - Robin C Vanderpool
- Department of Health Behavior, University of Kentucky College of Public Health, Lexington, Kentucky
| | | | - Karen D Cooper
- Kentucky River District Health Department, Hazard, Kentucky
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