Mammography Screening for Latinas with Diabetes
| Institution: | Golden Valley Health Centers | ||
| Investigator(s): |
Christine Noguera , M.S. -
Stergios Roussos , PhD, MPH -
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| Award Cycle: | 2006 (Cycle 12) | Grant #: 12AB-1900 | Award: $110,332 |
| Award Type: | CRC Pilot Award | ||
| Research Priorities | |||
| Disparities>Disparities: eliminating the unequal burden of breast cancer | |||
This is a collaboration with: 12AB-1901 -
Initial Award Abstract (2006)
Background: Latinas experience health disparities in both breast cancer and diabetes. Latinas have a lower survival rate than non-Latina white women, due predominantly to later diagnosis. Latino mortality rates of Type 2 diabetes are 1.5 times higher than non-Latino groups. Breast cancer and diabetes are linked in two ways that may be used to reduce disparities for both illnesses for Latinas. First, obesity/overweight and inactivity – both preventable – are leading risk factors for both breast cancer and diabetes for Latinas. Second, women with diabetes are less likely to receive age-appropriate mammography despite more health visits (where the complexity of caring for chronic illness is predicted to interfere with mammography). Hypothesis/Questions addressed: This Collaborative Pilot Award project will assist an existing community health center and researcher partnership to improve cultural and linguistically appropriate services (CLAS) in the Central Valley, home to one of the highest concentrations of Latinos in the USA. The Pilot Award will build on the team’s experience in CLAS to establish the infrastructure for outcomes research for known health disparities. The Pilot Award project will develop and test an intervention that adds breast cancer prevention to an evidence-based, culturally-tailored Diabetes Program serving Latinas in order to improve mammography. The Specific Aims of this Pilot Award are:
1. Develop an intervention that incorporates breast cancer prevention into the evidence-based GVHC Diabetes Program in a manner that is consistent with the Diabetes Program’s tailoring to cultural of Latinos with attention to patients with limited English proficiency.
2. Assess differential change in mammography compliance for Latinas age 40 and over participating in the Diabetes Program alone with those participating in the pilot Diabetes + Breast Cancer Detection Program.
3. Identify and prepare the programmatic/intervention components, research components, and infrastructure of the community-research partnership necessary to apply and successfully implement a Full Award. Methods: A Collaborative Team will consist of GVHC and SDSU staff and a Community Research Action Group (CRAG) representing community members with a stake in breast cancer, diabetes, and health disparities. The Team will review and refine elements of the healthcare “team” driven Diabetes Program: modify the diabetes registry to track and prompt for age-appropriate mammography, modify monthly mailers so that culturally tailored education and reminders include breast cancer prevention (while avoiding stigma and fear related to mammography) and train the Diabetes Program team to comply and support breast cancer screening guidelines. Once developed, the intervention will be tested by comparing changes in mammography among women age 40 and over with the Diabetes Program alone (site 1) compared to women in the Diabetes + Breast Cancer Detection Program. Diabetes Program participation rates and self-management variables (e.g., meeting self-care goals, Hb levels) will be tracked to assess potential positive or negative influences related to the addition of the breast cancer component. The Pilot project will provide information on intervention appropriateness and feasibility, ideal recruitment and retention strategies, estimated effect size, and protocols that would support planning and implementation of a Full Award to assess the efficacy of the intervention. Impact on breast cancer: Health disparities for mammography for Latinas are correlated with cultural and linguistic factors, such as fear due to equating a mammogram with death, and lack of trust and poor communication with healthcare staff. Given that over 25% of Latinas have diabetes, adaptation of diabetes care to take advantage of the more frequent visits and opportunities to strengthen patient-provider relationship may allow for a quick and non-threatening way to improve mammography for Latinas. This may result in earlier detection of cancer, which is currently not occurring for Latinas as with non-Latina white women, and which contributes to lower survival rates. Community involvement: Women of Courage, a nonprofit, grassroots group led by breast cancer survivors including GVHC staff, serves Merced County women who may be too young to receive insurance-subsidized mammography and/or have other barriers to screening and treatment. Women of Courage participated in the design of this Pilot Award proposal and will lead a Community Research Action Group during the Pilot Award. The CRAG will involve women with a stake in breast cancer, diabetes and health disparities in our community in active and meaningful partnership with the research and community healthcare agency in all facets of the Pilot Award.
Progress Report 1 (2006)
Breast cancer and diabetes are among two of the main illnesses for which Latino women have a high mortality rate representing a central focus in the reduction of health disparities. The GVHC-CBEACH team is partnering with a community-based breast cancer prevention organization, Women of Courage (WOC), to adapt GVHC’s diabetes program to include culturally and linguistically appropriate mammography intervention for Latinas with diabetes age 40 and older. A quasi-experimental pilot study will evaluate the intervention and develop the research infrastructure and information needed to propose a 3-year full award for an experimental assessment of the intervention effects to increase mammography for Latinas with diabetes. Progress was made in all three specific aims. An intervention to improve mammography screening within the existing diabetes program was developed through a review of the published literature and review of GVHC procedures and services for mammography and diabetes (Aim 1). Intervention components include: diabetes progress note with a prompt for an annual gynecological exam (which includes mammography), brief presentation on mammography guidelines and cultural and linguistic factors regarding screening Latinas, life-size talking poster in the waiting room, and mammography photo-novella. Initial measures were conducted to identify participants (Latinas over 40 with diabetes) in the two participating sites and the culturally-tailored baseline survey was developed and initiated (Aim 2). Infrastructure development and preparations for future research included: recruitment of research-trained coordinator, establishment of a functioning Community Advisory Board (CAG), and enhancing project decision-making based on data and evaluation findings. Major barriers involved the development of more systematic procedures and of volunteer and staff training. The recruitment of community members on the CAG, especially women who may have experienced cultural and linguistic barriers, took longer than expected and requires ongoing attention. Training of GVHC staff to conduct interviews and ensuring the importance of this was also challenging, but successfully accomplished over time. Lastly, preliminary assessment showed that fewer patients see health educators as often as was anticipated in the original research plan. Therefore, the study has reduced the role of health educators as part of the intervention. The major accomplishments surrounded establishing and implementing a strong partnership between the healthcare and research partners with the community organization (Women of Courage, WOC) leading the CAG. A significant amount of time was dedicated to co-understanding and implementing participatory research methods in the development of the intervention and baseline measurement. This has included pilot testing intervention and measurement tools with the community through the help of the community partner. In a similar manner, the project team spent time with clinical leaders and staff in GVHC to ensure that intervention and measurement procedures would fit in well and not disrupt existing healthcare services. The study is successfully on track and there is a good sense of support from the clinical partner (GVHC) and community partner (WOC) for understanding and participating in breast cancer research. The project is currently assessing baseline measures (e.g., mammography screening and related risk factors with a focus on culture and language barriers). The intervention phase will begin by July. Depending on preliminary findings, the project team aims to submit a letter of intent and proposal for a full award in the 2008 funding cycle.
