Participatory Action Research to Build Better Cancer Prevention Navigation for African Americans

Project: Research project

Project Details

Description

Participatory Action Research to Build Better Cancer Prevention Navigation for African Americans Participatory Action Research to Build Better Cancer Prevention Navigation for African Americans Participatory Action Research to Build Better Cancer Prevention Navigation for African Americans Principal Investigator: Mignonne C. Guy, PhD, Research Associate, Mayo Clinic in Arizona Co-Principal Investigator: Linda Larkey, PhD, Professor, Arizona State University, College of Nursing and Health Innovation; Research Affiliate, Mayo Clinic in Arizona Colorectal cancer (CRC) incidence and mortality rates are highest among African Americans (AAs) when compared to all other racial/ethnic groups. This disparity is particularly concerning given that CRC is largely preventable through the use of endoscopy (screening colonoscopy or sigmoidoscopy), yet at less than 49%, the national rates of CRC screening among African Americans is, at best, suboptimal. As such, researchers have focused their efforts on the prevention of CRC through patient navigation (PN) services for colonoscopy screening. Although PN in clinical settings has been successful in increasing colonoscopy screening rates, the leaky pipeline of AAs into the clinics to receive these preventive services remains a barrier to decreasing this disparity. Drs. Linda Larkey (ASU) and Usha Menon (Ohio State) are co-PIs on an NIH funded study (abstract attached) designed to reach racial and ethnic minorities in low-income neighborhoods with low rates of colorectal cancer screening, teach a brief cancer prevention/screening class in community sites, and to navigate a randomized half of class participants into a local community health care center to receive stool-based CRC screening kits. Specific knowledge and culturally-grounded understandings of the barriers to navigation and CRC screening are less well-known for the African American communities in Arizona. During recent focus groups conducted with patients at one of the largest multi-site Federally Qualified Health Care Centers in Arizona, AA participants noted that despite this clinic being the most conveniently located facility, they would not seek care at the site because they dont serve us (Mountain Park Health Center Diversity and Inclusion Report, 2011); a perception likely attributable to the predominately Latino population of patients served at this site. As such, the community-to-clinic navigation cancer prevention process being tested for dissemination and how well it can bridge the gap between AA community members and their expected medical home will be important to understand. Using a social ecological framework to guide this work, the purpose of the proposed will be to conduct a one-year exploratory study to: 1) examine the interpersonal, intrapersonal, and community/contextual factors that are barriers and facilitators to CRC screening among AAs, and 2) explore AA perspectives on key attributes of culturally relevant and inclusive health care service provision (navigation through screening) for community-based programs that are designed to improve CRC screening rates within this population. Special emphasis will be placed on barriers to seeking cancer preventive services at a health care facility perceived to favor one ethnic group over another. Study activities in this, and the larger study, will result data that will inform 'best practices' for cancer prevention navigation for AAs that can be incorporated into an implementation and/or dissemination study at a later date. This study would represent a collaborative partnership between the Mayo Clinic in Arizona and Arizona State University, with a minimal investment. Methods A .50 FTE African American community to clinic navigator (AAN) will be hired and trained to assist in recruiting AAs into the larger study, to teach community CRC education classes, and to navigate participants from the local community to the nearest Mountain Park Health Center. In the context of this role, Dr. Guy will train and oversee the plans for the AAN to document the processes as the study progresses and maintain a journal of the experiences shared by study participants. Study participants will include those AAs that the AAN has recruited into the larger community to clinic navigation intervention study (N=76). Post-community and clinic navigation (16 weeks after educational intervention), study recruits will be invited to participate in one 2 hour focus group session (10 groups total). Focus groups will be stratified by gender to explore differences between the two groups. Participants will be offered a $40 gift card as a token of appreciation for their time. An interview guide will be used to organize the focus group discussions and Dr. Guy will be the primary moderator. Discussions will be digitally recorded and supplemented by field notes taken; immediately following discussions, summary reports will be generated to capture relevant contextual information or body language. Upon completion of sessions, data will be transcribed verbatim. Using a social ecological framework, a thematic content analysis approach to qualitative inquiry will be used to identify major themes and codes. Focus group interview transcripts and summaries will be reviewed using NVivo qualitative data management software. Prior to analysis, Drs. Guy and Larkey will determine coding labels and definitions. Dr. Guy will independently code transcripts and a predetermined percentage of transcripts will be cross-coded by Dr. Larkey to ensure intercoder reliability. In the event of disagreement between the investigators regarding coding labels, Drs. Guy and Larkey will meet to discuss reasons for disagreement and modified coding labels appropriately
StatusFinished
Effective start/end date6/1/1312/30/14

Funding

  • Mayo Clinic Arizona: $25,028.00

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