Project Title: Replication of A Su Salud En Acción: Cooperative Agreements for Replication and Dissemination of Effective Breast and Cervical Cancer Health Education Interventions

Abstract:

The purpose of this project was to replicate the A Su Salud En Acción cancer prevention and control efforts in Hispanic communities. The ultimate goal of the replication is to increase the number of underserved Hispanic women who seek the services of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC). Historically, this project is a derivative of several previous studies. The A Su Salud Program extended from 1985 through 1990, and it applied social cognitive theories to reduce chronic disease and improve cancer control among Hispanics in South Texas. Then in 1992, The National Hispanic Leadership Initiative on Cancer (NHLIC): En Acción was developed to replicate the A Su Salud Program model, but it focused on diverse U.S. Hispanic populations in Texas, California, Florida and New York. In the A Su Salud En Acción program, we developed a replication package (i.e., training and instructional materials) and pilot tested it in a Texas/Mexico border site and an urban site in Nevada. Subsequently, it was implemented in only one site (Reno, NV). Our NBCCEDP partner personnel at each site have been trained to use public communication and peer networking to promote healthy behaviors (i.e., cancer risk reduction and increased Pap test and mammography screening) among NBCCEDP participants. Intervention methods include identifying community role models, publicizing them through mass media (TV, radio and newspapers) and promoting interpersonal communication using peer neighborhood networkers. Both academic and practical learning tools have been developed, and a small inventory of 25 copies of the replication package have been printed and are available through the contractor (University of Texas Health Science Center at San Antonio) for those interested in the program. The training package includes a project manual, appendices and video. An Internet website has also been developed that presents the program, its effects and recommendations for future applications. Program effectiveness has been monitored and evaluated throughout the program using management records, mass media content analysis, cancer screening participation (when available), and historical assessment of the replication process.

PI:

  • Amelie G. Ramirez, DrPH, Professor of Medicine and Deputy Director of the Chronic Disease Prevention and Control Research Center at Baylor College of Medicine

Funding Institution:

Centers for Disease Control and Prevention (CDC)

Funding Period:

4 yrs. – 1997-2001

Location/Service Area:

Laredo, TX; Las Vegas, NV; Reno, NV

Collaborators/Co-sponsors:

  • Texas Department of Health (National Breast and Cervical Cancer Early Detection Program [NBCCEDP] office)
  • Pilot Site #1: Laredo, Texas: Miguel Trevino, Director; Lowell Woodward, Chief Operating Officer; Rosaura Zapico, Program Coordinator, Gateway Community Health Center, Laredo, TX
  • Pilot Site #2: Las Vegas, Nevada: Fran Courtney, R.N., Director of Clinics and Nursing Services, Clark County Health District, Las Vegas, NV
  • Replication Site #1: Reno, Nevada: Susen Briganti/Nora Brashear, Coordinator, St. Mary’s Foundation and Corporate Relations, Reno, NV

Goals:

To replicate the A Su Salud En Acción cancer prevention and control efforts in Hispanic communities. The ultimate goal of the replication is to increase the number of underserved Hispanic women who seek the services of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC).

Results:

Laredo:

The Laredo site kickoff occurred in late 1998, and the project continued through September of 2000. This site had been identified and recruited to participate at the time of grant submission. Site criteria (especially those relating to local capacity) weren’t strictly applied due to their early support prior to funding. Additionally, it was hoped that we could persuade the state NBCCEDP office to increase funds to the site if we could prove need. Ultimately, we did not encourage the Gateway Clinic to continue the program since the NBCCEDP resources allotted to Laredo are exhausted every year with little or no promotion of services. This made the program difficult to fully roll out, as we didn’t want to bring more people to services than there were federal funds. For instance, from the onset we reduced our mass media activities (principally TV) and limited our messages to re-screening only, rather than first-time screening for breast and cervical cancer. Still, the clinic had to turn away a number of clients who thought the messages were encouraging general screening.

Secondly, the budget for this pilot was only $25,000; therefore, our performance objectives were set lower than those for the Nevada sites. On the other hand, we were fortunate to partner with an ongoing project sponsored by the Texas Tech University system that trained and employed a team of paid “Promotoras” to provide community action and clinic navigation services within several colonias where the project operated. This is a good example of the kinds of unique partnerships and linkages with other resources that this project took advantage of. To distinguish these two different but complementary community networkers, the peer networkers for the Salud En Acción program decided to call themselves “Corazones.” Regarding community outreach, the Salud En Acción program recruited over 170 Corazones (peer networkers), with 131 active networkers to date. An additional 20 Promotoras (paid peers who support the program but who are officially employed by Texas Tech, which operates social programs in the colonias) were active at the project’s conclusion. Of the sites that also distribute project small media (bulletins), small business (13), churches (7) and clinics (5) were the most active. Peer networker refresher sessions combined opportunities for leadership development, increased knowledge about breast and cervical cancer screening and social interaction. These sessions occurred quarterly. Community presentations (used to promote the program and recruit volunteers) were predictably low, as the purpose was to recruit volunteers and expand the network. Due to the constraints mentioned previously, the project’s goals of 100 Corazones and limited mass media were easier to maintain and didn’t require as many presentations. Regarding media production, small media (the project’s newsletter and a very small number of flyers from partner organizations) were produced and distributed monthly. Newsletter distribution averaged about 2000 per month, with distribution percentages as follows: Corazones 36%, Promotoras 22%, churches 16%, clinics 10%, small businesses 9.5%, with schools and community centers channeling the remaining 7%. Mass media relied on newsprint, with monthly stories featuring role models that discussed how they overcame barriers to breast and cervical cancer re-screening services. TV was avoided, as it tended to be received as a general screening story that, in turn, brought women to the clinic seeking NBCCEDP funded services that were not available. Administratively, staff meetings were conducted weekly.

Las Vegas

To summarize some of the most critical process data since inception of operations in November 1999, Las Vegas has recruited 144 peer networkers, of which 104 are currently active with 151 community sites, primarily small businesses, community centers and neighborhood associations contributing to the network where newsletters are distributed. Due to system challenges, it was decided to cap the number of volunteers to 140. Regarding media production, about 1500 bulletins are distributed each month, with 38,284 distributed to date. Peer networkers distribute almost 34%, small businesses 30% and community centers 19%. Regarding mass media, 173 news segments have been broadcast. The majority were produced by Univision (83%), the dominant Spanish language network. Twenty newspaper articles were published, and radio has had several talk show interviews, as well as running a PSA (which accounts for the high Radio Romantica number). Finally, the Salud En Acción program received a good amount of media coverage. Since June of 2000, the project has monitored the number of calls received by the program due to media and community outreach. Over the past 26 months, 3,561 calls were received due to the campaign. In terms of the media channel that leads to the call, TV accounted for 2,054 calls, newsletter 593, radio 327, program staff 280 and friends 131. Of those that called, 1,151 were referred for mammograms, and 3,100 were referred for Pap smears. The business of public health is typically underfunded, and this is the case in Las Vegas. Nonetheless, the project has been able to successfully increase service demand and expand the utilization of NBCCEDP resources as designed, especially among women over 50 years of age. More information on statewide screening services is available later in this section.

Reno:

This project was active until March 31, 2002, at which time the carry-over funds were depleted. Originally, funding would have ended on September 31, 2001. There are efforts underway to continue elements of the project (i.e., the newsletter) by converting it to a bulletin with no date reference. They are also considering including other health messages in the newsletter, such as immunization, diabetes and dental care aimed at under-insured Hispanic populations. Project staffing in Reno had remained stable, and the project continued to be very popular among community members and with the clinic staff until it ceased. While not all the performance objectives were met (i.e., less than 100 volunteers), the project was extremely well received in the community. Staff of the Saint Mary’s Redfield Clinic wrote several grant applications in an attempt to provide continued support for the community outreach model of health promotion used in the Salud En Acción project. At this time, none of the applications have been funded. Still, we are informed that staff is interested in trying to identify clinic outreach activities that might support the community health programs aimed at Latinos in Reno.

To summarize some of the most critical process data since inception of operations in February 2001, Reno recruited 76 peer networkers, of which 76 were active at the project’s conclusion. In addition, newsletters were also distributed through 66 community sites that were primarily small businesses (43), churches (7) community centers (6) and other Saint Mary’s Clinics (4). Due to staffing problems, it was decided to restrict the number of peer networkers to 75 persons. Regarding media production, about 840 bulletins were distributed each month with 24,303 distributed in all. Peer networkers distributed almost 26%, small businesses 38% and community centers 6%. Regarding mass media, 27 evening news segments were broadcast during the programs existence. The majority of the TV segments were produced by Univision (85%), the dominant Spanish language network. Eighteen newspaper articles were published, and radio was not used very much (17 programs). Since February 2001, the project has monitored the number of calls received by the program due to media and community outreach. Over the project’s 14 months of operation, 716 calls were received. In terms of communication channels that led to the calls, TV accounted for 181 calls, newsletters 112, radio 107, program staff 72 and friends 63. Of those that called, 146 were referred for mammograms, and 633 were referred for Pap smears.

Potential Impact:

This project increased breast and cervical cancer screening rates among Hispanic women in the intervention areas. It also gave our sponsoring organizations community alliances and networks that they can continue to use and build on as they address other public health issues in Nevada and Texas.

Publications: