Investigators united with national and state organizations in both Mississippi and Alabama and established statewide coalitions. In Mississippi, the DSN investigators partnered with the Mississippi State Department of Health and wrote a CDC-funded 5-year planning grant to develop the state’s first cancer plan. Moreover, the Mississippi Partnership for Comprehensive Cancer Control was established as a statewide coalition of organizations interested in reducing the burden of cancer in the state, with a DSN investigator as the first chair. In Alabama, the Alabama Partnership for Cancer Control in the Underserved was established as a nonprofit organization to build capacity for cancer control in the state.
A second tier of coalitions, coalitions on a community level, was developed by the CHAs within their communities. By partnering with other community groups interested in reducing health disparities, the CHAs disseminated their cancer-control messages more efficiently and on a larger scale than they would have by working independently. The community groups included local staff and volunteers from the American Cancer Society, health-care providers and organizations, African American sororities and fraternities, faith-based organizations, small business owners, and the National Cancer Institute’s Cancer Information Service. As a result of efforts of DSN staff and CHAs in 1 rural community in the Mississippi Delta, the Fannie Lou Hamer Cancer Foundation was established. (Ms. Hamer was a civil rights leader from the Mississippi Delta who fought for voting rights and died from breast cancer.) This is a significant reflection of the strong heritage and empowerment of African American CHAs in the Mississippi Delta.
The DSN recruited and trained 883 volunteer CHAs in Alabama and Mississippi to promote cancer awareness, recruit for clinical trials, and assist with community-based research. The mean age of the CHAs was 45 years, 97% of them were African American, 94% were women, 76% were high-school graduates or higher. From 2001 to 2004, CHAs organized and participated in 740 activities. They were involved in 176 health fairs and 72 church events and made 100 health presentations.
Additionally, CHAs assisted in recruitment to the National Cancer Institute–funded Prostate, Lung, Colon, and Ovarian Cancer Screening Trial at the University of Alabama at Birmingham. More than 1,000 African Americans were recruited to the trial in Alabama. CHAs are currently participating in recruitment to the National Lung Study Trial, retention of subjects in an industry-sponsored Human Papilloma Virus vaccine trial at the University of Alabama at Birmingham, and recruitment to the SELECT prostate cancer prevention trial in the Delta.
REACH 2010 established the Alabama Breast and Cervical Cancer Control Coalition with 19 coalition members across the state. This multidisciplinary, ethnically diverse coalition included 2 academic institutions, 3 state institutions, and a number of faith-based and community-based organizations. The coalition was successful in maintaining 95% of its members during the course of this 7-year effort.
The coalition identified individual, community-system, and health-care provider barriers to early detection and treatment of breast and cervical cancer and developed a community action plan to: (1) address barriers to participation in breast and cervical cancer screening on individual, system, and agents-of-change levels; (2) train volunteers as CHAs to implement the intervention; and (3) identify and train church and health-care representatives from each county to serve as advocates for the project and support the efforts of CHAs.
To complement the local, grassroots efforts of the CWG members and to further spread breast and cervical cancer awareness messages among the agents of change, the coalition awarded 45 mini-grants to nonprofit organizations interested in promoting the mission and goals of the REACH 2010. The REACH 2010 coalition enrolled 215 volunteers: 143 CHAs, 49 church representatives, and 23 health professionals; their mean age was 54 years; 96% of them were African American, 95% were women, and 60% were high-school graduates or higher. The CHAs identified 2,333 women eligible to participate in the breast and cervical cancer screening program, and 1,539 women were followed through the multiyear intervention.
The CHAAP study established partnerships with 6 major health-care networks or treatment facilities in 4 targeted counties. Thirty-eight community volunteers were recruited and trained as CHA navigators. All volunteers were African American, 97% were women, mean age 45 years, and 65% had a high-school education or higher. One hundred forty-seven women diagnosed with breast cancer or positive mammogram screening results were enrolled as patients. Of them, 65% had a confirmed diagnosis of breast cancer and 25% had abnormal mammograms; 92% were African American; 73% had annual income less than $10,000; 32% were separated or divorced; 52% were unemployed; 22% had no insurance coverage at all, and 52% had Medicare or Medicaid.
The CHA navigators identified the following barriers faced by patients: 72% of patients required more information about breast cancer, 57% had financial needs, 67% needed emotional support, 61% asked for help with hospital navigation, 52% were in need of social support, 44% needed transportation to facilities, and 31% had barriers resulting from religous beliefs. Of a total 1,384 appointments, navigators were successful in helping patients overcome barriers and keep 1,286 of their appointments, resulting in a 93% compliance rate.