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1.  The Role of Family History of Cancer on Cervical Cancer Screening Behavior in a Population-Based Survey of Women in the Southeastern United States 
Background
The objective was to determine the association of self-reported family history of cancer (FHC) on cervical cancer screening to inform a potential link with cancer preventive behaviors in a region with persistent cancer disparities.
Methods
Self-reported FHC, Pap test behavior, and access to care were measured in a statewide population-based survey of human papillomavirus (HPV) and cervical cancer (n=918). Random-digit dial, computer-assisted telephone interviews (CATI) were used to contact eligible respondents [adult (18–70) women in South Carolina with landline telephones]. Logistic regression models were estimated using STATA 12.
Findings
While FHC+ was not predictive (OR=1.17, 95% CI 0.55, 2.51), private health insurance (OR=2.35, 95% CI 1.15, 4.81) and younger age (18–30 years: OR=7.76, 95% CI 1.91, 3.16) were associated with recent Pap test behavior. Family history and cervical cancer screening associations were not detected in the sample.
Conclusions
Findings suggest targeting older women with screening recommendations and providing available screening resources for underserved women.
doi:10.1016/j.whi.2013.03.003
PMCID: PMC3700594  PMID: 23722075
2.  Provider Communication and Role Modeling Related to Patients' Perceptions and Use of a Federally Qualified Health Center-based Farmers' Market 
Health promotion practice  2013;15(2):288-297.
Farmers’ markets have the potential to improve the health of underserved communities, shape people’s perceptions, values, and behaviors about healthy eating, and serve as a social space for both community members and vendors. This study explored the influence of health care provider communication and role modeling for diabetic patients within the context of a farmers’ market located at a federally qualified health center (FQHC). Although provider communication about diet decreased over time, communication strategies included: providing patients with “prescriptions” and vouchers for market purchases; educating patients about diet; and modeling healthy purchases. Data from patient interviews and provider surveys revealed that patients enjoyed social aspects of the market including interactions with their health care provider, and providers distributed prescriptions and vouchers to patients, shopped at the market, and believed the market had potential to improve the health of FHQC staff and patients. Provider modeling of healthy behaviors may influence patients’ food-related perceptions and dietary behaviors.
doi:10.1177/1524839913500050
PMCID: PMC3871943  PMID: 23986503
federally qualified health center; farmers’ market; diabetes; obesity prevention; patient-provider communication; communication intervention
3.  Program Planners’ Perspectives of Promotora Roles, Recruitment, and Selection 
Ethnicity & health  2012;18(3):262-279.
Objective
Program planners work with promotoras (the Spanish term for female community health workers) to reduce health disparities among underserved populations. Based on the Role-Outcomes Linkage Evaluation Model for Community Health Workers (ROLES) conceptual model, we explored how program planners conceptualized the promotora role and the approaches and strategies they used to recruit, select, and sustain promotoras.
Design
We conducted semi-structured, in-depth interviews with a purposive convenience sample of 24 program planners, program coordinators, promotora recruiters, research principal investigators, and other individuals who worked closely with promotoras on United States-based health programs for Hispanic women (ages 18 and older).
Results
Planners conceptualized the promotora role based on their personal experiences and their understanding of the underlying philosophical tenets of the promotora approach. Recruitment and selection methods reflected planners’ conceptualizations and experiences of promotoras as paid staff or volunteers. Participants described a variety of program planning and implementation methods. They focused on sustainability of the programs, the intended health behavior changes or activities, and the individual promotoras.
Conclusion
To strengthen health programs employing the promotora delivery model, job descriptions should delineate role expectations and boundaries and better guide promotora evaluations. We suggest including additional components such as information on funding sources, program type and delivery, and sustainability outcomes to enhance the ROLES conceptual model. The expanded model can be used to guide program planners in the planning, implementing, and evaluating of promotora health programs.
doi:10.1080/13557858.2012.730605
PMCID: PMC3901517  PMID: 23039847
4.  Preparing Promotoras to Deliver Health Programs for Hispanic Communities: Training Processes and Curricula 
Health promotion practice  2012;14(3):10.1177/1524839912457176.
Training is an essential component of health programs that incorporate promotoras de salud (the Spanish term for community health workers) in the delivery of health education and behavioral interventions to Hispanics. During training sessions, promotoras are exposed to information and skill-building activities they need to implement the health programs. This analysis was one component of a broader study which explored program planners' approaches to recruiting and training promotoras to deliver and sustain health promotion programs for Hispanic women. The purpose of this study was to examine promotora-curriculum and training processes used to prepare promotoras to deliver health programs. The authors examined transcripts of 12 in-depth interviews with program planners and conducted a content analysis of seven different training materials used in their respective promotora programs. Interview themes and narratives included program planners' varying conceptualizations of promotora-training, including their personal definitions of “training the trainer,” the practice of training a cadre of promotoras before selecting those best fit for the program, and the importance of providing goal-directed, in-depth training and supervision for promotoras. The content analysis revealed a variety of strategies used to make the training materials interactive and culturally competent. Study implications describe the importance of planners' provision of ongoing, goal-directed, and supervised training using both appropriate language and interactive methods to engage and teach promotoras.
doi:10.1177/1524839912457176
PMCID: PMC3876408  PMID: 22982761
community health workers; curriculum; cultural competence; interviews; content analysis
5.  Sustainability of promotora initiatives: Program planners’ perspectives 
Journal of public health management and practice : JPHMP  2013;19(5):10.1097/PHH.0b013e318280012a.
The use of promotoras de salud is an increasingly widespread delivery approach for community-based health education and promotion programs targeting obesity-related lifestyle behaviors for Hispanic populations. Addressing a gap in the literature, this research examined the sustainability of promotora-led initiatives from the perspectives of those who plan, implement, and evaluate these programs. We conducted 24 in-depth interviews with program planners representing 22 promotora programs focused on Hispanic women’s health in ten states. Findings illustrated program planners’ opinions regarding the components, logistics, and barriers to promotora program sustainability. Several participants challenged the notion of promotora program sustainability by reframing the issue as promoting individual promotoras’ well-being and social mobility rather than maintaining their role in the program over time. Implications for community health planning, management, and policy include developing sustainability strategies during program planning stages and implementation of policies to more effectively integrate promotoras into existing healthcare systems at local, state, and national levels.
doi:10.1097/PHH.0b013e318280012a
PMCID: PMC3827959  PMID: 23295409
6.  Assessing the Influence of Health Literacy on HIV-Positive Women’s Cervical Cancer Prevention Knowledge and Behaviors 
Women living with HIV (WLH) bear a disproportionate burden of cervical cancer and may face challenges understanding health information. The purpose of this study was to assess the influence of health literacy on WLH cervical cancer screening knowledge and behaviors. WLH were recruited from clinic- and community-based settings in the southeastern USA. The majority of women completing a questionnaire assessing factors related to cervical cancer were African American (90 %). About 38 % of women reported low health literacy. Compared to women with high health literacy, these women were more likely to report having had ≥2 Pap tests during the year after HIV diagnosis (p=0.02), and less likely to have had a Pap test <1 year previously (p=0.05). There was no difference in cervical cancer or human papillomavirus knowledge among those with low versus high health literacy. Results revealed mixed finding on the influence of health literacy on screening knowledge and behaviors.
doi:10.1007/s13187-013-0470-4
PMCID: PMC3769692  PMID: 23564430
Health literacy; HIV-positive women; Cervical cancer
7.  Findings from the Community Health Intervention Program in South Carolina: Implications for Reducing Cancer-Related Health Disparities 
BACKGROUND
The South Carolina Cancer Prevention and Control Research Network (SC-CPCRN) implemented the Community Health Intervention Program (CHIP) mini-grants initiative to address cancer-related health disparities and reduce the cancer burden among high-risk populations across the state. The mini-grants project implemented evidence-based health interventions tailored to the specific needs of each community.
OBJECTIVE
To support the SC-CPCRN’s goals of moving toward greater dissemination and implementation of evidence-based programs in the community to improve public health, prevent disease, and reduce the cancer burden.
METHODS
Three community-based organizations were awarded $10,000 each to implement one of the National Cancer Institute’s evidence-based interventions. Each group had 12 months to complete their project. SC-CPCRN investigators and staff provided guidance, oversight, and technical assistance for each project. Grantees provided regular updates and reports to their SC-CPCRN liaisons to capture vital evaluation information.
RESULTS
The intended CHIP mini-grant target population reach was projected to be up to 880 participants combined. Actual combined reach of the three projects reported upon completion totaled 1,072 individuals. The majority of CHIP participants were African-American females. Participants ranged in age from 19 to 81 years. Evaluation results showed an increase in physical activity, dietary improvements, and screening participation.
CONCLUSIONS
The success of the initiative was the result of a strong community-university partnership built on trust. Active two-way communication and an honest open dialogue created an atmosphere for collaboration. Communities were highly motivated. All team members shared a common goal of reducing cancer-related health disparities and building greater public health capacity across the state.
doi:10.1007/s13187-013-0479-8
PMCID: PMC3755099  PMID: 23645547
8.  Creating a Cadre of Junior Investigators to Address the Challenges of Cancer-Related Health Disparities: Lessons Learned from the Community Networks Program 
Community-based participatory research (CBPR) initiatives such as the National Cancer Institute’s Community Networks Program (CNP) (2005–2010) often emphasize training of junior investigators from underrepresented backgrounds to address health disparities. From July to October 2010, a convenience sample of 80 participants from the 25 CNP national sites completed our 45-item, web-based survey on the training and mentoring of junior investigators. This study assessed the academic productivity and CBPR-related experiences of the CNP junior investigators (n=37). Those from underrepresented backgrounds reported giving more presentations in non-academic settings (9 vs. 4 in last 5 years, p=0.01), having more co-authored publications (8 vs. 3 in last 5 years, p=0.01), and spending more time on CBPR-related activities than their non-underrepresented counterparts. Regardless of background, junior investigators shared similar levels of satisfaction with their mentors and CBPR experiences. This study provides support for the success of the CNP’s training program, especially effort directed at underrepresented investigators.
doi:10.1007/s13187-012-0361-0
PMCID: PMC3407323  PMID: 22528636
9.  Reducing Cancer Disparities Through Innovative Partnerships: A Collaboration of the South Carolina Cancer Prevention and Control Research Network and Federally Qualified Health Centers 
Journal of Cancer Education  2012;27(1):59-61.
The South Carolina Cancer Prevention and Control Research Network, in partnership with the South Carolina Primary Health Care Association, and Federally Qualified Health Centers (FQHCs), aims to promote evidence-based cancer interventions in community-based primary care settings. Partnership activities include (1) examining FQHCs’ readiness and capacity for conducting research, (2) developing a cancer-focused data sharing network, and (3) integrating a farmers’ market within an FQHC. These activities identify unique opportunities for public health and primary care collaborations.
doi:10.1007/s13187-011-0272-5
PMCID: PMC3272325  PMID: 21932143
Community health centers; Evidence-based cancer interventions
10.  Operationalization of community-based participatory research principles across the National Cancer Institute’s Community Network Programs 
American Journal of Public Health  2011;102(6):1195-1203.
Objectives
To examine how the National Cancer Institute-funded Community Network Program (CNP) operationalized principles of community-based participatory research (CBPR).
Methods
Based on our review of the literature and extant CBPR measurement tools, scientists from nine of 25 CNPs developed a 27-item questionnaire to self-assess CNP operationalization of nine CBPR principles.
Results
Of 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles to recognize community as a unit of identity, build on community strengths, facilitate co-learning, embrace iterative processes in developing community capacity, and achieve a balance between data generation and intervention. CNPs varied in extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging community in research dissemination, and striving for sustainability.
Conclusions
Although tool development in this field is in its infancy, findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.
doi:10.2105/AJPH.2011.300304
PMCID: PMC3292685  PMID: 22095340
Cancer disparities; community health; empowerment; health status disparities; indigenous populations; minority health; partnerships; training
12.  Assessing Readiness for Establishing a Farmers’ Market at a Community Health Center 
Journal of Community Health  2012;37(1):80-88.
Farmers’ markets are community health promotion interventions that increase access to fresh fruits and vegetables. As farmers’ markets continue to develop, it is important to strategically locate them in settings that are accessible to populations disparately affected by health disparities. One potential setting is a community health center. The goal of this analysis is to extend existing research on community readiness to identify indicators of preparedness among community health centers for establishing onsite farmers’ markets. The sampling frame for the readiness assessment included all community health centers in South Carolina (N = 20) representing 163 practice sites. Data collection included two brief online surveys, in-depth key informant interviews, and secondary analysis of contextual data. Five themes related to readiness for establishing a farmers market at a community health center were identified: capacity, social capital, awareness of health problems and solutions, logistical factors, and sustainability. Findings from this study provide guidance to researchers and community health center staff as they explore the development of environmental interventions focused on reducing diet-related health conditions by improving access to healthy foods.
doi:10.1007/s10900-011-9419-x
PMCID: PMC3208118  PMID: 21643822
Community health center; Federally qualified health center; Obesity; Farmers’ market; Community readiness
13.  Cervical Cancer Prevention: New Tools and Old Barriers 
Cancer  2010;116(11):2531-2542.
Cervical cancer is the second most common female tumor worldwide and its incidence is disproportionately high (>80%) in the developing world. In the U.S., where Pap tests have reduced the annual incidence to approximately 11,000 cervical cancers, more than 60% of cases occur in medically-underserved populations as part of a complex of diseases linked to poverty, race/ethnicity, and/or health disparities. Because carcinogenic human papillomavirus (HPV) infections cause virtually all cervical cancer, two new approaches for cervical cancer prevention have emerged: 1) HPV vaccination to prevent infections in younger women (≤18 years old) and 2) carcinogenic HPV detection in older women (≥30 years old). Together, HPV vaccination and testing, if used in an age-appropriate manner, have the potential to transform cervical cancer prevention particularly among underserved populations. Yet significant barriers of access, acceptability, and adoption to any cervical cancer prevention strategy remain. Without understanding and addressing these obstacles, these promising new tools for cervical cancer prevention may be futile. We share our experiences in the delivery of cervical cancer prevention strategies to U.S. populations experiencing high cervical cancer burden: African-American women in South Carolina, Alabama, Mississippi; Haitian immigrant women in Miami; Hispanic women in the U.S.-Mexico Border; Sioux/Native American women in the Northern Plains; white women in the Appalachia; and Vietnamese-American women in Pennsylvania and New Jersey. Our goal is to inform future research and outreach efforts to reduce the burden of cervical cancer in underserved populations.
doi:10.1002/cncr.25065
PMCID: PMC2876205  PMID: 20310056
16.  Breast Cancer Disparities in South Carolina: Early Detection, Special Programs, and Descriptive Epidemiology 
Breast cancer is the most commonly diagnosed cancer among women,1 and risk increases substantially with age.2 It is the second leading cause of cancer death among women in South Carolina and in the United States (U.S.). In South Carolina, European-American women are more likely to be diagnosed with breast cancer than are African-American women (see Figure 1);3 however, African-American women are more likely to die from breast cancer than are European-American women (see Figure 2).4 Although breast cancer can occur in men, women are at a much (≈100-fold) higher risk of developing breast cancer.
PMCID: PMC2965587  PMID: 17319236
18.  Interdisciplinary, Translational, and Community-Based Participatory Research 
Preventing cancer, downstaging disease at diagnosis, and reducing mortality require that relevant research findings be translated across scientific disciplines and into clinical and public health practice. Interdisciplinary research focuses on using the languages of different scientific disciplines to share techniques and philosophical perspectives to enhance discovery and development of innovations; (i.e., from the “left end” of the research continuum). Community-based participatory research (CBPR), whose relevance often is relegated to the “right end” (i.e., delivery and dissemination) of the research continuum, represents an important means for understanding how many cancers are caused as well as for ensuring that basic science research findings affect cancer outcomes in materially important ways. Effective interdisciplinary research and CBPR both require an ability to communicate effectively across groups that often start out neither understanding each other’s worldviews nor even speaking the same language. Both demand an ability and willingness to treat individuals from other communities with respect and understanding. We describe the similarities between CBPR and both translational and interdisciplinary research, and then illustrate our points using squamous cell carcinoma of the esophagus as an example of how to deepen understanding and increase relevance by applying techniques of CBPR and interdisciplinary engagement.
doi:10.1158/1055-9965.EPI-08-1166
PMCID: PMC2679168  PMID: 19336548

Results 1-18 (18)