Describing the evidence linking interprofessional education interventions to improving the delivery of safe and effective patient care: a scoping review.

Empirical evidence indicates that collaborative interprofessional practice leads to positive health outcomes. Further, there is an abundance of evidence examining student and/or faculty perceptions of learning or satisfaction about the interprofessional education (IPE) learning experience. However, there is a dearth of research linking IPE interventions to patient outcomes. The objective of this scoping review was to describe and summarize the evidence linking IPE interventions to the delivery of effective patient care. A three-step search strategy was utilized for this review with articles that met the following criteria: publications dated 2015-2020 using qualitative, quantitative or mixed methods; the inclusion of healthcare professionals, students, or practitioners who had experienced IPE or training that included at least two collaborators within coursework or other professional education; and at least one of ten Centers for Medicare & Medicaid Services quality measures (length of stay, medication errors, medical errors, patient satisfaction scores, medication adherence, patient and caregiver education, hospice usage, mortality, infection rates, and readmission rates). Overall, n=94 articles were identified, providing overwhelming evidence supporting a positive relationship between IPE interventions and several key quality health measures including length of stay, medical errors, patient satisfaction, patient or caregiver education, and mortality. Findings from this scoping review suggest a critical need for the development, implementation, and evaluation of IPE interventions to improve patient outcomes.

Meeting the needs of rural cancer patients in survivorship: Understanding the role of telehealth.

OBJECTIVE: This study explores perceptions about the role of telehealth in providing health and supportive services to Australian rural/regional cancer patients and survivor during COVID-19 and the quality of these services to inform future practice. DESIGN: Data were collected as part of a bi-annual survey on client satisfaction at a rural/regional community cancer wellness centre in Australia. SETTINGS AND PARTICIPANTS: Rural/regional cancer patients and survivors (n = 66) completed an online survey. MAIN OUTCOME MEASURES: The three main outcome measures were: (1) attitudes towards telehealth; (2) preference for future cancer support services; and (3) experiences with video/telehealth. RESULTS: Younger participants were more likely to use allied health services via video/telehealth during COVID-19 than their older counterparts. The preferred format for cancer support services in future was face-to-face (59% for younger and 42% for older participants), telehealth (10% for both groups) and mixed (31% for younger and 48% for older participants). CONCLUSIONS: Telehealth has benefits for the delivery of health and supportive services to rural/regional cancer patients and survivors. Nurses can play a key role in assessing the support needs of cancer survivors and facilitating strategies to ensure that survivors have the skills necessary to access telehealth support.

Trauma-Informed Care for Inpatient Palliative Care Social Work: Applying Existing Models at the Bedside.

Coexisting serious illness and posttraumatic stress place hospitalized individuals at risk for complex pain, anxiety, and retraumatization. Hospital palliative care social workers increasingly recognize the value of trauma-informed care (TIC) for reducing harm in the inpatient setting. Despite this recognition, there is limited operationalization of TIC principles for inpatient interventions. This paper integrates each TIC principle with inpatient psychosocial interventions to advance trauma-informed competencies among inpatient palliative care social workers and to provide a foundation for future TIC implementation research.

Psychosocial issues and quality of life of parenting partners of young women with breast cancer.

PURPOSE: Data are lacking about the association between quality of life (QOL) and psychosocial issues of partners of young women with breast cancer who co-parent dependent children. METHODS: We conducted a cross-sectional analysis of partners of women with breast cancer diagnosed at age ≤ 40. Among those partners reporting at least one dependent child under 18 years old at the time of diagnosis, we used multiple linear regression to examine associations between partner QOL and sociodemographic and psychosocial factors, and the patient's cancer stage and time since diagnosis. RESULTS: Of the 219 parenting partners, all identified as male with a median age of 44 years; 96% (204/213) reported working full-time at the time of the survey. Fifty-four percent endorsed behaviors indicating maladaptive coping. In adjusted analyses, less than full-time employment (ß = - 8.76; 95% CI = - 17.37, - 0.14), younger age (ß = - 0.35; 95% CI = - 0.069, - 0.02), greater parenting concerns (ß = 0.56; 95% CI = 0.36, 0.75), clinically relevant anxiety symptoms (ß = 13.79; 95% CI = 10.24, 17.35), lower post-traumatic growth score (ß = - 0.33; 95% CI = - 0.51, - 0.16), lower social support (ß = - 0.21; 95% CI = - 0.29, - 0.12), lower sexual satisfaction (ß = - 0.40; 95% CI = - 0.62, - 0.19), and breast cancer stages 3 (ß = 7.61; 95% CI = 0.19, 15.02) and 4 (ß = 12.63; 95% CI = 1.91, 23.34), when compared to stage 0, were associated with lower partner QOL. CONCLUSION: Parenting partners of young women with breast cancer have substantial unmet psychosocial needs. Interventions are needed to enhance QOL and promote adaptive coping for this population.

Effects by educational attainment of a mammography screening patient decision aid for women aged 75 years and older.

BACKGROUND: To help inform screening decisions, a mammography screening decision aid (DA) for women aged 75 years and older was tested in a cluster randomized clinical trial of 546 women. DA use increased women's knowledge of the benefits and harms of mammography and lowered screening rates. In the current study, the objective was to examine whether participants' views of the DA and/or its effects differed by educational attainment. METHODS: A secondary analysis was conducted of 283 women who received the DA before a personal care provider (PCP) visit during the trial to examine the acceptability of the DA and its effects on knowledge of the benefits and harms of mammography, screening intentions, and receipt of screening by educational attainment. Adjusted analyses accounted for clustering by PCP. RESULTS: Of the 283 participants, 43% had a college education or less. Regardless of educational attainment, 87.2% found the DA helpful. Women with lower educational attainment were less likely to understand all of the DA's content (46.3% vs 67.5%; P < .001), had less knowledge of the benefits and harms of mammography (adjusted mean ± standard error knowledge score, 7.1 ± 0.3 vs 8.1 ± 0.3; P < .001), and were less likely to lower screening intentions (adjusted percentage, 11.4% vs 19.4%; P = .01). Receipt of screening did not differ by educational attainment. CONCLUSIONS: A mammography DA for women aged 75 years and older was helpful to women regardless of their educational attainment; however, those with a college degree or greater understood the DA and, possibly as a result, lowered their screening intentions. Future studies need to examine how to better support informed decision making around mammography screening in older women with lower educational attainment. LAY SUMMARY: The authors examined data from a previous study to learn the effects of a mammography decision aid (DA) for women aged 75 years and older according to their level of education. Overall, women found the DA helpful, but women with lower educational attainment found it harder to understand the benefits and harms of mammography screening and were less likely to lower their screening intentions than women with a college degree. The findings suggest that women aged 75 years and older who have lower educational attainment may need an even lower literacy DA and/or more support from health care professionals.

Exploring the challenges in accessing care and support for cancer survivors in Australia during COVID-19.

Background: Amidst this global pandemic, the impact on accessing care and support for cancer survivors in Australia is uncertain and unknown. The purpose of the current study is to explore the impact that COVID-19 had on Australian rural/regional cancer survivors and their ability to access health services, treatment, and supportive care during this pandemic.Methods: Cancer survivors (n = 66) completed an online survey regarding the impact of COVID-19 on their access to medical and support services.Results: Findings indicated that COVID-19 had a significant impact on the lives of cancer survivors with the biggest challenges being reduced social support and the inability to see their health care providers. Findings also revealed that older participants reported greater impact and distress due to COVID-19.Conclusions: In order to ensure that the health and support needs of cancer survivors are not negatively impacted, providers of psychosocial support may need to make strategic changes in the provision of access to health and support services.

Moving closer to death: understanding psychosocial distress among older veterans with advanced cancers.

BACKGROUND: Early identification of psychosocial distress is important to address the needs of vulnerable populations and influence symptom management. Older veterans diagnosed with life-limiting cancers are particularly vulnerable because they often have unmet needs, experiencing psychological or emotional problems and gaps in healthcare communication, which extends suffering. Lack of emotional support, ongoing physical pain, and unresolved symptom control can further increase distress among older veterans, contributing to complexity of decision-making for end of life (EOL) care. OBJECTIVE: We explored older veterans' experiences and identification of psychosocial distress in cancer care to better understand how they describe distress while facing the end of life. METHODS: Guiding this study is a conceptual framework from psychosocial oncology with the multifactorial experience of distress indicated by NCCN guidelines for distress screening. We use a phenomenological approach to explore the experience of psychosocial distress among older veterans diagnosed with advanced cancers at risk for dying within a year. INCLUSION CRITERIA: Provider response of "no" to, "Would you be surprised if your patient died within a year?" and "yes", to the question, "Have you talked with your patient about the severity of their illness as being life-limiting, terminal?" RESULTS: Five themes emerged: (1) the meaning of distress: "It's hard to explain"; (2) severity of advanced cancer: "There's no stage five"; (3) distressing thoughts about the possibility of dying: "Either way, it's life limiting"; (4) coping: "Deal with it and hope for a better day"; and (5) personal factors: "I don't want to be anything but a man who can handle adversity." Findings suggest older veterans may have unique cancer experiences different from other populations. CONCLUSION: Older veterans in this study exhibited distressing symptoms which demonstrate they are at risk for declining health and in need of support for their distress. Healthcare providers are urged to understand the complexity of distress to provide the best possible treatment for older veterans.

Partners of young breast cancer survivors: a cross-sectional evaluation of psychosocial concerns, coping, and mental health.

PURPOSE: Evaluation of psychosocial concerns, coping style, and mental health in partners of young (diagnosed at ≤40 years) survivors of early-stage breast cancer (BC). DESIGN: Cross-sectional; partners participated in a one-time survey. SAMPLE: 289 participants; most were male, white, working full-time, college educated, with median age of 43 years, parenting children <18 years old. METHODS: Logistic regression was used to explore associations with anxiety and depression (≥8 on Hospital Anxiety and Depression sub-scales). FINDINGS: Overall, 41% reported symptoms of anxiety, 18% reported symptoms of depression, and 44% identified maladaptive coping. Multivariable regression analyses revealed: lower social support and poorer quality of life significantly associated with depression (p < .05); maladaptive coping, fulltime employment, poorer caregiver QOL, and less education significantly associated with anxiety. CONCLUSIONS: Partners of young BC survivors who use more maladaptive coping strategies, report less social support, work fulltime, and/or who have lower education levels experience negative mental health outcomes. IMPLICATIONS FOR PSYCHOSOCIAL ONCOLOGY: Enhancing constructive coping and ensuring all partners have access to supportive resources may improve partners' emotional adjustment.

Secondary Traumatic Stress and Related Factors in Australian Social Workers and Psychologists.

Secondary traumatic stress (STS) is an indirect form of trauma affecting the psychological well-being of mental health workers. This study examined STS and related factors of empathetic behavior and trauma caseload among a purposive sample of 190 social workers and psychologists. Participants completed an online questionnaire comprising demographics, the Secondary Traumatic Stress Scale, and the Empathy Scale for Social Workers. A moderated moderation model was used to evaluate the hypothesized relationship between the amount of trauma in clinician caseload and STS, as moderated by empathy and personal trauma history. Approximately 30 percent of participants met the criteria for a diagnosis of STS. Results indicated that although caseload trauma was not an independent predictor of STS, there was a significant interaction between caseload trauma and personal trauma history on STS. Similarly, empathy alone was not directly related to changes in STS, yet the trauma in caseload effect on STS was moderated by empathy, and that relationship was moderated by personal trauma history. This overall effect was shown to significantly predict STS. The current study highlights the importance of developing evidence-based risk strategies for mental health workers working in the area of trauma and at risk of developing symptoms of STS.

Exploring Anabolic-Androgenic Steroid Use and Teen Dating Violence Among Adolescent Males.

BACKGROUND: Reports indicate that 4% of the adolescent males in 2015 had taken steroids without a doctor's prescription. Anabolic-androgenic steroids (AAS) are illicit drugs that have commonly been used to help build muscle mass. AAS use is associated with negative biological, psychological, and social side effects including substance use, suicidal behavior, and violent behavior. OBJECTIVES: This exploratory study, guided by an integrated theoretical framework that included the General Aggression Model and the Biopsychosocial Model, examined the relationship between adolescent male AAS use and teen dating violence. METHODS: This cross-sectional, secondary data analysis was conducted using the 2013 and 2015 Massachusetts Youth Health Survey (MYHS). Participants were high school-aged males with a total sample of 2,080. Primary data analysis was conducted using hierarchical logistic regression. RESULTS: Findings suggested that adolescent males who used steroids at least once in their lifetime, compared to those who did not, had greater odds of engaging in teen dating violence. Further, males who identified as a sexual minority had greater odds of using anabolic-androgenic steroids, as were those who had at least one suicide attempt in the previous 12 months. CONCLUSIONS: Adolescent male AAS use is associated with multiple psychosocial factors that practitioners, school personnel, and parents must be aware of.

Optimizing screening, brief intervention, and referral to treatment (SBIRT) training for nurses and social workers: Testing the added effect of online patient simulation.

Background: Social workers and nurses are critical to the amelioration of substance misuse, making their training in evidence-based practices such as screening, brief intervention, and referral to treatment (SBIRT) particularly pertinent. Online patient simulation (OPS) is one training modality that allows students to develop and practice SBIRT skills that they might not obtain through didactic instruction, but it can be time and resource intensive. The aim of this study was to test the effect of OPS, over and above in-person training, on students' SBIRT attitudes, knowledge, and perceived skills. Methods: Social work and nursing students (N = 308) were recruited from a college in the northeastern United States. Students in the study were randomly assigned to either training as usual (TAU), which included pre-coursework videos, in-person didactic instruction, and role-plays, or the experimental condition (EXP), consisting of TAU plus access to self-paced SBIRT skills practice using OPS by SIMmersion. The SBIRT Attitudes, Self-perception of Skills, and Knowledge (AKS) survey was delivered at baseline, immediately post-training, and at 30-day follow-up (post-30) to assess overall changes as well as changes in the specific domains of SBIRT confidence, importance, and attitudes. Paired t tests were conducted to determine differences in mean scores between time points for the entire sample. Independent-samples t tests were conducted to test differences between EXP and TAU on AKS scores at each time point and to test differences between high and low OPS use. Results: Results showed a significant difference from pre- to post-training on composite AKS scores. There were no significant differences between TAU and EXP in composite scores or by AKS domain, and no differences within the EXP group for those with high and low use. Conclusions: Participants in EXP did not have significantly increased AKS scores, demonstrating that access to OPS did not produce an additive effect on the acquisition of self-perceived SBIRT knowledge, attitudes, and skills.

Impact of an Interprofessional Primary Care Training on Fear of Cancer Recurrence on Clinicians' Knowledge, Self-Efficacy, Anticipated Practice Behaviors, and Attitudes Toward Survivorship Care.

There are an estimated 15.5 million cancer survivors in the United States, with numbers projected to increase. Many cancer survivors are receiving survivorship care in primary care settings, yet primary care providers report a need for additional training on addressing medical and psychosocial concerns of cancer survivors. This paper presents findings from a pilot study on the effectiveness of a novel training for interprofessional primary care providers on the clinically significant issue of fear of cancer recurrence. The on-site training was provided to a total of 46 participants, including physicians (61%), physician assistants (11%), nurse practitioners (7%), nurses (17%), and social workers (4%) in six different primary care practices. The average number of years of professional experience was 18.8, with standard deviation of 10.9. Results of paired-sample t tests indicated that the training increased knowledge and self-efficacy of providers in identifying and addressing FCR. The training was well-received by participants, who had high confidence in implementing practice behavior changes, although they also identified barriers. Results suggest the feasibility of a brief training for continuing education and have implications for models of care delivery in cancer survivorship.

Decreasing hazards of Alzheimer's disease with the use of antidepressants: mitigating the risk of depression and apolipoprotein E.

OBJECTIVE: Alzheimer's disease (AD) is a neurodegenerative disease, manifesting in clinically observable deficits in memory, thinking, and behavior that disproportionately affects older adults. Susceptibility genes, such as apolipoprotein ε4, have long been associated with an increased risk of AD diagnosis. Studies have shown associations between depression and increased risk of AD development. Furthermore, findings from previous investigations suggest mixed effects in the use of psychotropic medication in older adults. The hypothesis for this study is that antidepressant use modifies the increased hazard of depression or such that a non-significant hazard will result with respect to eventual AD development. METHODS: Utilizing data from the National Alzheimer's Coordinating Center, we examined evaluations of 11,443 cognitively intact participants. Survival analysis was used to explore relationships between depression, apolipoprotein E, AD diagnosis, and antidepressant use. RESULTS: An analytical sample of 8732 participants with normal cognition was examined. Among users of antidepressant medication, the hazard, in most cases, was no longer statistically significant. One generic medication showed protective benefits for users (p < 0.001). In addition, there was a statistically significant relationship between recent depression (n = 2083; p < 0.001), lifetime depression (n = 2068; p < 0.05), and ε4 carrier status (n = 2470; p < 0.001) and AD development. CONCLUSIONS: The findings suggest that a mechanism related to antidepressant use may reduce the hazard of eventual AD. Furthermore, the findings reinforce the association between depression, apolipoprotein E (APOE) ε4, and AD diagnosis. This study contributes to the emerging literature exploring interventions aimed at decreasing the risk of AD by targeting potentially modifiable psychosocial risk factors such as depression. Copyright © 2017 John Wiley & Sons, Ltd.

Psychosocial risk factors and Alzheimer's disease: the associative effect of depression, sleep disturbance, and anxiety.

OBJECTIVES: Alzheimer's disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions. METHODS: Data from the National Alzheimer's Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models. RESULTS: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations. CONCLUSION: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.

Chronic Health Illnesses as Predictors of Mild Cognitive Impairment Among African American Older Adults.

Approximately 5.5 million individuals are diagnosed with Alzheimer's disease (AD) dementia, a number which includes those with mild cognitive impairment and asymptomatic individuals with biomarkers of AD. There is a higher incidence of mild cognitive impairment (MCI) in African American populations as compared to White populations, even when controlling for sociodemographic factors. The existing body of ethnically/racially targeted research on MCI has been limited by few studies with the ability to generalize to African American communities. This study sought to examine whether medical conditions which occur at a higher rate in African American individuals increase the hazard of subsequent MCI development. A secondary data analysis of the National Alzheimer's Coordinating Center Uniform Data Set was employed to examine the associations between health conditions (congestive heart failure, traumatic brain injury, diabetes, hypertension, hypercholesterolemia, B12 deficiency, thyroid disease) and their relationship to MCI. The analytic sample included 2847 participants with 9872 observations. Binary logistic generalized estimating equation modeling was used to examine repeated measures over the course of 1-11 observations. Education was associated with MCI development, specifically those with some college or college graduates (p < 0.001) and more than college (p = 0.002). Female sex was associated with development of MCI (p < 0.001). African Americans with traumatic brain injury (TBI) were more likely to develop MCI (p < 0.001) compared to those with no reports of a TBI. Inactive thyroid conditions decreased the risk of MCI development (p = 0.005) compared to those without thyroid disease. Though vascular factors are often attributed to higher mortality and neurodegeneration in African Americans, congestive heart failure, diabetes, high cholesterol, hypertension, diabetes, nor seizures were associated with an increased risk of MCI development. Findings from this study provide formative data to develop targeted interventions for subsets of the African American community, including those with higher educational levels, those with TBI, and those with a history of thyroid disease. While it may not be possible to prevent MCI development, it is possible to modify lifestyle behaviors contributing to these health conditions, such as falls that are often experienced by older adults. Practitioners can increase awareness, knowledge, and resources relevant to clients.

Developing content for an interprofessional training on fear of cancer recurrence (FCR): Key informant interviews of healthcare professionals, researchers and cancer survivors.

BACKGROUND: Growing numbers of cancer survivors are receiving healthcare through primary care practitioners, who often lack cancer-specific expertise to effectively treat survivors' concerns. Addressing that gap, this study aimed to develop content for a training on fear of cancer recurrence (FCR), a common concern in survivorship. METHODS: Grounded in naturalistic inquiry, 42 key-informant interviews were conducted, transcribed, and analyzed for themes. Participants were healthcare professionals, researchers, and cancer survivors Results: Results included themes ranging from: rich conceptualizations of FCR, opportunities and challenges for addressing FCR in healthcare settings, interventions to address FCR, and important information to include in a training on FCR. CONCLUSIONS: This paper provides content for an interprofessional training and highlights the importance of developing trainings for interprofessional teams, given identified barriers that physicians face in addressing FCR and other psychosocial concerns of survivors in primary care.

Oral health and cancer screening in long-term care nursing facilities: Motivation and opportunity as intervention targets.

OBJECTIVE: The objective of this study is to propose empirically and conceptually supported interventions that might increase the capability and opportunity to provide of oral hygiene care and oral cancer screening in long-term nursing care facilities. BACKGROUND: Improving the oral health in the older adult population is a priority of the Healthy People 2020 initiative. Poor oral health disproportionably affects older populations, which indicates lower participation in regular oral health care (OHC) that includes screening and early detection of oral cancer. MATERIAL AND METHODS: A rigorous recruitment protocol yielded a purposive sample of nursing home Administrators and Directors of Nursing who participated in nine discrete focus groups (n = 34) in several regions of Massachusetts. Interview data were integrated with a conceptual framework of the Health Belief Model and the "capability," "opportunity," "motivation" and "behavior" of the COM-B system to identify potential interventions to increase oral health and oral cancer screening. We used NVivo to identify conceptual themes related to potential intervention targets. RESULTS: Participants identified several impediments to oral hygiene and cancer screening in the context of the conceptual model. High barriers, low opportunities and low motivation were themes identified as potential targets for intervention. CONCLUSIONS: Our findings suggest that the intervention likely to increase OHC and consequently oral cancer screening include: training certified nurses' aides using dental students and volunteers; educating family members about OHC and oral cancer screening, and increasing oral cancer awareness.

Victimization and Violence: An Exploration of the Relationship Between Child Sexual Abuse, Violence, and Delinquency.

Child sexual abuse (CSA) continues to be a major public health issue with significant short- and long-term consequences. However, little contemporary research has examined the relationship between CSA and delinquent and violent behavior in adolescence. Children who have been sexually abused experience a unique form of victimization compared to children who have endured other forms of maltreatment, as CSA can result in feelings of shame, powerlessness and boundary violations. The purpose of this study was to examine the effect of CSA on delinquent and violent behavior in adolescence. We examined self-report data at the age 18 interview from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) on measures of sexual abuse experience, and engagement in delinquent and violent behavior in the past year. All participants reported either a history of maltreatment or were identified at-risk based on demographic risk factors. Participants included 368 males and 445 females who self-reported experiences of CSA and delinquent and violent behavior (N = 813). Findings indicated that, when controlling for gender and race, the odds of engagement in delinquent and violent behavior for those who have experienced CSA are 1.7 times higher than for those who have not. Additionally, female victims of CSA were .52 times less likely to engage in violent and delinquent behavior compared to their male counterparts. Further efforts are needed to examine the effects of CSA on violent and delinquent behavior to better guide treatment efforts that prevent juvenile justice involvement.

Breast care screening for underserved African American women: Community-based participatory approach.

Traditional health promotion models often do not take into account the importance of shared cultural backgrounds, beliefs, and experiences unique to underserved African American women when designing community-based cancer screening and prevention programs. Thus, the purpose of this study was the development, implementation, and evaluation of a community-based participatory research (CBPR) program designed to increase breast cancer screening awareness in an underserved African American population by providing culturally appropriate social support and information. The study includes 357 African American women who participated in the program and completed the 6-month follow-up questionnaire. The program consisted of a 45-minute play, using community members and storytelling to honor and incorporate five different cultural experiences (skits) with breast care and cancer. Overall, findings indicate that the educational intervention was effective. In addition, these findings are consistent with the literature that suggests that educational interventions that include knowledge to alleviate concerns, dispel myths, and create awareness can increase breast cancer screening participation rates. Furthermore, these findings confirm the importance of CBPR in health promotion activities in reducing health and cancer disparities.