Cancer screening and prevention in rural Wisconsin: the Greater Marshfield Experience.

BACKGROUND: Providing medical services to rural residents results in unique challenges to providers and patients. Cancer screening (CS) and early detection services (EDS) are frequently underutilized with rural residents often presenting with advanced cancer at diagnosis. A comprehensive approach to determine barriers and overcome them constitutes "The Greater Marshfield Experience." METHODS: Focus groups with rural residents determined the greatest barriers to receipt of CS and EDS were distance, cost, time from work and self-reliant behavior. Directives to address these concerns were to keep information simple and provide services at the workplace. In response, Marshfield Clinic and its research division developed a collaborative research partnership with public health agencies (PHA), federally funded government programs and volunteer agencies. RESULTS: In-house activities to remove barriers for providing CS and EDS included the development of a separate screening unit for these activities. Reminder systems were employed to notify patients of the need and availability of preventative services. Co-payments for health screening services were eliminated from the clinic owned health plan. Area residents near poverty level were encouraged to enroll in federally subsidized health plans that promoted and paid for CS and EDS. Federally funded cancer screening studies were implemented that funded breast and cervical cancer screening and evaluated the benefits of screening for prostate, lung, colorectal and ovarian cancers (PLCO). Outreach activities included developing partnerships with local PHA and minority groups and providing mobile screening services to remote areas. CONCLUSION: Concentrated, collaborative efforts to develop in-house systems and outreach activities resulted in delivery of CS and EDS in remote areas.

Results of a rural breast health education demonstration project.

The Healthy People 2000-National Health Promotion and Disease Prevention Objectives call for an increase in breast health education to the public to increase women's knowledge about breast cancer and the benefits of screening. A breast health outreach education intervention for community health professionals was designed, implemented, and evaluated. The barriers to continuing education of health professionals of rural areas were addressed. Low-cost, county-based seminars using a comprehensive breast health education curriculum were provided for community health professionals. The intervention demonstrated an increase in a professional's knowledge about breast cancer and breast cancer screening, and an increase in their breast self-examination skills. Six months after intervention, community health professionals reported an increase in the frequency of their breast self-examination performance.

Cancer education interventions for rural populations.

To respond to major needs expressed by 15 farm family focus group participants, education interventions were designed to overcome barriers to primary prevention for skin cancer. Farmers are at high risk for developing skin cancer because of occupational exposure. In an attempt to increase skin cancer prevention education in a rural population, three demonstration projects were developed and field tested. Projects were designed to overcome barriers defined by the focus groups. One project evaluated a school-based education intervention. A second project evaluated a family-based education intervention. Knowledge gain was the evaluation endpoint of these two projects. Significant knowledge gain was demonstrated for these projects. A third project was designed to deliver skin cancer information directly to farmers using veterinarians. Farmers found this method of delivery acceptable.