Building capacity for collaborative research between basic scientists and underrepresented communities in cancer research.

PURPOSE: Basic science research is critical for understanding biological mechanisms essential to advances in cancer prevention, diagnoses and treatment. However, most of this research is conducted outside of the purview of community observation or input, leaving these research processes mysterious and subsequent findings disconnected from the communities they intend to benefit. This paper discusses strategies to build capacity for collaborations between basic scientists and Hispanic community members at the University of Arizona Cancer Center (UACC). METHODS: Through partnership of the Cancer Biology Program and Office of Community Outreach and Engagement both at UACC, the Research Outreach for Southern Arizona (ROSA) program was developed as a way to forward the following strategies to build capacity for collaboration: forming a community working group, launching a community and student ambassador program, hosting scientific cafés and developing a community-based survey. RESULTS: The strategies underpinning the ROSA program have been integral in bridging dialogue between basic scientists and the community and fostering bidirectional learning opportunities. Each of the strategies presented have documented successes and based on the lessons learned, they have evolved into productive and integral parts of UACC's overall strategy of bridging scientific research and communities. CONCLUSION: While the strategies discussed are evolving, they help foster dialogue and exchange between basic scientists and community members that demystifies basic science research and facilitates culturally tailored approaches to address health disparities of vulnerable communities. These strategies also have the potential to shift cancer research into a paradigm that is more collaborative and transformative.

Health promotion interventions for African Americans delivered in U.S. barbershops and hair salons- a systematic review.

BACKGROUND: African American adults suffer disproportionately from obesity-related chronic diseases, particularly at younger ages. In order to close the gap in these health disparities, efforts to develop and test culturally appropriate interventions are critical. METHODS: A PRISMA-guided systematic review was conducted to identify and critically evaluate health promotion interventions for African Americans delivered in barbershops and hair salons. Subject headings and keywords used to search for synonyms of 'barbershops,' 'hair salons,' and 'African Americans' identified all relevant articles (from inception onwards) from six databases: Academic Search Ultimate, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, PubMed, Web of Science (Science Citation Index and Social Sciences Citation Index). Experimental and quasi-experimental studies for adult (> 18 years) African Americans delivered in barbershops and hair salons that evaluated interventions focused on risk reduction/management of obesity-related chronic disease: cardiovascular disease, cancer, and type 2 diabetes were included. Analyses were conducted in 2020. RESULTS: Fourteen studies met criteria for inclusion. Ten studies hosted interventions in a barbershop setting while four took place in hair salons. There was substantial variability among interventions and outcomes with cancer the most commonly studied disease state (n = 7; 50%), followed by hypertension (n = 5; 35.7%). Most reported outcomes were focused on behavior change (n = 10) with only four studies reporting clinical outcomes. CONCLUSIONS: Health promotion interventions delivered in barbershops/hair salons show promise for meeting cancer screening recommendations and managing hypertension in African Americans. More studies are needed that focus on diabetes and obesity and utilize the hair salon as a site for intervention delivery. TRIAL REGISTRATION: PROSPERO CRD42020159050 .

Access to Care as a Barrier to Mammography for Black Women.

Racial disparities in breast cancer screening, morbidity, and mortality persist for Black women. This study examines Black women's mammography beliefs and experiences with specific focus on barriers to mammography access in an urban city in the South East, United States. This retrospective, qualitative study used Penchansky and Thomas' conceptualization of health care access as the framework for the data analysis. In-depth, semistructured interviews were conducted with 39 Black women. Structural and personal factors continue to create barriers to mammography among Black women. Barriers to mammography were identified for each of the Penchansky and Thomas five dimensions of access to care: accessibility, affordability, availability, accommodation, and acceptability. Clinical practice strategies to increase mammography screening in Black women must be multifactorial, patient-centered, and culturally congruent. Policy development must address the structural barriers to mammography screening through expansion of health insurance coverage and increased accessibility to health care.

Training Community Health Workers in Motivational Interviewing to Promote Cancer Screening.

Health disparities researchers attempting to engage and effectively deliver interventions to underserved populations often encounter a number of challenges ranging from geographical considerations to more complex issues of medical mistrust. While there are a number of strategies researchers may employ to address these challenges, one of the most successful of these has been the use of community health workers (CHWs). Despite the documented success of CHWs, little information exists on the use of theory-driven intervention strategies with these community partners. Researchers who have partnered with CHWs tend to provide brief descriptions of training strategies and provide little discussion of the challenges and barriers to training a lay population in the delivery of technical interventions, including ensuring fidelity to the intervention protocol. The purpose of this article is to describe the feasibility of training CHWs to deliver a motivational interviewing intervention to promote cancer screening in underserved populations. With this article we present an innovative way to use motivational interviewing delivered by CHWs. Specifically, we will detail the development of the training protocol, the implementation of that training in a variety of research settings, and the development and implementation of fidelity protocols. We will use examples from two research studies where CHWs were successfully trained to use MI to promote cancer screening in underserved communities to highlight the challenges and barriers faced in developing and implementing the training and strategies used to overcome these challenges during the refinement of the intervention.

Primary Care Providers' Attitudes Related to LGBTQ People: A Narrative Literature Review.

The purpose of this article is to review the current literature describing primary care providers' (PCPs) attitudes related to lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people. LGBTQ individuals experience significant health disparities, and these inequities may be better understood via an ecological systems framework. PCPs' actual or perceived discriminatory attitudes can lead to suboptimal treatment or health outcomes for LGBTQ people. A review of the literature from 2005 through January 2017 was completed using the Cumulative Index for Nursing and Allied Health Literature and PubMed (Medline) databases. The purpose, sample, measure(s), design, findings, strengths, and weaknesses of each study were examined; and findings were synthesized, summarized, and critically appraised. Eight articles were eligible for review. There was significant heterogeneity in the studies' purposes, research questions, LGBTQ population(s) of focus, and findings. Many PCPs' attitudes toward LGBTQ people were positive, but a minority of each studies' participants had negative attitudes toward LGBTQ people. Stigma and health care barriers negatively affect LGBTQ health. Interventions must address LGBTQ health disparities at the individual, mesosytem, exosystem, and macrosystem levels. Research, education, and practice strategies all must be integrated across socioecological levels as components of a population-based approach to eliminate health disparities for LGBTQ persons.

Spousal support and knowledge related to cervical cancer screening: Are Sub-Saharan African immigrant men interested?

Sub-Saharan African immigrant (SSAI) men have significant influence on the health-seeking behavior including cervical cancer screening uptake by their female partners/wives. We conducted a qualitative descriptive study with 21 SSAI men to explore knowledge, perceptions, and support related to cervical screening. Participants were aged 36 ± 9 years, college educated (88%), and 53% have lived in the U.S. > 5 years. Three themes emerged; inadequate cervical cancer knowledge, willingness and strategies for support, and shared versus autonomous decision making for screening. Social structure with emphasis on male leadership could be leveraged in cervical cancer screening promotion for SSAI women.

Social support and breast cancer screening in rural Appalachia.

PURPOSE: Women in the Appalachian region have a high mortality rate attributable to cancer in spite of lower incidence of cancer compared with the general US population. Empirical evidence suggests that social support influences cancer outcomes, including adherence to screening guidelines and treatment recommendations. The purpose of this study is to examine the impact of social support on breast cancer screening patterns in a sample of rural Appalachian women. METHODS: This paper reports the results of analyses of baseline cross-sectional data on breast cancer screening collected during a community-based group-randomized trial. We used the 2010 National Health Institute Survey questionnaires and the Medical Outcomes Study Social Support Survey to assess screening behavior and perceived social support, respectively. Data were analyzed using ANCOVA and ANOVA to assess the mean social support on breast cancer screening patterns (frequently, irregularly, and rarely/never) and relevant sociodemographic variables. FINDINGS: Of the eligible participant records analyzed (N = 289), 50% were married, 36% were employed, 20% attended college, 40% had no mammogram in 6 years, and 20% never had mammograms. Overall social support score was high at 73.1 (SD = 18.2). Association between breast cancer screening patterns and social support scores was not statistically significant at α < 0.05 (P value = 0.09). CONCLUSIONS: Although social support as it measured in this study does not show significant associations with screening patterns, it is important to understand how social network structures may influence screening patterns. Familial and social roles/responsibilities that result in reported social support may also be the barrier to cancer screening and other prevention health behaviors.

Using text messages to promote health in African-Americans: #HeartHealthyandCancerFree.

OBJECTIVES: African-Americans are vulnerable to both cancer and cardiovascular disease (CVD) due to intricately connected risk factors. Use of text messages is an innovative method to provide health information to reduce these risks. The aim of this study was to test the feasibility and acceptability of a text messaging intervention to reduce CVD and cancer risk factors in African-Americans. DESIGN: We developed an intervention using text messages culturally tailored for African-Americans over age 50 who were at risk (one or more modifiable risk factors) for CVD and/or cancer. Sociodemographic data, biologic measures, cancer screening practices, and general health status were assessed. Group interviews were conducted to assess feasibility and acceptability. RESULTS: Participants were primarily female (69%), aged 58 ± 5 years, who were married (59%) and worked full time (56%). In terms of feasibility and acceptability, themes of encouragement through text messages received and a desire for a longer study period emerged from group interviews with participants. Participants experienced significant decreases in waist circumference (41 ± 5 vs 40 ± 5, p = .002), systolic blood pressure (147 ± 25 mmHg vs 138 ± 20 mmHg, p = .009), diastolic blood pressure (87 ± 16 mmHg vs 82 ± 10 mmHg, p = .02), total cholesterol (194 ± 35 mg/dL vs 173 ± 32 mg/dL, p < .001), and low-density lipoprotein levels (100 ± 32 mg/dL vs 86 ± 29 mg/dL, p = .015). Five participants had colorectal cancer screening, two had prostate cancer screening, and four had mammograms. CONCLUSIONS: Use of text messages was widely accepted among participants. Significant CVD risk reductions and increased cancer screenings were noted. Future studies should incorporate innovative strategies such as text messaging in promoting health in vulnerable populations.

Identifying Communication Barriers to Colorectal Cancer Screening Adherence among Appalachian Kentuckians.

Utilizing data from 40 in-depth interviews, this article identifies both barriers and facilitators to colorectal screening guideline adherence among Appalachian Kentucky adults recruited through a community-based research network. Key findings identify (a) varying levels of knowledge about screening guidelines, (b) reticence to engage in screening processes, and (c) nuanced communication with healthcare providers and family members regarding screening adherence. What participants knew about the screening process was often derived from personal stories or recalled stories from family members about their screening experiences. Reticence to engage in screening processes reflected reports of cumbersome preparation, privacy issues, embarrassment, medical mistrust, fear of receiving a cancer diagnosis, and lack of symptoms. Participants cited many ways to enhance patient-centered communication, and the findings from this study have implications for health communication message design and communication strategies for healthcare practices in Appalachian Kentucky clinics.

Promoting Mammography with African-American Women in the Emergency Department Using Lay Health Workers.

The objective of this study was to test the efficacy of a pilot intervention to increase mammography utilization among African-American women recruited from those waiting in the emergency department (ED)for non-urgent complaints. In a 3-armed pilot of a randomized controlled trial we compared the effects of a brief motivational interview delivered by a lay health worker with those of a culturally targeted brochure and a usual care control group. The results showed that one quarter (23%) of the sample reported having never had a mammogram prior to the study. There was no group difference by mammography status at the 3-month interview. More than one quarter of those retained in the study indicated they had received a mammogram during the study (27.4%). The conclusions from the study were that lay health workers are a valuable asset and may be used in innovative settings such as the ED to increase screening among vulnerable populations.

Health Behavior Decision-making in African-American Adults Diagnosed with Schizophrenia.

Little is known about the factors that influence health behavior decision-making among people with schizophrenia. The purpose of this qualitative study was to describe the processes used by 10 African-American adults with schizophrenia when making health behavior decisions and identification of perceived barriers and facilitators to health. Three phases of health behavior decision-making were identified: Recognizing Complex Components of Health, Personalizing Components of Health, and Tracking Health Status. Findings may guide clinicians' efforts to improve the health status of patients, as well as influence future research in understanding health behavior decision-making among vulnerable populations.

#4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial.

BACKGROUND: Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas. OBJECTIVE: This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah. METHODS: We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign. RESULTS: The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management. CONCLUSIONS: Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors. TRIAL REGISTRATION: ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/50392.

A Motivational Interviewing Intervention to Promote CRC Screening: A Pilot Study.

BACKGROUND: Appalachian Kentuckians suffer a disproportionate incidence and mortality from colorectal cancer (CRC) and are screened at lower rates (35%) compared with 47% of Kentuckians. OBJECTIVE: The aim of this study was to evaluate the efficacy of a motivational interviewing intervention delivered by trained Lay Health Advisors on CRC screening. METHOD: Eligible participants recruited from an emergency department (ED) completed a baseline survey and were randomized to either the control or the motivational interviewing intervention provided by Lay Health Advisors. Follow-up surveys were administered 3 and 6 months after baseline. To evaluate potential differences in treatment and control groups, t tests, χ2, and Mann-Whitney U tests were used. RESULTS: At either the 3- or 6-month assessment, there was no difference in the CRC screening by group (χ2 = 0.13, P = .72). There was a significant main effect for the study group in the susceptibility to CRC model; regardless of time, those in the intervention group reported approximately 1-point higher perceived susceptibility to CRC, compared with controls (est. b = 0.68, P = .038). Age and financial adequacy had a significant effect related to CRC screening. Older participants (est. b = 0.09, P = .014) and those who reported financial inadequacy (est. b = 2.34, P = .002) reported more screening barriers. CONCLUSION: This pilot study elucidated important factors influencing the uptake of CRC for an ED transient population and this may be useful in the design of future interventions using motivational interviewing in EDs. IMPLICATIONS FOR PRACTICE: Nurses can provide information about CRC screening guidelines and provide referrals to appropriate screening resources in the community.

Evaluating Social Support and T2D Risk Factors Among Members of Rural-Dwelling Grandparent-Headed Households.

Purpose: This study examines the associations of social support and type 2 diabetes (T2D) risk factors among members of rural-dwelling, grandparent-headed households (GHH). Methods: Prospective data were collected from rural-dwelling members of GHH with no known diagnosis of T2D. Data collected on family characteristics, T2D clinical risk factors, and social support were assessed. Results: Sixty-six grandparents and 72 grandchildren participated in the study. The average age and HbA1Cs were 59.4 years and 6.2% ± 1.4 for grandparents and 11.8 years and 4.9% ± 0.6 for grandchildren. Most grandparents were found to have prediabetes or undiagnosed diabetes. The number of people living in GHHs was associated with grandparents' triglycerides, HDL, and BMI. Average social support scores among grandparents suggested moderately high perceived social support (79 ± 3.4). For grandchildren, social support from grandparents was associated with diastolic blood pressure and HbA1C, whereas support from teachers, classmates, and close friends was associated with HbA1C and BMI in grandchildren. Implications: This study shows that grandparent caregivers are at an increased risk for T2D. Perceived social support between grandparents and grandchildren influences T2D risk factors. However, social support provided by peers, teachers, and close friends is also associated with T2D risk factors in grandchildren. These findings support the use of family-based diabetes prevention programming, peer support, and school settings as mechanisms for interventions to reduce T2D in adolescents, particularly those within GHHs.

Adaptation of colorectal cancer screening tailored navigation content for American Indian communities and early results using the intervention.

BACKGROUND: American Indians (AI) experience major colorectal cancer (CRC) screening disparities with commensurate inequity in CRC mortality and other outcomes. The purpose of this report is to describe the methods and early results of adapting a previously successful intervention for the AI community. METHODS: The educational content and delivery strategy of the parent intervention were adapted for AIs guided by an adaptation framework and cultural consultations with the community and clinicians. As part of the environmental scanning, we identified the need to substantively revise our data entry, collection, and tracking system and develop a REDCap database for this purpose. In this study, we staggered the implementation of the intervention in each facility to inform the process from one clinic to the next, and assess both the clinical outcomes of the tailored intervention and the implementation processes across two clinic settings, Facilities A and B. RESULTS: The REDCap database is an indispensable asset, and without it we would not have been able to obtain reliable aggregate screening data while improvements to facility electronic health records are in progress. Approximately 8% (n = 678) of screening-eligible patients have been exposed to the navigator intervention. Of those exposed to the navigator intervention, 37% completed screening. CONCLUSIONS: With the small numbers of patients exposed so far to the intervention, it would be premature to draw any broad conclusions yet about intervention effects. However, early screening completion rates are substantial advances on existing rates, and we have demonstrated that a tailored navigator intervention for facilitating CRC screening was readily adapted with provider and community input for application to AIs. A REDCap database for tracking of CRC screening by navigators using tablets or laptops on- or offline is easy to use and allows for generation of aggregate, anonymized screening data. TRIAL REGISTRATION: There was no health intervention meeting the criteria of a clinical trial. The University of Arizona Institutional Review Board granted exemption from obtaining informed consent from patients undergoing CRC screening after administration of the tailored navigation intervention as usual care.

Hair Stylists as Lay Health Workers: Perspectives of Black Women on Salon-Based Health Promotion.

Lay health workers (LHWs) have been effective in delivering health promotion to underserved, vulnerable populations. Hair stylists are well positioned to serve as LHWs in addressing health disparities among Black women in the U.S. The purpose of this qualitative study was to explore the extent to which hair stylists influence their Black female clients and clients' preferences for their stylist's role in salon-based health promotion programming. Eight virtual platform focus groups were conducted with Black women (n = 39) who receive hair care services from a licensed hair stylist across the U.S. Most participants had a college degree (89.8%), health insurance (92.3%), a primary care provider (89.7%), and the majority had at least one chronic disease (56.4%). Participants reported higher potential for influence related to level of trust in the stylists and for stylists they find relatable and credible. Trust, relatability, and credibility were further determined by racial and gender congruence. Client interviewees felt stylists should model healthy behaviors and reported they may not be receptive to stylist-delivered health promotion out of the context of a hair-health connection. In this sample of well-educated clients, there was an expressed preference for stylists to provide referral to healthcare professionals or solicit experts for health topics out of the scope of haircare rather than guide the health promotion efforts themselves. Findings from this study can inform future development of acceptable salon-based, stylist-led health promotion programs that partner stylists with health experts to deliver health promotion.

Factors associated with participation in cancer prevention and control studies among rural Appalachian women.

Rural Appalachian women bear a disproportionate burden from many types of cancer yet often are underrepresented in cancer research. This article uses 2 case studies to illustrate barriers faced and strategies used when recruiting hard-to-reach rural participants. Recruitment barriers include the population's competing demands and lack of trust of outsiders. Strategies employed include involving insider advocates, highlighting the positive experiences of early participants, spending extensive time in the community, and emphasizing potential community benefits of the study. We suggest recruitment strategies to better involve rural women and others who, by virtue of being "hard-to-reach," often are overlooked.

Mammography promotion in the emergency department: a pilot study.

OBJECTIVES: The objective of this pilot study is to assess the need, desire, and applicability of a mammography promotion project in the emergency department (ED). DESIGN AND SAMPLE: A convenience sample from the ED of a public University hospital was surveyed to determine their mammography status, interest in a program to promote mammography, and barriers to mammography. MEASURES: The survey included demographics information, health care access, including health insurance and primary care provider, mammography status and date of mammogram, as well as a checklist of potential barriers. Participants were also asked whether they would be interested in mammography promotion in this setting. RESULTS: More than 15% of the 197 women surveyed had never received a mammogram, and more than half had not received 1 in the past year. The most common barriers to mammography were competing demands and money. Three quarters of the women said they would be interested in mammography promotion while waiting for care in the ED. CONCLUSIONS: This study provides promise that mammography promotion activities may be appropriately placed in the ED and provides a solid platform from which researchers and nurses may launch efforts to develop preventive health interventions in innovative public health care settings.

Assessing Diabetes Risk Factors in Rural Dwelling Grandparent Caregivers.

OBJECTIVE: The purpose of this study is to assess type 2 diabetes mellitus (T2DM) risk factors in grandparent caregivers living in a rural environment. METHODS: Clinical measures (hemoglobin A1c [HbA1c], blood pressure, and lipids) and self-reported data on social environment factors were attained. Data were analyzed via Pearson's correlation and regression models. RESULTS: By clinical definition of diabetes (HbA1c ≥ 6.5%), 21% were prediabetic and 28% had undiagnosed T2DM. There was an association between the number of individuals in the home and triglycerides (r = -.25), high-density lipoproteins (HDL; r = .43), and body mass index (BMI; r = .39). Guardianship status had a significant association with BMI (r = -.38). There was a significant association between low-density lipoprotein (LDL; r = -.32) and access to community shared resources. In the adjusted linear model, the number of grandchildren in the home had a significant relationship with HDL (ß = .012, p = .021) whereas the number of individuals living in the home had a statistically significant relationship with HDL (ß = .026, p < .000) and BMI (ß = .046, p = .02). In addition, 15% of participants reported being food insecure. DISCUSSION: Efforts are needed to identify and screen at-risk populations living in geographically isolated areas. Considerations should be given to leveraging existing community resources for grandparent caregivers via schools, health systems, and government agencies to optimize health and well-being.