Assessing needs and assets for building a regional network infrastructure to reduce cancer related health disparities.

Significant cancer health disparities exist in the United States and Puerto Rico. While numerous initiatives have been implemented to reduce cancer disparities, regional coordination of these efforts between institutions is often limited. To address cancer health disparities nation-wide, a series of regional transdisciplinary networks through the Geographic Management Program (GMaP) and the Minority Biospecimen/Biobanking Geographic Management Program (BMaP) were established in six regions across the country. This paper describes the development of the Region 3 GMaP/BMaP network composed of over 100 investigators from nine institutions in five Southeastern states and Puerto Rico to develop a state-of-the-art network for cancer health disparities research and training. We describe a series of partnership activities that led to the formation of the infrastructure for this network, recount the participatory processes utilized to develop and implement a needs and assets assessment and implementation plan, and describe our approach to data collection. Completion, by all nine institutions, of the needs and assets assessment resulted in several beneficial outcomes for Region 3 GMaP/BMaP. This network entails ongoing commitment from the institutions and institutional leaders, continuous participatory and engagement activities, and effective coordination and communication centered on team science goals.

Developing strategies for reducing cancer disparities via cross-institutional collaboration: outreach efforts for the partnership between the Ponce School of Medicine and the Moffitt Cancer Center.

The disproportionate burden of cancer among U.S. Hispanics is well documented. Historically, epidemiologic data on U.S. Hispanics and cancer have aggregated all Hispanics as one homogeneous group without appreciating the diversity of this population with regard to nativity (nationality/geographic origin). The authors report on the initial efforts of a collaborative academic institutional partnership between a minority-serving institution and a National Cancer Institute-designated cancer center to address cancer health disparities in two Hispanic communities in Puerto Rico and Florida. This article outlines the joint Outreach Program's initial collaborative strategies and activities in community outreach, cancer education, and research that mutually benefit both the Ponce (Puerto Rico) and Tampa (Florida) Hispanic communities. This partnership program used innovative multipronged community-engagement strategies in the two communities to reduce cancer health disparities. Specific projects and lessons learned from three outreach/cancer education projects and two pilot research projects are discussed. The challenges of balancing service and research agendas in communities with disparate levels of resources and infrastructure are summarized to inform future initiatives in this partnership, as well as serve as an example for similar minority-serving institution/cancer center partnerships to reduce cancer health disparities.

Perceptions of colorectal cancer among three ethnic subgroups of US blacks: a qualitative study.

Colorectal cancer (CRC) is currently associated with one of the highest burdens of morbidity and mortality among American men and women. Racial/ethnic disparities are well documented and the subject of intense research and intervention. Our understanding of disparities related to awareness and perceptions about causes, risk factors, and screening for CRC among subgroups of blacks in the United States is limited. This may be in part because grouping US-born blacks and foreign-born blacks as one homogeneous group obscures possible within-group differences. This study aimed to explore the cultural perceptions of CRC among 3 ethnic subgroups of blacks: African Americans (US born), foreign-born blacks from English-speaking Caribbean countries, and Haitian-born blacks. The study was informed by a community-based participatory research approach, using a cross-sectional mixed qualitative and quantitative methods design. A total of 62 individuals from the 3 ethnic subgroups participated in semistructured, in-depth qualitative and structured quantitative interviews. Qualitative findings revealed no stark differences among the 3 ethnic subgroups in their overall perceptions of cancer as well as their attitudes related to barriers, motivation, and resources for CRC screening. However, there were subtle differences in perceptions of curability, preventive practices, and preferred sources of information among the three ethnic subgroups of US blacks. The study has important implications for the design of educational materials and targeted interventions for diverse groups of US blacks.

Initial efforts in community engagement with health care providers: perceptions of barriers to care for cancer patients in Puerto Rico.

OBJECTIVE: Cancer health disparities are evident among Puerto Rican Hispanics, both for those on the island and in the mainland United States. Less is known about cancer care services available on the island. Through the Ponce School of Medicine and Moffitt Cancer Center partnership, focus groups with health care providers (HCP) were conducted to explore needs and barriers related to cancer care services with an ultimate goal of developing a cancer control and prevention program for the southern area of Puerto Rico. METHODS: To engage the community in outreach efforts to identify barriers to cancer care in Ponce, Puerto Rico, we conducted two focus groups with HCPs from a variety of settings, including general hospitals, private clinics, pharmacies, and government agencies. These 90-minute focus groups were conducted in Spanish and moderated using a semi-structured interview guide that explored the needs and barriers related to cancer control and prevention services. RESULTS: We analyzed content using the emergent material for identifying patterns, themes, and perceptions. Our qualitative analysis indicated that providers had significant concerns about unmet patient needs and system factors, which served as barriers to quality cancer care delivery. Key barriers included unmet practical needs, such as transportation, treatment affordability, lack of resources, and unmet needs for social support and education services. CONCLUSION: Future research will examine other key informants' (e.g., patients, caregivers) perspectives and identify which issues can be addressed by the partnership grant and which must be addressed by policymakers.

Cultural Acceptability of a Smoking Relapse Prevention Intervention for Pregnant Women in Puerto Rico: Providers' Feedback.

Hispanic women are more likely than non-Hispanic women to quit smoking during pregnancy, indicating that relapse-prevention interventions may benefit this population. We conducted qualitative interviews with health care providers in Puerto Rico who serve pregnant women regarding the cultural acceptability of Libres Para Siempre Por Mi Bebé y Por Mi (transcreated from the English version, Forever Free for Baby and Me), a smoking relapse-prevention booklet series. Providers praised the overall quality of the content, interactive activities, vignettes, and partner booklet. Recommendations included condensing the content, and distributing the booklets during one-on-one counseling and via "charlas"(community themed presentations). Overall, these smoking relapse-prevention materials are culturally acceptable among health care providers, yet there is a need to attend to local cultural preferences for delivering the intervention.

Creating community-academic partnerships for cancer disparities research and health promotion.

To effectively attenuate cancer disparities in multiethnic, medically underserved populations, interventions must be developed collaboratively through solid community-academic partnerships and driven by community-based participatory research (CBPR). The Tampa Bay Community Cancer Network (TBCCN) has been created to identify and implement interventions to address local cancer disparities in partnership with community-based nonprofit organizations, faith-based groups, community health centers, local media, and adult literacy and education organizations. TBCCN activities and research efforts are geared toward addressing critical information and access issues related to cancer control and prevention in diverse communities in the Tampa Bay area. Such efforts include cross-cultural health promotion, screening, and awareness activities in addition to applied research projects that are rooted in communities and guided by CBPR methods. This article describes these activities as examples of partnership building to positively affect cancer disparities, promote community health, and set the stage for community-based research partnerships.

Exploring disparities and variability in perceptions and self-reported colorectal cancer screening among three ethnic subgroups of U. S. Blacks.

PURPOSE/OBJECTIVES: To explore perceptions of colorectal cancer (CRC) and self-reported CRC screening behaviors among ethnic subgroups of U. S. blacks. DESIGN: Descriptive, cross-sectional, exploratory, developmental pilot. SETTING: Medically underserved areas in Hillsborough County, FL. SAMPLE: 62 men and women aged 50 years or older. Ethnic subgroup distribution included 22 African American, 20 English-speaking Caribbean-born, and 20 Haitian-born respondents. METHODS: Community-based participatory research methods were used to conduct face-to-face individual interviews in the community. MAIN RESEARCH VARIABLES: Ethnic subgroup, health access, perceptions of CRC (e.g., awareness of screening tests, perceived risk, perceived barriers to screening), healthcare provider recommendation, and self-reported CRC screening. FINDINGS: Awareness of CRC screening tests, risk perception, healthcare provider recommendation, and self-reported use of screening were low across all subgroups. However, only 55% of Haitian-born participants had heard about the fecal occult blood test compared to 84% for English-speaking Caribbean-born participants and 91% for African Americans. Similarly, only 15% of Haitian-born respondents had had a colonoscopy compared to 50% for the English-speaking Caribbean and African American subgroups. CONCLUSIONS: This exploratory, developmental pilot study identified lack of awareness, low risk perception, and distinct barriers to screening. The findings support the need for a larger community-based study to elucidate and address disparities among subgroups. IMPLICATIONS FOR NURSING: Nurses play a major role in reducing cancer health disparities through research, education, and quality care. Recognition of the cultural diversity of the U. S. black population can help nurses address health disparities and contribute to the health of the community.

Addressing cancer disparities through community engagement: improving breast health among Haitian women.

PURPOSE/OBJECTIVES: To describe processes for fostering community engagement among Haitian women to facilitate breast health education and outreach that are consonant with Haitians' cultural values, literacy, and linguistic skills. DATA SOURCES: Existing breast cancer education and outreach efforts for Haitian immigrant communities were reviewed. Local community partners were the primary source of information and guided efforts to create a series of health-promoting activities. The resultant partnership continues to be linked to a larger communitywide effort to reduce cancer disparities led by the Tampa Bay Community Cancer Network. DATA SYNTHESIS: A systematic framework known as the CLEAN (Culture, Literacy, Education, Assessment, and Networking) Look Checklist guided efforts for improved communications. CONCLUSIONS: Community engagement forms the foundation for the development and adaptation of sustainable breast education and outreach. Understanding and considering aspects of Haitian culture are important to the provision of competent and meaningful care. IMPLICATIONS FOR NURSING: Nurses should expand their skills, knowledge, and competencies to better address the changing demographics of their communities. Nurses also can play a critical role in the development of outreach programs that are relevant to the culture and literacy of Haitian women by forming mutually beneficial partnerships that can decrease health disparities in communities.