Increasing Mammography Among Latinas with Disabilities
|Institution:||Central Coast Center for Independent Living|
Elsa Quezada , -
H. Stephen Kaye , Ph.D. -
|Award Cycle:||2006 (Cycle 12)||Grant #: 12AB-2701||Award: $125,000|
|Award Type:||CRC Pilot Award|
|Disparities>Disparities: eliminating the unequal burden of breast cancer|
This is a collaboration with: 12AB-2700 -
Initial Award Abstract (2006)
Introduction to the research topics: Women with disabilities and Latinas make up two groups who have not received the attention needed for breast cancer screening. Although the recommended guideline for women over 40 is to have an annual mammogram, research shows that fewer women with major physical disabilities follow that guideline, compared to women without disabilities. Similarly, research shows that many fewer Latinas follow the mammography guidelines than non-Hispanic women. Even worse, many Latinas never get mammograms—twice as many as women who are not Latina. In 2004–05, Community Resources for Independent Living, a non-profit organization serving people with disabilities in suburban Alameda County, conducted a Healthy Women Project which successfully showed that health education could motivate women with physical disabilities to obtain mammograms. The participants included mostly white or African American women. In the proposed project, we plan to apply lessons learned from the Healthy Women Project to a different and particularly vulnerable population—Latinas with disabilities, who are mostly poor, often speak only Spanish, and live in an agricultural area with few accessible health facilities. We propose to (1) expand the project to include improving accessibility of health facilities and training in self-advocacy for the participants, (2) build in the cultural and communication supports needed to serve Latinas with physical or sensory disabilities, and (3) work toward systems change through community education and dissemination of project findings. The question(s) or central hypotheses of the research:
1. If Latinas with disabilities receive support from other Latinas, education about the importance of breast cancer screening, skills to speak up for themselves in healthcare settings to meet their own healthcare needs, and access to places to go to get their mammography needs met in a culturally appropriate way, will they be more motivated to comply with mammography guidelines?
2. Even with limited resources, can community clinics, other health care providers, and disability organizations work together to break down communication, physical, and attitudinal barriers and increase access to mammography services and programs for Latinas with disabilities?
3. If this community removes the barriers, and provides support, education, skills, and resources to Latinas with disabilities, will more such women get their mammograms as recommended? The general methodology: This project will use a peer health education approach that includes support, information, and skill building. Also, the project will work with health clinics to change the way they do business to improve the clinic’s ability to serve Latina women with disabilities. To determine whether the project made a difference, the women will participate in a survey before and at the end of the project to determine if they understand more about the issues and have changed their attitudes towards mammography. The project will also follow-up the women to see if they went for their mammograms and what experiences they had with the screening. Innovative elements of the project: In this project, we are reaching out to Latinas with disabilities, using lessons learned in another community, and finding out whether providing education and changing the environment to meet the specific needs of these women will change people’s attitudes and their health behaviors, and potentially save lives. Community involvement: This project involves the disability community, the Latino/a community, the women’s health advocacy community and people providing community-based medical and public health services to the underserved residents of Monterey, San Benito, and Santa Cruz counties. People from all these groups will participate in all phases of the project, both as project partners and as members of the Advisory Committee. Participating organizations include local disability organizations serving people with hearing or visual impairments, Clinica de Salud del Valle de Salinas, the Monterey County Health Consortium, and Every Woman Counts.
Progress Report 1 (2007)
Both women with disabilities and Latinas are less likely to obtain mammograms than their non-minority counterparts. This project aims to develop and evaluate the effectiveness of an intervention to increase mammography rates among a population of Latinas with disabilities, through a combination of health education and improved physical and programmatic accessibility of healthcare facilities. To meet these objectives, initial efforts focused on establishing and enhancing community partnerships, including the formation of an Advisory Committee. Primary partnerships are in place with a chain of nonprofit community health centers, local Medi-Cal managed care agency, local chapter of the American Cancer Society, Area Agency on Aging, In-Home Supportive Services, a community organizing group that promotes literacy and involvement in the community, the health department and an independent living center in Hayward, CA. The first aim of the project is to to use peer education to teach Latinas with disabilities about the importance and availability of mammography, along with training in healthcare self-advocacy. Currently, we are awaiting a second round of human subjects approval. The intervention will begin in June 2007. Data collection instruments, including pre- and post-interevention surveys, subject recruitment flyer, recruitment and follow-up scripts have been created. Each form was developed in English and translated into Spanish. Bilingual and bicultural members of the Advisory Committee have reviewed the Spanish versions for word choice and cultural appropriateness. Additionally, the initial intervention curriculum has been developed, tentatively including an innovative method (Breast Cancer Bingo) developed by a new partner organization (Latinas Contra Cancer). The second aim is the assessment of local mammography facilities for overall and mammography-specific accessibility, and to work in partnership with providers to improve accessibility, and reassess to measure changes. We formed partnerships with healthcare organizations, including the health department, to begin assessment of accessibility of local healthcare facilities, beginning with those offering mammograms. The third aim is to educate local healthcare providers, community leaders, and community members about barriers to obtaining needed breast cancer screenings and on successful strategies to overcome such barriers. This portion of the project will take place in Year 2 of the project.