American Indian and Alaska Native Cancer Early Detection Seminar Recruitment Strategies January 18, Presented by: Noel Pingatore, BS, CPH
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1 American Indian and Alaska Native Cancer Early Detection Seminar Recruitment Strategies January 18, 2009 Presented by: Noel Pingatore, BS, CPH Objectives: Objective: The participants will be able to identify a minimum of three tested and utilized recruitment strategies targeting Native Americans and Cancer screening and education programs. Objective: Participants will identify three common components used to develop an effective recruitment strategy or activity. Objective: The Participants will be able to identify three resources for locating recruitment strategies and interventions. 2
2 Pre Knowledge Questions 3 There are many tested and proven effective outreach and recruitment strategies targeting AI/AN population groups. 1. True 2. False 3. Don t know/ Don t want to answer 79% 14% 7% 1 2 3
3 Examples of successful components used to develop effective recruitment strategies and activities, include: 1. Use of Facts and Figures 2. Use of CBPA/ Community input 3. Use of traditional language 4. Answers 1 and 2 5. Answers 1,2, and 3 4. Don t know/ Don t want to answer 46% 23% 15% 8% 8% 0% 0% 0% 0% Please name two resources for identifying recruitment strategies and interventions specific to the AI/AN population 1. Native American Cancer Research and the Mayo Clinic Spirit of Eagles 93% 2. Native American Cancer Research and CDC The Community Guide to Prevention 3. Mayo Clinic Spirit of the Eagles and Cancer Planet. 4. Don t know / Don t want to answer 0% 0% 0% 0% 0% 0% 7% 0% 0%
4 What we ve learned that works Ask the community for their answer to the problem Involved the community in your project Share local facts and figures Use of local language, traditions, figures, pictures Gatherings, foods and incentives 7 Some examples of successful strategies and activities: The Courage Calendar The Pink Shawls Project Direct Mailings Mother s Day Cards One on One Education Navigators, providers 8
5 What we ve learned when we ve talked with the community- Fear is one of the most common reasons people don t access or receive cancer screening tests. They don t want to know if they are ill Some believe the tests themselves cause illness; tests/ procedures are uncomfortable If they are found to have cancer, they are afraid of treatments; accept a death sentence Our outreach and recruitment strategies need to address their fears: Focus on Survivorship Local survivorship stories Include testing procedures Survivor volunteers and networks Use of local, trusted Community Health Staff, i.e. Navigators to walk through the process 10 NACR ARS Item
6 The Courage Calendar: Inspired and funded by the Avon Foundation Breast Care Fund; Portraits of Courage, Voices of Hope photo essay Features Native American Breast Cancer Survivors photos and stories; the calendar format serves as monthly reminders for self breast exam and to schedule clinical breast exams and mammograms, as well as other health screenings. 11 NACR ARS Item
7 Courage Calendar Survey Purpose: to gather feedback from community members on the calendar to explore if it changed their thoughts or feelings related to breast cancer, and if it motivated them toward specific actions or behaviors 14 NACR ARS Item
8 Calendar Distribution: 10 tribal sites, 1 urban Indian community center 1,000 (approximate) calendars distributed Sample: 4 sites returned surveys 75 respondents 66 female, 9 male Age distribution of sample 60+ 9% <30 yrs 17% 50 to 59 30% 30 to 39 19% 40 to 49 25%
9 Experience with breast cancer/breast problems: self, family or friends No 36% Yes 64% 17 Native American Cancer Research ;
10 70% 60% 50% 40% 30% 20% 10% Where have you seen the calendar? 19 0% Own copy family/friend's copy at tribal health center at other tribal center Other Content of Survey Respondents were asked if reading the calendar: motivated them toward specific actions (doing SBE, encouraging family/friends to get screening, etc.) Changed their thinking Affected their feelings related to breast cancer, screening & treatments
11 Motivation to take specific actions (women respondents) 60% 50% 40% 30% 20% 10% 0% Get Screening Do SBE Make app't Not at a Some Very Much Motivation to take actions 60% 50% 40% 30% 20% not at all some very much 10% 0% encourage family to get screening want more info
12 Change in thoughts related to breast cancer: made me think that 80% 70% 60% 50% 40% 30% 20% not at a some very mu 10% 0% more people survive b.c. more common happens to younger women too early/regular screening saves lives MICHIGAN INTER-TRIBAL COUNCIL
13 Effect of reading the calendar stories on feelings related to breast cancer made me less afraid of: 60% 50% 40% 30% 20% 10% 0% getting screens and tests getting cancer not at all some very much MICHIGAN INTER-TRIBAL COUNCIL Impact on confidence about effectiveness of treatments "Made me feel more confident about treatments" not at all, 10% very much, 49% some, 41% Thank you Chuck Wiggins, PhD, UNM SEER!
14 Strongest Findings Motivated me to make sure I get screening Made me think that more people survive breast cancer than I thought Made me think that early and regular screening can save lives
15 Qualitative Findings Most common narrative comments were around the following themes: 1) High visual appeal (the women featured, the photographs, etc.) beautiful, well done 2) Appreciation for recognizing local women, local community, personal connection 3) Appreciation for the calendar being Native specific Summary Strongest findings seems to relate to motivation, thoughts and feelings around the issue of screening & survival Did not appear to increase fear among respondents Respondents were positive about the calendar featuring local women from their tribes, and being Native Specific
16 Other Effective Recruitment Strategies The Pink Shawls Project Developed with Community Participation Use of focus groups and interviews Use of traditions, i.e. dancing, regalia, foods, pictures and values such as family Steele CB, Cardinez CJ, Richardson LC, Tom-Orme L, Shaw K. Surveillance for Health Behaviors of American Indians and Alaska Natives Findings from the Behavioral Risk Factor Surveillance System, , CANCER 2008, in press
17 Pink Shawls DVD Survey Demographics 78% had seen the DVD at a Community Event All were female 44% were between the ages of 40-49; 33% were and 11% were younger than 30; 11% were age 60 and over All had either experienced Breast Cancer or knew someone who had. 33 Summaries from the Pink Shawls Project 75% felt viewing the video motivated them to do self breast exam very much 25% reported some 88% reported very much that the video made them think that early and regular screening can save lives. 12% reported some 78% felt very much motivated to encourage family members to get screening. 22% felt some (0 reported not at all) 34
18 This picture is from the Bay Mills Indian Community in the Upper Peninsula. This Project grew quickly across the state and then across the country.
19 Additional Responses regarding perceptions 88% reported (very much) that the DVD made them think that more people survive breast cancer than they previously thought. (22% some ) 63% report (very much) that breast cancer is more common than they thought. (37% some ) 78% reported (very much) that breast cancer happens to younger women too. (22% some ) 37 Adapting Best and Promising Practices as effective outreach strategies: Use of CDC s Community Guide to Prevention Client Reminders One on One Education Reducing Structural Barriers Provider assessment and feedback Provider reminders
20 National Cancer Institute Research Testing Intervention Programs http.rtips.cancer.gov Use of Direct Mailing to increase screening mammography Telephone Care Management Programs Reminder Postcards One of One Education HAPPY MOTHER S S DAY...Moccasined Feet Dancing Lightly, She is the Pride and Future of Our People. Today many women in Michigan are living with breast cancer. They are living today because they received early screening. One in Eight Women will get breast cancer in their lifetime. The best way to survive breast and cervical cancer is to find it early. Starting at age 18 or onset of sexual activity, every woman needs a yearly pap and pelvic examination, and monthly self breast exams. Starting at age 40, every women needs a mammogram each year. Please call your local tribal health clinic or nearest County Health Department to schedule an appointment today. Your good heatlh is a gift of respect to you and those you love. Sponsored by Your Tribal Health Clinic, The AVON Breast Care Fund, and the State of Michigan Breast and Cervical Cancer Control Program. 40
21 More Resources that you can use and adapt Cancer Planet The Community Guide American Cancer Society National Cancer Institute/ SAMHSA State Health Departments, Cancer Section, Minority Health Office, BCCCP 41 AI/AN specific resources: Native American Cancer Research Get on the Path to.. Mayo Clinic Spirit of Eagles Reminder postcards, videos, teaching tools, materials, games, resources ( Tree of Life) National Native Women s Health Resource Center 42
22 Additional Suggestions: Art and Museum Events Survivor Fashion Shows Community Luncheons and Teas Use of Women only wellness days at the Clinic, Pink Party Tree of Life Crafting Groups, teaching necklaces and key chains, circle of life quilts Focus on family Use of Native specific facts and figures Have Fun! 43 Summary to develop effective outreach and recruitment strategies and activities: Attain input from your community Use local language, facts and figures, photos; Utilize traditional gatherings, foods, and incentives Utilize proven AI/AN projects and resources Native American Cancer Research Mayo Clinic Spirit of Eagles National Native Women s Health Resource Center Utilize and adapt best and promising practices The community Guide National Cancer Institute 44
23 There are many tested and proven effective outreach and recruitment strategies targeting AI/AN population groups. 1. True 2. False 3. Don t know/ Don t want to answer 79% 14% 7% Examples of successful components used to develop effective recruitment strategies and activities, include: 1. Use of Facts and Figures 2. Use of CBPA/ Community input 3. Use of traditional language 4. Answers 1 and 2 5. Answers 1,2, and 3 4. Don t know/ Don t want to answer 46% 23% 15% 8% 8% 0% 0% 0% 0%
24 Please name two resources for identifying recruitment strategies and interventions specific to the AI/AN population 1. Native American Cancer Research and the Mayo Clinic Spirit of Eagles 93% 2. Native American Cancer Research and CDC/ The Community Guide to Prevention 3. Mayo Clinic Spirit of the Eagles and Cancer Planet. 4. Don t know / Don t want to answer 0% 0% 0% 0% 0% 0% 7% 0% 0% Meegwetch! Thank you for your time and attention today For s, you may reach me at noelp@itcmi.org; ext
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