Building Bridges to Cancer Prevention: Outcomes of a cancer education and screening intervention for refugee women in the US
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1 Building Bridges to Cancer Prevention: Outcomes of a cancer education and screening intervention for refugee women in the US Amy Raines-Milenkov, DrPH Assistant Professor University of North Texas Health Science Center Migration, Ethnicity, Race and Health (MERH) May 17, 2018 Edinburgh, Scotland
2 TOP US STATES FOR REFUGEE RESETTLEMENT, 2016 Number of refugees resettled California 7,909 Texas 7,803 New York 5,026 Michigan 4,258 Ohio 4,194 Arizona 4,110 30% North Carolina Washington Pennsylvania 3,342 3,233 3,219 54% 76% Illinois 3,125 91% Source: US Office of Refugee Resettlement
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4 REFUGEE ARRIVALS IN TEXAS ,785 15, ,759 10,729 7, , Data Source: , Texas Refugee Health Program,
5 Grant Periods Prevention Grant
6 Preventive Cancer Screenings and Vaccinations for Refugees Less Likely than US Born Access to Health Services Health providers who counsel on vaccination and screening Demand for the services Ability to understand language (written, verbal and nonverbal) of health system Few competing priorities Transportation Beliefs, education and experiences that support preventive medical care Other Supports: child care
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8 Building Bridges Model Trauma Informed Screenings Community Advisors & Collaboratio n Participant Lay Health Educator Outreach and Education Health Provider Education
9 7 Health Educators 5 Groups Bhutanese/Nepali Karen, Chin Somali Congolese 1 language group Arabic 13 languages
10 BUILDING BRIDGES PROCESS Outreach, Consent & Enrollment Housing Houses of Worship Cultural Events Word of Mouth Education Adapted from Research Tested Interventions & for each population 13 languages Small group & One-on-One Settings Screenings & Navigation Appointments Transportation Interpretation Follow-Up
11 PARTICIPANTS Enrolled people from 20 countries of origin 30 languages (with interpreters) Top Four Countries of Origin: Karen/Karenni (Burma) Somalia Bhutan Democratic Republic of the Congo
12 PARTICIPANTS AND SCREENINGS/VACCINATIONS 683 enrolled as of May WOMEN 79% 144 MALES 21% Cervical Cancer (21 & older) Colon Cancer (50 & older) Hepatitis B (18 and older) Colon Cancer (50 & older) Hepatitis B (18 & older) HPV Vaccination (14-26) Mammogram (40 & older) HPV Vaccination (14-26)
13 Characteristics of Participants, 2014 May 2018 (n=683) Age, years Total Female (n=539) Male (n=144) Age Range (min-max) Average / Mode Age 40/31 39 /31 46 /38 Health Insurance No Health Insurance 50% (338/679) Formal Education 52% (257/536) 41% (51/143) Average years Literacy Speaks English Well/Very Well 25% (171/676) 25% (132/534) 27% (39/142) US Residence Average years (min-max) 4 (0-28) 4 (0-28) 4 (0-28)
14 REFUGEES ARE AN UNDERSERVED US POPULATION Never screened/not up to date AT ENROLLMENT DATE Awareness 62% 73% Cervical Mammogram 70% 93% Hepatitis B HPV VACCINE Pap screening in last 3 years, 21 and older Mammogram in last 12 months, 40 and older Do not know Hepatitis B status* *All refugees screened at initial medical exam in US Never heard of the HPV vaccine among female participants
15 ACTIVITIES Community Advisor Meeting Vaccination Event Health Provider Training Health Education Session Scientific Presentation Team Building
16 May 2014-February 2018 Intervention Outcomes* Cervical Cancer Screening 63% of eligible women completed screening (180/286) 5% of results abnormal (10/180) Trauma influenced participation Female midwives and Ob/Gyn were essential
17 Mammogram 84% of eligible participants completed screening (138/164) 12% of results were abnormal (17/138) I will go back [for the mammogram] because it is important for women. I should go back even if the result is normal the first time.
18 Hepatitis B Screened 412 individuals (enrolled and not enrolled) 6% screened HBV positive (24/412) and were previously unaware of their status despite being screening at the mandatory refugee medical screening Connection to follow-up monitoring not readily available The educator helps with everything, helps with transportation, scheduling appointments, help with interpretation, arranging for transportation, and good explanation during classes.
19 HPV Vaccination 9-26 years of age 138 vaccinated or process 43% dose completion We didn t know that cancer can be treated or prevented. We thought if you get cancer you always die.
20 I did not know we had anything inside our bodies. I thought the babies were just under the skin. Thanks for teaching us about the body. CHALLENGES: EDUCATION & AWARENESS Cancer can spread from person to person, so we usually avoid people who have it.
21 CHALLENGES: RISK PERCEPTION Good Muslims do not get cancer. Only white people get cancer.
22 CHALLENGES: CAUSES If you fall and injure yourself then it may cause cancer. My husband poisoned me so that is why I have stomach pain.
23 Sometimes when someone has Hepatitis B, the traditional healers can use a metal stick that has been heated in fire to press three dots on the stomach to cure it. CHALLENGES: TREATMENT/ SCREENING Mammograms are painful. They stuck a needle in my chest and pulled out all my blood.
24 CHALLENGES: POLITICAL CLIMATE I'll look Syrian children in the face and say they can't come. Why are we having all these people from sh**hole countries come here? -Trump
25 Building Bridges Lessons Learned (or reinforced) PATIENCE FLEXIBILITY OTHER NEEDS SELF CARE
26 Dissemination of Results Expansion: Reproductive Health Maternal and Child Health Chronic Disease Mental Health Expansion to identified and unmet needs Maternal and child health Chronic diseases, nutrition Mental health Comprehensive wellness Sustainability Sustainability of Efforts Provider training Organizational change Organizational Change
27 BUILDING BRIDGES WITH GRATITUDE MERH, 2018 Eva Baker, MPH, Co-Director and Program Manager Martha Felini, PhD, Evaluator Lan Yang, Student Biostatistician Elvis Longanga Diese, Health Educator Sara Onsa, Health Educator Anab Abdi, Health Educator Aisha Ojha, Health Educator Hlawn Iang, Health Educator K Paw, Health Educator Natalie Buhigiro, Health Educator Radhika Subedi, former Health Educator Halimo Mudey, former Health Educator Laurette Rudasingwa, former Health Educator Emelda Thein, former Health Educator
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