U54 Pilot Study (2015-2018) NIH/NCI Grant U54 143931 FRIDAY NOON LECTURE SERIES Aziza Lucas Wright, M.Ed. Instructor Charles R. Drew University of Medicine and Science Community Engagement Division College of Medicine Friday, June 8, 2018
Supporting African American Churches to Promote Cancer Screening Community PI: Aziza-Lucas Wright, M.Ed. (CDU) Academic PI: Annette Maxwell, Dr.P.H. (UCLA) Community Liaison: Pastor Rhonda Santifer, MMin (CDU) Community Health Educator: Claudia Vargas Outreach Core Investigators: Loretta Jones, Th.D. (CDU and HAAF) Roberto Vargas M.D., M.P.H. (UCLA & CDU) U54 Pilot Study (2015-2018) NIH/NCI Grant U54 143931
Cancer Statistics in South L.A. Cancer Death Rates (age-adjusted/ 100,000 population) L.A. County South L.A. (SPA 6) Lung cancer 27.5 30.7 Breast cancer 20.5 22.8 Cervical cancer 3.0 5.8 Colorectal cancer 13.8 16.0 Source: Los Angeles County Department of Public Health. Key Indicators of Health 2017
Project History Present Your Body Pilot Study conducted with 11 African American churches in South L.A. in 2011 Romans 12:1 (KJV).present your bodies a living sacrifice. Principal Investigator: Aziza Lucas-Wright, M.Ed. Co-P.I.s: Loretta Jones, M.A.; Mohsen Bazargan, Ph.D. Sample 800 members of African American churches Survey assessed: access to care knowledge and beliefs regarding prevention and early detection of cancer, history of cancer screening (breast, cervix, colorectal, prostate) tobacco use history of chronic diseases
Project History Present Your Body Findings Main reasons for not obtaining cancer screening tests: never thought about it doctor did not tell me I needed it put it off It would be very helpful (83%) or somewhat helpful (12%) to hear about cancer prevention and screening at church; 77% liked to receive information from trained peers
Church Partners
2016-17 Community Health Advisors
Specific Aims Aim 1: BUILD: Build the capacity of churches to promote cancer screening Aim 2: ASSIST: Assist 10 churches in developing a 12-month work plan Aim 3: ASSESS: Evaluate the outcomes and potential effectiveness of this intervention
Methods 1. Training of Community Health Advisors (CHAs) 2. Recruitment: CHAs inform parishioners, neighbors, friends and invite them to participate in the study 3. Baseline Assessment: CHAs identify men and women 50-75 years of age who are overdue for cancer screening tests (colorectal, breast, prostate, cervical cancer) 4. Counseling, print information, and a follow-up reminder call evidence based strategies: CHAs encourage cancer screening based on national guidelines 5. Evaluation: Researchers call participants 3 months later to assess if they got screened.
Flow Chart for CHAs Attend CHA training & receive study materials Increase awareness about the study at church Recruit adults ages 50 75, determine if eligible to join study (keep log sheet of who was approached) Obtain informed consent (give research information sheet to participants) Conduct baseline assessment to determine adherence to cancer screening guidelines Conduct one-on-one education using scripts Pass out print information Make a reminder call (phone or in person)
Study Design: One Group Pre/Post Mixed-Methods Design CHAs conduct Recruitment & Baseline Assessments Participants adherent to national cancer screening guidelines Non-adherent Participants CHAs provide oneon-one counseling, print information, reminders 3 Month follow-up survey to assess screening status UCLA/CDU train CHAs and assist in developing a work plan for each church Bi-directional Capacity Building Efforts UCLA/CDU provides ongoing monitoring and feedback for CHAs and assists with problem solving (e.g., finding programs for un/under-insured) End of Study Mtg: Share results and discuss sustainability
CHAs Partnered with 10 churches & trained 51 Community Health Advisors ages 45-82 Gender Men Women Level of education High school/some college Completed 4 years of college Completed graduate/professional degree N 10 41 22 18 11 % 20% 80% 43% 35% 22% Has professional background in health-related field 25/51 49% Currently employed part- or full-time 20/51 39% Cancer survivor 8/51 16% Ever had a colonoscopy 44/51 86% Ever did a stool blood test 30/51 59%
CHA Training 2-Agenda Review purpose of the study Informed Consent: Community Health Advisors ~ Quiz before training Human Subject Protection or IRB Participant recruitment & determining eligibility ~ Informed consent: respondents Early research studies Tuskegee Syphilis Study Experiments by Nazi physicians Focus on scientific findings over human subjects Learning about program components ~ baseline assessment, one-on-one education, how to respond to barriers to screening, reminders Observe role playing ~ What if scenario Activity: Role playing by Community Health Advisors Quiz after training
Evaluation of CHA Trainings Pre and Post-Test Measures (partial): CHA demographic information CHAs knowledge of human subjects protection rules (5 items) CHAs knowledge of colorectal cancer screening guidelines (4 items) CHAs perceived self-efficacy for performing specific tasks of the study protocol (13 items, Cronbach s alpha >.90) Results (N=51) Knowledge scores on Human Subject Rules (p<.03) Knowledge scores on CRC screening guidelines (p<.001) Self-efficacy to serve as CHA (p<.0001) Post-training scores were unrelated to demographic characteristics of CHAs CHAs have recruited 498 participants and provided counseling to 240 participants (as of 1/12/2018)
Results - CHAs After the trainings, most Community Health Advisors knew the National Colorectal Cancer Screening Guidelines % Correct Knowledge of Colorectal Cancer Screening Guidelines Before the training After the training Screening should start at age 50 65% 94% Stool blood test is recommended annually 55% 94% Colonoscopy is recommended every 10 years 40% 75%
Preliminary Data June 2016 January 2018 Recruitment & Baseline Assessment (N=498) Adherent to national cancer screening guidelines 52% Non-adherent 48% One-on-one counseling, print information, reminders 3 Month follow-up survey to assess screening status (ongoing) 80 hours of CHA training (20 sessions x 4 hours) 86 hours of group debriefings to date (43 sessions x 2 hours) plus individual debriefings as needed 2 End of Study Celebration & Debriefings
Preliminary Data: Baseline (N=376) Cancer Screening Test Colorectal Cancer Screening (stool blood test in last 12 months or colonoscopy in last 10 years) Up to date with national screening guidelines Number of participants counseled N % N 277/376 74% 99 2015 LA County Health Survey (random sample of 8,000 adults in LA) SPA6 results Mammogram (245 women) (in past 2 years) Pap test (245 women) (in past 3 years or Pap + HPV test in pasts 5 years) 195/245 80% 50 201/245 82% 44 Ever received HPV test 77/245 31% PSA test ever received (131 men) 90/131 69% 78% 84% PSA test discussion with doctor (131 men) 79/131 60% 52 As of 8/3/2017, a total of 168 participants received counseling on one or more cancer screening test(s).
Preliminary Data: 3 Month Follow-up (N=98) During the past 3 months. Discussed with doctor N % Colorectal cancer screening 49/98 50% Breast cancer screening 39/67 58% Cervical cancer screening 32/67 48% PSA testing (for Prostate Cancer) 14/31 45% Obtained screening test* Stool blood test 16/67 24% Colonoscopy (Plus 6 scheduled or planning to schedule) Mammogram (Plus 4 scheduled or planning to schedule) 9/67 13% 11/28 39% Pap Test 7/27 26% PSA Test (Prostate Cancer Test) 8/24 33% * Was only asked if not up to date at baseline
Preliminary Data - Quotes Majority of participants (83%) said that they learned something important from their discussion with a Community Health Advisor Early detection can save your life I need to take better care of my health I never heard of stool blood test, easier than colonoscopy I can do a home stool blood test if my insurance won t pay for colonoscopy Importance of regular screening; increased risk for cancer with age Remember to get screened even if you feel healthy Getting checked is better than trying to avoid the doctor Each person I talked to I felt I was really doing something (Community Health Advisor from one of our partner churches)
Limitations & Conclusions Limitations All findings are based on self-report No control group for comparison Data collection not complete; small numbers Conclusions Churches and church volunteers in South LA are willing and able to promote cancer screening Parishioners and others are willing to participate in this study and interested to learn more about cancer screening Future Challenges and Questions How can we sustain these efforts to promote cancer screening in South LA? Need to address other cancer risk factors in South LA such as HPV testing Healthy eating and physical activity to reduce obesity HPV vaccination
GRATITUDE Jaydutt Vadgama, PhD, Vice President for Research and Health Affairs, Professor of Medicine-UCLA School of Medicine, Chief, Division of Cancer Research and Training, Endowed Chair in Cancer Research, Director-Center to Eliminate Cancer Health Disparities, Department of Internal Medicine Loretta F. Jones, PhD, ThD, Assistant Professor-CDU, Founder and CEO Healthy African American Families