Enhancing the Effectiveness of Community Health Workers to Reduce Cervical Cancer Disparities in African American Women

ABSTRACT
The hysterectomy-corrected incidence of cervical cancer (CC) is high among African American women. Widespread screening and follow-up would eliminate most new cases of CC because the natural progression of precancerous cervical lesions is slow, allowing for treatment and cure. However, evidence suggests that this level of screening and follow-up is not consistently achieved. Among African American women, screening rates remain below recommended levels. These outcomes are modifiable.
One promising solution to this problem is patient navigation (PN). PN was originally developed to support timely breast cancer care using community members as lay navigators. Based on the initial success of this approach, the National Cancer Institute conducted a multicenter Patient Navigation Research Program to validate and extend these findings across a range of cancers. PN enhanced timely care across patient populations. Even with navigation, diagnostic resolution among African American patients remained an area for improvement. Broader implementation of patient navigation is likely to improve outcomes.
In previous pilot work, we developed and tested a prototype, mobile PN intervention designed for African American women (mNav) and lay navigators (mNav-D) to improve CC outcomes. These products are front-ends to the same server-based program, and thus fully integrated. For patients, mNav includes an integrated web-based risk assessment that allows our SMS software app to select and deliver videos and text messages tailored to each woman’s screening needs. Pilot work with 42 African American women ages 21 to 65 informed the development of this product. For navigators, mNav-D provides an “at a glance” overview of key performance metrics while also supporting easy entry of encounter-level patient data. Development of this product was informed by formative research with 16 PNs working in a range of settings. We also interviewed 12 participants who had either upstream or downstream touch points with electronic health record (EHR) workflows. The data across these pilot studies strongly supports the feasibility and potential effectiveness of these products, far exceeding the proposed benchmarks.
During Phase II we will complete development of mNav and mNav-D in consultation with our three content experts. We will then examine the effectiveness of mNav and mNav-D to increase adherence to cervical screening guidelines via medical review among African American women who are overdue for screening. Participants will be randomly assigned to either the intervention condition (PN + mNav/mNav-D) or to usual care (PN only). Secondary measures will assess cancer screening knowledge, perceived benefits and challenges of screening, and intentions to screen.
PHS 398/2590 (Rev. 09/04, Reissued 4/2006) Page Biographical Sketch Format Page

Grant Number: 5R44MD015221-04
NIH Institute/Center: NIH
Principal Investigator: DOUGLAS BILLINGS