©2000 Breast Cancer Outreach Strategies:

Models that Work

For the Farmworker Population

National Center for Farmworker Health, Inc.

Presented by:

Alicia Gonzales-Leadership Development & Training Center

Director

&

Monica Saavedra-Embesi-Migrant Health Education Coordinator

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National Center for Farmworker Health

National Non-profit Organization, Est. 1975 Located in Buda, TX Provide training & technical assistance to a

network of federally funded Migrant and Community Health Centers Primary Constituents Other interested organizations

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Mission Statement

To improve the health status of

farmworker families through the innovative application of

human, technical and information

resources.

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NCFH Focus Areas1. Leadership Development & Training

On-site consultation and facilitation Leadership and skills-building training Health promoter and health based trainings Migrant health orientation & training Translation & patient ed. Material development

2. Network Development & Expansion Call for Health Program-1-800-377-9968

3. Migrant Health Network Support Resource Center & Library

Houses collection of bilingual patient ed materials and FW specific resources

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Leadership Development & Leadership Development & TrainingTraining Center

Health Education Focus: Development Experience

Health Curricula Breast Cancer Oral Health HIV Diabetes

Patient Education Materials Promotora Training

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Commonly Used Outreach Strategies w/FW’s

Popular education is engaging and empowering. It works to transform not only the lives of the participants, but the whole society.

Popular Teaching Strategies Incorporate the following outreach strategies into your education delivery:

Group activities Brainstorming Role-playing Games Ice-breakers Testimonials Theater Foto-novelas

Use of Lay Health Promotor models Health Navigation Program

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Model Programs

Rural Women’s Health Project-Florida Women’s Center of Jacksonville-Jacksonville, FL The Rose-Houston, TX Cancer & Chronic Disease Consortium-El Paso, TX Multicultural Human Dev. Corporation-Lincoln, NE Kentucky Cancer Program-Louisville, KY Delaware Breast Cancer Coalition-Wilmington, DE Cultivando la Salud-Buda, TX

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Model Program

Cultivando La Salud

A Breast and Cervical Cancer

EducationProgram

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About the Cultivando la Salud Program (CLS)

1 out of 11 R & D projects funded across the U.S. by CDC (1999-2002)

Proved successful and rec’d continued funding from SGK

Focuses on Breast and Cervical Cancer Development of low literacy and culturally

appropriate educational materials Promotora Program Model Reaches hard to serve populations Proven to be effective in increasing B & C cancer

screening

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Cultivando la Salud: Breast and Cervical Cancer Program

Overview Develop, test, replicate and disseminate a

breast & cervical cancer program that will build on the promotora model.

Build capacity within health centers through training & technical assistance to implement the program. Develop and carry out educational

strategies to increase knowledge of breast & cervical cancer and improve skills and behaviors that influence screening.

Evaluation component

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To increase breast and cervical cancer screening among migrant and seasonal farmworker women aged 50 and older.

To increase capacity for Migrant and Community Health Centers.

Program Goals:

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Evaluation Underwent extensive testing in the

development, implementation, and completion phases

Conducted over 15 Focus Groups Pilot tested surveys, materials, and

implementation Trained over 30 organizations

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PROGRAM DEVELOPMENT

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Intervention Mapping

NEEDS ASSESSMENT

Identify the at-risk population, quality of life

and health problemsDistinguish environmentaland behavioral causes Review key

determinants

INTERVENTION MAP

IMPLEMENTATION

EV

ALU

AT

ION

P r o x i m a l P r o g r a mO b je c t iv e s M a t r ic e s

sp ec i f y th e p e r f o r m a n c e o b j ec t i v e s s p e c i f y i m p o r t a n t, c h a n g e a b l e d e t e r m i n a n ts d if f e r e n t i a t e th e t a r g e t p o p u l a ti o n c r e a t e m a t r i c e s o f p r o x i m a l p r o g r a m o b j ec t i v e s

T h e o r e t ic a lM e th o d s &P r a c ti c a l S tr a t e g ie s

b r a i n s t o r m m e t h o d s t o a c h ie v e p r o x i m a l p r o g r a mo b j ec t i v e s

u se t h e t h e o r e ti c a l a n d e m p i r i c a l l i t e r a t u r e t of u r t h e r d e li n e a te t h e m e t h o d s a n d th e r e l ev a n tp a r a m e te r s f o r m e th o d s

t r a n sl a t e m e th o d s i n t o st r at e g ie s

P r o g r a m D e s i g n o p e r a ti o n a l i z e t h e s tr a te g i e s i n t o p l a n sc o n si d e r i n g i m p l e m e n t o r s a n d s i te s

d e si g n i n st r u c ti o n m a t e r i a ls p r e t e st i n st r u c t i o n m a t e r i a l s w i t h th e t a r g e t g r o u p p r o d u c e t h e m a t e r i a ls

A d o p t io n &I m p le m e n t a ti o nP l a n

d e v e l o p a l i n k a g e sy s t e m sp ec i f y a d o p ti o n a n d i m p l e m e n t a ti o n

p e r f o r m a n c e o b j ec t i v e s sp e c if y d e t e r m i n an t s o f a d o p t i o n a n d

i m p l e m e n t a ti o n w r it e a n i m p l e m e n ta t i o n p l a n

M o n it o r in g &E v a l u a t io n P l a n

d e v e l o p a n e v a lu a t io n m o d e l u si n g i n f o r m a ti o nf r o m th e p r e v i o u s s t e p s o f I n t e r v e n t io n M a p p i n ga n d i n f o r m a t i o n f r o m t h e n e e d s a ss e ss m e n t .

d e v e l o p e f f e ct e v a l u a t i o n q u e s ti o n s f r o m th e n e e d sa ss e ss m e n t a n d p r o x im a l p r o g r a m o b j e c t i v em a tr i c es . R e f e r to t h e m a t r ic e s a s b l u e p r i n t s f o ri n st r u m e n t d e v e l o p m e n t .

d e v e l o p p r o c e ss ev a l u a t i o n q u e st i o n s f r o mi n te r v e n t i o n m a p p i n g m e t h o d s, st r a t e g i e s a n dim p l e m e n t a t i o n p la n s.

Outcomes Tasks

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CLS Tools & Resources

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Replication Package

Program Manual

Breast & Cervical Cancer Training Curriculum

“Tool Box” to be used by Promotoras to provide education to Farmworkers Components include:

Lesson Plans Flipchart Video Pamphlets

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Program Manual(For Program Planners)

“HOW-TO” Manual Background and

Program Description

Goals and Objectives

Program Implementation

Overview of the Program Materials

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Program Manual(Continued)

RESOURCES Promotora Job Description Recruitment & Training Management & Maintenance of

Promotora Programs Contact Forms Staffing Plan and budget Evaluation and Sample Evaluation

Tools

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B & C Training Curriculum

Lessons: Introduction to the Training Role of the Promotoras Reaching Farmworker

Women Finding Breast Cancer Early Barriers to Breast Cancer

Screening Finding Cervical Cancer Early Barriers to Pap Test

Screening Teaching Methods Practice Session Using

Program Materials Resources and Referrals Evaluation

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Promotora Tool Box

Video Flipchart Lesson Plans Breast Model

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Video

Spanish Only Portrays FW Women 50 and over at

work and home Takes the viewer step by step for the

CBE, Mammogram, Pap Test, and highlights the BSE

The FW women engage in a barriers discussion

Testimonials

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Flipchart

Comprehensive & Flexible tool

Bilingual Script for

Promotora; graphics for woman

Barriers, Exams, and Testimonials

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Lesson Plans

Step-by-Step on how to conduct a session

Comprehensive lesson plans

3 options based on time: a, b, and c

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CLS PROGRAM FOUNDATION

PROMOTORA MODEL

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PROMOTORAS IN THE FIELD

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Role of Promotoras in Cultivando La Salud

Provide B&C cancer education to women in cohort through one on one home visits

Identify & help women overcome barriers to screening

Motivate women to get screened Provide referrals to local screening providers Assist them in making and keeping their

appointments Served as link between the client and

screening service Offer other assistance as needed

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Educational Components

Promotoras conducting door-to-door outreach in farmworker areas/colonias

Using program materials, group presentations & one-on-one contacts

Referrals to B&C screening providers Follow-up

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Why the CLS Program?

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Evidence Evidence based results Tested in the community with

community members Farmworker specific Use of the promotora model

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Screening Completion- Women in Cohort

Site 1 Eagle Pass, TXIntervention

Site 2Anthony, NM

Comparison

Site 3 Merced,CA

Intervention

Site 4 Watsonville, CAComparison

Mam Cohort with follow-up

36.8% 30.8% 58.3% 28.8%

Pap Cohort with follow-up

32.4% 22.4% 76.9% 25.0%

CLS Program Results 20002

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****Intervention Effect****Intervention Comparison p value

MammographyCompletion

N=307

40.8% 29.9% .049

Pap TestCompletion

N=170

39.5% 23.6% .025

CLS Program Results 2002

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Current NCFH BC Activities

CLS Nationwide Trainings 2 day-Train the Trainer Direct Hands on Promotor Training

CLS Hays County Intervention Use of Promotor Model Rural Hispanic Community Breast Cancer Outreach & Referrals for Screening

Call for Health Program 800-bilingual toll free line Provides referrals and $ assistance for qualifying

FW patients in need of screening or treatment

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Contact Information Alicia Gonzales, Leadership Development &

Training Center Director 512-312-5469 gonzales@ncfh.org

Monica Saavedra-Embesi, Migrant Health Education Coordinator 512-312-5468 saavedra@ncfh.org

www.ncfh.org 1800-531-5120

@2006 NCFH

FINGracias