Cancer Screening Interventions Resources Reference Package

Cancer Screening Interventions Resources Reference Package

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Cancer Screening Interventions Resources Reference

Package Moving evidence into practice

© McMaster University, May 2013

A product of the “Tools to Support Effective Knowledge Translation Practice and

Research in Cancer Control” Project

Escarpment Cancer Research Institute (ECRI)

Department of Oncology, Faculty of Health Sciences

McMaster University, Hamilton, Ontario, Canada


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Cancer Screening

Interventions

Resources Reference

Package Welcome to the Cancer Screening Interventions Resources

Reference Package.

The Cancer Screening Interventions Resources Reference Package is the result

of a project conducted to identify the “how to” information for

developing and implementing effective strategies to facilitate the uptake

of cancer screening. The project followed on the heels of a previous

systematic review, which was used to inform an Ontario practice

guideline, that found i) small media (targeted at the client); ii) client

reminders; and iii) audit and feedback of the health care professional were

effective knowledge translation implementation strategies for

facilitating the uptake of cancer screening.

Not only is it important to know what works, as was found with our

systematic review, but as equally important is to know how something

works. This information is essential in guiding implementation efforts

and in locally adapting and replicating an effective strategy in various

settings. Through our ‘KT Tools’ project we sought to identify resources

that provided the “how to” information for the cancer screening

implementation strategies.

The Resources Reference Package represents a collection of summary

information abstracts (referred to as “Profiles”) on how to

operationalize cancer screening uptake strategies. The Package is

intended for use by those “in-the-field” charged with planning,

developing, and implementing cancer screening programs.

On behalf of the project team, I hope you will find the Resources

References Package a useful and convenient reference document.

Sincerely,

Melissa C. Brouwers, PhD Principal Investigator, “Tools to Support Effective Knowledge Translation

Practice and Research in Cancer” Project

Moving

Evidence

into Practice

One of the goals of

KT is to facilitate the

uptake and

application of

evidence. With the

plethora of research

in this area, we

understand “what”

works in terms of

effective KT

interventions to

move “evidence”

into “practice”. We

are less clear,

however, on “how

to” operationalize

these interventions

in the practice

setting to optimize

effectiveness.

The Resources

Reference Package

contains summary

profiles of resources

for “how to”

operationalize cancer

screening uptake

strategies.


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Content

The contents of the Cancer Screening Interventions Resources Reference Package are

provided for informational and educational purposes only. All information is

provided on an “as is” basis without any warranties of any kind. Links are

provided for information and convenience only. We cannot accept responsibility

for the sites linked to, or the information found therein. A link does not imply an

endorsement of a site; likewise, not linking to a particular site does not imply

lack of endorsement.

Disclaimer

Care has been taken in the preparation of the information contained in this

document. The Cancer Screening Interventions Resources Reference Package makes

no representation or guarantees of any kind whatsoever regarding the content or

use or application and disclaims any for the application or use in any way.

Copyright Statement

Information may be cited with appropriate acknowledgement in scientific

publications without obtaining further permissions. For other intended uses,

please contact us. Unless otherwise noted, all materials contained in this

document are copyrighted and may not be used except as provided in this

copyright notice and other propriety notice provided with the relevant

materials. All copies of this material must retain the copyright and any other

proprietary notices contained on the materials. No material may be modified,

edited or taken out of context such that its use creates a false or misleading

statement or impression as to the positions, statements or actions of those named.

Funding

The “Tools to Support Effective Knowledge Translation Practice and Research in Cancer

Control” (“KT Tools”) project was conducted with the support of funding

provided by Cancer Care Ontario (CCO) and the Ontario Institute for Cancer

Research (OICR) (through funding provided by the Ministry of Health and Long-

Term Care and the Ministry of Research & Innovation of the Government of

Ontario). The project also received support from KT Canada funding from the

Canadian Institutes of Health Research (CIHR).

All work produced herein is editorially independent from its funding agencies.


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Melissa Brouwers, PhD Principal Investigator

Associate Professor and Co-Lead of Health Services Research, Department of Oncology, Faculty of

Health Sciences, McMaster University

Deputy Scientific Director & Scientist, Escarpment Cancer Research Institute, Department of

Oncology, Faculty of Health Sciences, McMaster University

Affiliate Member, Department of Clinical Epidemiology & Biostatistics, McMaster University

Provincial Scientific Director, Program in Evidence-based Care, Cancer Care Ontario (CCO)

Dafna Carr, MBA

Co-investigator

Director, Policy, KTE and Primary Care, Cancer Screening, Prevention and Cancer Control

Cancer Care Ontario (CCO)

Anna Gagliardi, PhD Co-investigator

CIHR New Investigator in Knowledge Translation

Assistant Professor, Departments of Surgery; Institute of Health Policy, Management and

Evaluation; and Institute of Medical Science, Faculty of Medicine, University of Toronto

Affiliate Scientist, Division of Support, Systems, & Outcomes, Communities of Health, Toronto

General Research Institute

Cheryl Levitt, MD, MBBCh, CCFP, FCFP Co-investigator

Professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University

Heather Logan, RN, BScN, MHSc, CHE Co-investigator

Executive Director, Canadian Association of Provincial Cancer Agencies (CAPCA)

Chair, Surveillance Advisory Committee, Canadian Partnership Against Cancer (CPAC)

Carol Sawka, MD, FRCPC Co-investigator

Medical Oncologist, Odette Cancer Centre

Vice President, Clinical Programs and Quality Initiatives, Cancer Care Ontario (CCO)

Professor, Departments of Medicine, Public Health, Health Policy Evaluation and Management,

University of Toronto

Project Co-Investigators


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Lava Bahirathan, MSc (candidate) Student Research Assistant Graduate Student, Public Health Program, Faculty of Applied Health Sciences, University of Waterloo

Lisa Durocher, MSc Research Assistant

Department of Oncology, Faculty of Health Sciences, McMaster University

George Farjou, BHSc, BSc (Medicine) (candidate) Student Research Assistant

Medical School Student, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster

University

Julie Makarski, MSc Project Manager

Research Program Manager, Health Services Research and Knowledge Translation Projects Portfolio

Escarpment Cancer Research Institute, Department of Oncology, Faculty of Health Sciences, McMaster

University

Contact Information

For any inquiries, please contact Julie Makarski at McMaster University, Hamilton,

Ontario, [email protected].

Project Office Team

mailto:[email protected]


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We would like to acknowledge and thank the following individuals for their various forms of

assistance during the course of our project:

Cythnia Vinson

Dissemination and Diffusion Coordinator

Division of Cancer Control and Population Sciences, National Cancer Institute, USA

For providing us with information pertaining to the Research-tested Intervention Programs (RTIPs)

database and program.

Susan Fekete

Program Director

Screening Action Group

Canadian Partnership Against Cancer Corporation (CPAC)

For facilitating the external review of the draft summary profiles by members of the National Cancer

Screening Networks

Members of the National Cancer Screening Committees (Canada)

For their time and feedback in reviewing the draft summary profiles of the Resources Reference Package

Kate Kerkvliet

Student Research Projects Assistant


For assisting in the formatting and editing of draft versions of the Reference Resource Package

Hanna Seok

Student Research Projects Assistant


For assisting in the formatting, editing and final compilation of the Reference Resource Package

All other individuals who were contacted and responded to our various requests for

information throughout the course of this project.

Acknowledgments


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SECTION I.

i. Background …..…..…..…..…..…..…..…..…..…..…..…..…..…..…..…..….. 10

ii. Objectives …..…..…..…..…..…..…..…..…..…..…..…..…..…..…..…..…... 11

iii. Methods …..…..…..…..…..…..…..…..…..…..…..…..…..…..…..…..…..… 11

iv. Results …..…..…..…..…..…..…..…..…..…..…..…..…..…..…..…..…..…... 13

v. Conclusions …..…..…..…..…..…..…..…..…..…..…..…..…..…..…..…..…. 16

SECTION II.

i. About the Cancer Screening Interventions Resource Profiles …..…… 18

ii. How to Use the Resource Profiles …..…..…..…..…..…..…..…..…..…… 18

Breast Screening Resources …..…..…..…..…..…..…..…..…..…..….. 19

Cervical Screening Resources …..…..…..…..…..…..…..…..…..…..… 47

Colorectal Screening Resources …..…..…..…..…..…..…..…..…..….. 59

Breast & Cervical Screening Resources …..…..…..…..…..…..…..… 72

Breast, Cervical & Colorectal Screening Resources …..…..…..…… 82

Appendix A. Additional Resources …..…..…..…..…..…..…..…..…..…..… 89

Appendix B. Legend for Resource Profiles …..…..…..…..…..…..…..……. 90

Table of Contents


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i. Background Across the cancer control continuum, several research advances have been made that

can lead to a reduction in the incidence, mortality and morbidity of disease (1-4). For

example, the appropriate uptake of population-based breast, cervical and colorectal

cancer screening may lead to a reduction in mortality and/or identification of patients

with earlier and more treatable disease.

In order to facilitate the uptake of cancer screening, the identification of effective

strategies is warranted. In 2009, the Program in Evidence-based Care (PEBC) of

Cancer Care Ontario (CCO) developed an implementation practice guideline

regarding effective knowledge translation (KT) interventions for promoting the

uptake of cancer screening (5). The practice guideline was informed by a systematic

review, which identified the following as effective implementation strategies to

facilitate cancer screening uptake (Table 1):

Small media

Client reminders

Audit and feedback of the health care professional

While the PEBC’s practice guideline project identified KT strategies of known

effectiveness for cancer screening uptake, it also found that these interventions are

poorly and inconsistently operationalized in the research studies, thereby making

their translation into practice challenging and suboptimal. Indeed, this was also

found in another project by Brouwers et al (2010) (6), which examined the

effectiveness of KT interventions across the cancer continuum.

In short, although previous research has led to a short list of KT interventions of

known effectiveness, a gap remains in how to design, operationalize and implement

those interventions in the field. While identification and analysis of effective KT

intervention strategies are important first steps, if full benefits from advances in KT

research are to be realized and cancer control improved, the operationalization details

are required.

Table 1. Definitions of KT Interventions*

Screening

Intervention

Definition

Small Media Included videos or tailored/untailored

printed materials such as letters, brochures,

pamphlets, flyers, or newsletters distributed

by health care systems or community groups

Section I. Project Information


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Client Reminders Printed letter or postcard or telephone

communications that are client-tailored or

untailored interventions and reminder or

recall notifications. Could include one or

more of follow-up printed or telephone

reminder; additional text or discussion with

information about barriers to screening; or

appointment scheduling assistance.

Provider Audit and

Feedback

Involved evaluation of provider performance

in delivering or offering screening to clients

(assessment) and presenting providers with

information about their performance in

providing screening services (feedback).

Could involve either group or individual

practices, with possible comparison to goal or

standard. *Adapted from: Brouwers, De Vito, Carol, Carroll, Cotterchio, et al. Interventions to Increase the Uptake

of Cancer Screening. Evidence-based Series #15-7. March 26, 2009. Available at:

https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=43168

ii. Objectives In 2011, the “Tools to Support Effective Knowledge Translation Practice and Research

in Cancer Control” (‘KT Tools’) project was launched. Following on the heels of the

PEBC cancer screening practice guideline project, this program of research was

established to identify the operationalization information for the effective strategies of

small media, client reminders, and provider audit and feedback for cancer screening

uptake.

The core objective of the project was to identify candidate resources available to

support the implementation or application of KT interventions relevant to cancer

screening. Specifically, we sought to identify practical, “how to” resources (e.g.,

training manuals, checklists, guides, etc.) that have been used to guide the

development, implementation or evaluation of the KT intervention strategy.

iii. Methods To accomplish our objective, we conducted an integrated search of the published and

grey literatures to identify resources intended to guide the development,

implementation or evaluation of the effective cancer screening uptake interventions of

small media, client reminders and provider audit and feedback. A resource was

defined as a “how to” tool if it contained information explaining the development of

the intervention and/or information that would guide or facilitate the implementation

of the intervention (Figure 1). Examples of “how to” tools included protocols,

training manuals, tool kits, outlines, checklists, aids, guides, etc.

https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=43168


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Figure 1. Representation of what constitutes a resource in reference to the timeline of

a project

i. The Overall Search for “how to” Tools

In acknowledging the nature of our topic, we undertook a multi-faceted approach to

our search for “how to” tools. Recognizing that some tools might not follow the

traditional process of publication in peer-reviewed journals, we included as part of

our search strategy the targeted search of several on-line KT resources. Our search

was an iterative process with periodic refinement as we better understood the area in

the context of the literature and the “practical” landscape.

a. Published Literature

Using an evidence-based search strategy to target this area (7), we searched the

databases of MEDLINE, EMBASE, CINAHL, and PsychINFO for the period of 1995

through to 2010.

b. Grey Literature

Targeted search of on-line KT resources:

The following databases were deemed relevant to our project and were searched to

identify potential “how to” tools:

Health Evidence (http://www.healthevidence.org);

KT Clearinghouse (http://ktclearinghouse.ca/home);

McMaster KT+ (http://plus.mcmaster.ca/kt/Default.aspx);

The National Collaborating Centre for Methods and Tools (http://nccmt.ca/ ).

Additional on-line resources and Internet-based search:

In addition to the a priori on-line resources searched, we took to the Internet and

searched the specific web sites of: Rx for Change (a collaborative between Cochrane’s

EPOC group and CADTH); Canadian Health Services Research Foundation (now

known as the Canadian Foundation for Healthcare Improvement, CFHI); Ottawa

Hospital Research Institute (OHRI); Research and Development Resource Base,

University of Toronto; Canadian Partnership Against Cancer (CPAC); Public Health

Agency of Canada (PHAC); Canadian Public Health Association (CPHA); and the

World Health Organization (WHO).

DEVELOPMENT

Process of developing the intervention

IMPLEMENTATION

Process of applying the intervention

RESOURCE

Start of project

End of project

Intervention developed and ready to use in project

http://www.healthevidence.org/

http://ktclearinghouse.ca/home

http://plus.mcmaster.ca/kt/Default.aspx

http://nccmt.ca/


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Further, we conducted an open search of the Internet using the GOOGLE search

engine and search terms such as “cancer screening tools” and “cancer implementation

tools”.

c. Contacting Primary Authors of Relevant Research Papers

The authors of all papers that met inclusion criteria for the PEBC’s systematic review

of the cancer screening implementation practice guideline development project (n=42)

were also contacted to seek the operationalization details for their respective

strategies. All authors were contacted via email with a total of two follow-up emails if

a response to the initial email request was not received.

d. Contacting “In-the-Field” Experts

In acknowledging that some practical “how to” tools may not be readily and/or

publicly available and instead held a local sites, we decided to contact those working

“in-the-field” to request information for any tools they may have used or developed

in their context. Stakeholders from the Canadian National Screening Networks

(Breast, Cervical, Colorectal) were provided with an invitation letter outlining our

request and a form template to complete with the details we required.

ii. Development of Resource Summary Profiles

For each resource that met inclusion criteria, we created structured summaries, using

the information found for each resource. The profiles are intended as a summary and

a reference resource, which also includes listings of the core source of information for

easy access by the user.

In addition, two research staff evaluated the development and implementation

information found for each resource to assess its completeness of reporting. A ranking

of either Excellent (i.e., really clear, easily replicable), Good (i.e., moderately clear,

somewhat replicable), or Fair (i.e., low, poor, not clear or detailed enough for any

replication) was provided for each resource.

iii. External Review of the Draft Summary Profiles

To seek their feedback regarding the layout, content, and usability of our draft

summary profiles, we asked members of the Canadian National Screening Networks

(through the Networks’ Program Director) to review draft versions of the profile

summaries and to provide us with their feedback via a structured on-line survey

(November 2012 to January 2013).

iv. Results From our initially proposed search strategy (i.e., published literature and targeted

grey literature search of on-line KT resources), we expanded our strategy to also

include the Internet-based search and contacting primary authors and field experts.

This expansion was warranted as we gained clarity in the area of these “how to” tools

and given our lack of results in trying to identify the “how to” tools or resources with


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our initial search strategy methods. What we found was that the search of the grey

literature would turn out to be an important component of our overall search strategy,

in finding and accessing the resources. The fact that the resources were identified

through ‘grey literature’ sources is not surprising given the previous finding that

peer-reviewed published papers evaluating the KT intervention strategies lack the

operationalization information for how to implement them.

i. Overall Search Results

Our search yielded a total of 2,315 items for review with a total of 139 meeting

inclusion criteria. From those, we identified 23 eligible “how to” resources; 52.2%

involved client reminders; 34.8% involved small media; and 13.0% were

multicomponent. No resources for audit and feedback were found. Of the 23

resources, 87.0% described how they developed their resource and 95.7% provided

implementation information. Evaluation information was available for only one

resource (see Resource Profile 1, in Section II).

From the ‘Authors contact’ step, only one author responded and provided “how to”

information for their strategy. Further, although we received 22 “resources” from the

“in-the-field” experts, none met our inclusion criteria.

Our search efforts led us to the “Research-tested Intervention Programs” or “RTIPS”

database. Of an important note, although some resources that met our inclusion

criteria were identified through published literature sources, it was only through the

“RTIPs” database that we were able to actually access the resources.

ii. The Research-tested Intervention Programs (RTIPs) Database

Our search of the Internet (via GOOGLE) identified the web site for “Cancer Control

P.L.A.N.E.T.” (http://cancercontrolplanet.cancer.gov/) and through it we found the

“Research-tested Interventions Programs” (RTIPs) database program resource

(http://rtips.cancer.gov/rtips/index.do). The RTIPs database proved invaluable as a

source of the practical “how to” information. In fact, it was only through RTIPs that

we were able to access and obtain the actual resource. It is not surprising that we

were only able to access resources through such an on-line repository, given the

finding from previous research that this information is poorly presented and most

often absent in published papers that report the evaluation of the intervention

strategies.

The RTIPs database (a collaborative between the US National Cancer Institute (NCI)

and the Substance Abuse and Mental Health Services Administration (SAMHSA))

contains in it various public health/prevention related programs that must meet

specific criteria for inclusion. For each program included, the practical resources

associated for each program are listed and made publicly available (under the

“Products” section). For any program that does not have a “how to” resource, RTIPs

works with the program’s primary contact to develop the resource (usually titled

“Implementation Guide”).

http://cancercontrolplanet.cancer.gov/

http://rtips.cancer.gov/rtips/index.do


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In addition to finding the “how to” resources in RTIPs, we also found other resources

that may be of interest to those who work to adapt effective interventions in their

local setting. Further assessment of these resources was beyond the scope of our

project, but we include them in this report (Appendix A) as sources of potentially

useful information related to cancer control, particularly screening, activities.

Lastly, we also found a Canadian version of the Cancer Control P.L.A.N.E.T.

(http://www.cancercontrolplanet.ca/). In it is contained a link to the “RTIPs” database

and a note indicating “Information for Canada coming soon”.

iii. External Review

The external review achieved a response rate of 63%. The majority of responses were

positive regarding the layout and usability of the resource summary profiles; some

respondents felt that the addition of further details in the profiles would strengthen

their usability. The feedback provided by the Stakeholders was considered and

incorporated while compiling the final versions of the summary resource profiles.

The 23 resources are presented in Table 2 and the summary Profiles for each are

included in Section II of this report.

Table 2. Summary of Resources

Resource Intervention Type

Development Info

Implementation Info

Small Media

Client Reminder

Incl. Completeness Incl. Completeness

Breast Cancer Screening Resources (n=10)

Campaign Materials List

✓ ✓ Good ✓ Excellent

Community Health Education Manual

✓ ✓ Fair ✓ Good

SPARCS Program Implementation Guide

✓ ✓ ✓ Good ✓ Good

Training Manual ✓ ✓ Fair ✓ Excellent

Caller Instructions ✓ ✓ Fair ✓ Excellent

Caller Script ✓ ✓ Fair ✓ Excellent

Caller Documentation Description

✓ ✓ Fair ✓ Excellent

Implementation Guide ✓ ✓ Excellent ✓ Good

Intervention Flowchart ✓ X N/A ✓ Excellent

Telephone Script ✓ X N/A ✓ Excellent

Cervical Cancer Screening Resources (n=3)

Vietnamese Outreach Worker Manual

✓ ✓ Excellent ✓ Excellent

Chinese Outreach Worker Manual


Cambodian Outreach Worker Manual


Colorectal Cancer Screening Resources (n=5)

http://www.cancercontrolplanet.ca/


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Health Educator’s Manual

✓ ✓ Good ✓ Excellent

Implementation Guide ✓ ✓ ✓ Good ✓ Good

Instructor Materials ✓ ✓ ✓ Fair X N/A

Physician Oriented Implementation Protocol

✓ ✓ Fair ✓ Good

Call Script ✓ X N/A ✓ Fair

Breast & Cervical Cancer Screening Resources (n=3)

FoCas Outreach Plan ✓ ✓ Good ✓ Good

FoCas Outreach Plan of Action

✓ ✓ Good ✓ Good

Project SAFe Program Tool Kit

✓ ✓ Good

✓ Excellent

Breast, Cervical & Colorectal Cancer Screening Resources (n=2)

Prevention Care Management Manual


Prevention Care Manager Training Outline


v. Conclusions Through the ‘KT Tools’ project we sought to address the gap in how to design,

operationalize and implement KT intervention strategies known to effectively

facilitate the uptake of cancer screening. The ‘KT Tools’ project presented both

challenges and learning opportunities. Although some resources were identified

through the published literature, the primary information pertaining to their

development and implementation were contained in non-peer-reviewed sources.

Indeed, it was only through the RTIPs database that we were able to access the actual

resources.

While there is a vast literature available on the effectiveness of cancer screening

interventions, opportunities exist for improving the translation of their

operationalization in practice. Strategies to formally compile and make readily

available the operationalization information, or “how to” resources, is warranted.

Our results have culminated in this package titled, “Cancer Screening Interventions

Resources Reference Package”. Section II comprises the Resource Profiles.


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References

1. Mandel JS, Bond JH, Church TR, Snover DC, Bradley GN, Schuman LM et al.

Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl

J Med. 1993;328:1365-71.

2. Hardcastle JD, Chamberlain JO, Robinson MH, Amar SS, Balfour TW, et al.

Randomised controlled trial of faecal-occult blood screening for colorectal cancer.

Lancet. 1996;348:1472-7.

3. Kronberg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O. Randomised study

of screening for colorectal cancer with faecal-occult blood test. Lancet. 1996;348:1467-

71.

4. Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ et al. The effect

of fecal occult blood screening on the incidence of colorectal cancer. N Engl J Med.

2000;343:1603-7.

5. Brouwers MC, De Vito C, Bahirathan L, Carol A, Carroll JC, Cotterchio M et al.

Effective interventions to facilitate the uptake of breast, cervical and colorectal cancer

screening: an implementation guideline. Impl Sci. 2011,6:112.

http://www.implementationscience.com/content/6/1/112

6. Brouwers MC, Garcia K, Makarski J, Daraz L for the Evidence Expert Panel of the

KT for Cancer Control in Canada Project Research Team. The landscape of knowledge

translation interventions in cancer control: What do we know and where to next? A

review of systematic reviews. Impl Sci. 2011,6:130.


7. Wilczynski NL, Haynes RB for the QI Hedges Team. Optimal search filters for

detecting quality improvement studies in Medline. Qual Saf Health Care. 2010;19:e31.

doi: 10.1136/qshc.2010.042432.




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i. About the Cancer Screening Interventions Resource Profiles

Each Profile contains summary information for each of the resources that met the

inclusion criteria of our project. The information in each Profile was obtained through

various sources identified through our searching activities. Each source is referenced

in the Profile.

Each Profile is intended as a quick reference that includes a synopsis of key

development, implementation and evaluation information available to facilitate the

operationalization of the intervention resource. Each Profile was prepared according

to the template Legend included in Appendix B. Each resource is presented in the

context of its overall screening program. For some resources, and given the

complexity of the information available, their Profiles contain information for both the

resource-level and program-level.

The Profiles are intended for use by those working “in-the-field” responsible for

planning, developing, and implementing cancer screening programs.

ii. How to Use the Resource Profiles

The Resource Profiles are meant as a reference document only and additional links to

primary source information are included at the end of each Profile. Users of the

Profiles are encouraged to access those links for further and complete details. Also

included are direct links to the resources themselves for easy access by the user.

The Resource Profiles are for information purposes only. It is recommended that the

Legend in Appendix B is reviewed prior to reading the Profiles, so that the user

understands the layout and contents of the Profile.

Section II. Resource Profiles


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Resource Profile 1. Campaign Materials List

Resource Profile 2. Community Health Education Manual

Resource Profile 3. SPARCS Program Implementation Guide

Resource Profile 4a. Training Manual

Resource Profile 4b. Caller Instructions

Resource Profile 4c. Caller Script

Resource Profile 4d. Caller Documentation Description

Resource Profile 5. Implementation Guide

Resource Profile 6a. Intervention Flowchart

Resource Profile 6b. Telephone script

Breast Screening Resources


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Resource Profile 1: Campaign Material List

Earp et al. (2002)

I. GENERAL INFORMATION

Program:

North Carolina Breast Screening Program The North Carolina Breast Cancer Screening Program (NC-BCSP) is a community-wide, lay health advisor intervention designed to increase mammography use among African American women living in rural communities. Lay health advisors engage in one-on-one conversations with women using culturally sensitive materials to reinforce their promotion of breast cancer screening.

Population: African American Female Adults (50+ years)

Setting: Rural community and religious establishments

Country: United States – North Carolina

II. RESOURCE INFORMATION

Intervention:

Small Media (Various campaign materials and informational items were developed for the program and distributed throughout community settings – brochures, posters, holiday cards, church fans, newsletters, video etc.)

Resource Description:

The Campaign Materials List is a listing of materials, along with examples, used by the Lay Health Advisors to campaign and promote breast cancer screening. It describes the distribution process of the program materials. A Training Manual and Training Materials List are also available and can be accessed by the above link.

II. DEVELOPMENT INFORMATION

Key Development Steps:

Focus Groups/Consultations Other: Advisory Groups

Completeness of Reporting:

Good (i.e., moderately clear, somewhat replicable)

Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the small media intervention (campaign materials): Source 1: “Before the intervention, we conducted 25 focus groups with older African American women (5 in each intervention county) and interviews with key community informants to guide training of lay health advisors and targeting of materials for each county. Focus groups examined local women’s (1) knowledge and attitudes related to breast cancer, (2) social support, and (3) attitudes toward the health care system.” “At the individual level, advisors engaged in one-to-one conversations (approximately 2 per week per advisor) with women they knew and used culturally sensitive materials informed by the focus group data and behavioral change theory to reinforce their promotion of breast cancer screening.” Source 2: “The NC-BCSP community advisory groups guide the activities of the LHA,

http://rtips.cancer.gov/rtips/productDownloads.do?programId=566594


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provide support for LHA efforts and ensure that outreach strategies and messages are culturally responsive and effective… advisory groups assisted NC_BCSP staff in interpreting the focus group results and using the latter to design the NC-BSCP county specific educational brochures. This included selecting local women and sites to be photographed for the brochures." (pg 7) “The NC-BSP's LHAs have designed and conducted a variety of novel community outreach efforts related to breast cancer and breast cancer screening, supported by the specialists. In one of the most fruitful activities (carried out in May 1995), LHAs from all 5 counties organized an initiative known as the Mother's Day Blitz. Targeting local churches as a setting in which to spread the word, the LHAs concentrated on the more than 40 African American churches to which they themselves belong…. The LHAs also have spearheaded the development of educational materials, including the church bulletin inserts and hand fans (which display the NC-BSCP logo) used during the Mother's Day Blitz, and posters that feature local women promoting breast cancer screening. The posters include messages especially intended to appeal to older African American women (e.g. "You're a wife, mother, grandmother, friend… Others depend on you, get a mammograms").” (Pg 10)

III. IMPLEMENTATION INFORMATION

Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the small media intervention (campaign materials): Source 2: “On Mother's Day, the LHAs gave testimonies during church services, included inserts about breast cancer in church bulletins, placed "hand fans" (displaying the NC-BCSP logo) in church pews... The blitz proved so successful that the LHAs plan to organize special holiday events throughout the year (e.g. Valentine's day). Other LHA activities include assembling "beauty bags" containing breast cancer information for distribution in beauty parlors, setting up information tables at supermarkets…”

Implementation Guide: “Campaign Materials: LHAs need material to distribute to the community, such as church fans, brochures, posters, and holiday cards. LHAs also wear beaded necklaces, breast cancer awareness t-shirts, and/or hats that identify them as LHAs. Exact campaign materials may vary across sites, but the should be appropriate for the intervention. Newsletters: These quarterly, eight-page documents are distributed to LHAs to share information about important health topics and LHA activities.”


Excellent (i.e., really clear, easily replicable)

IV. EVALUATION INFORMATION

Evaluation of Tool: Other: Interviews, activity report

Description: The following are excerpts taken from the program’s articles and other resources pertaining to the evaluation of the small media intervention: Source 1: “The COS should conduct randomly scheduled telephone interviews with individual LHAs to capture data describing LHA activities, such as their frequency, how many women were reached, and what types of help or information were offered.”



22

Source 2: “During the last segment of the training, the LHAs were presented with a 2 page, 12 item activity report and asked to document their activities on a quarterly basis. To assemble a picture of LHA activities in each county and to assess individual LHAs' activity levels, the form asked the LHAs to document the number of group presentations made about mammograms or breast cancer in the past 3 months, the number of contacts made with individual women in the past week, and the topics covered and education materials (e.g. brochures) used during these events.” (pg 14)

Evaluation of Program:

RTIPS RE-AIM Scores

Research Integrity 3.7 Reach 80.0%

Intervention Impact 1.0 Effectiveness 66.7%

Dissemination Capability 5.0 Adoption N/A

Scoring Scheme: 1.0=low; 5.0=high Implementation 37.5%

V. ADDITIONAL INFORMATION

Website Links: Program Information

Main article: Source 1: Earp JA, Eng E, O'Malley MS, Altpeter M, Rauscher G, Mayne L, Mathews HF, Lynch KS, Qaqish B. (2002). Increasing use of mammography among older, rural African American women: results from a community trial. American Journal of Public Health, 92(4), 646-654. Additional article: Source 2: Earp, J. A. L., Viadro, C. I., Vincus, A. A., Altpeter, M., Flax, V., Mayne, L., et al. (1997). Lay health advisors: A strategy for getting the word out about breast cancer. Health Education & Behavior, 24 (4), 432-451.

http://rtips.cancer.gov/rtips/programDetails.do?programId=566594

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=11919066













23

Resource Profile 2: Community Health Education Manual

Paskett et al. (2006)


Program:

Robenson County Outreach Screening and Education (ROSE) Project The ROSE Project uses lay health advisors (LHAs) to deliver an individualized, home-based health education intervention with subsequent follow-up support to improve rates of mammography screening in a population of women who are traditionally underserved by cancer control efforts.

Population: Low-income American Indian, Black and White (not of Hispanic or Latino origin) adult women (40+)

Setting: Home-based, Rural

Country: United States


Intervention:

Small Media The program consists of three in-person home visits 30 to 90 minutes in duration, in which visit materials (brochures, pamphlets, bookmarks) are provided. The women also receive two follow-up postcards that address the woman's stage of change and offer mammography scheduling assistance.


The CHE (Community Health Education) Manual is to be used as a training aid and a reference document. The CHE Manual provides operational information regarding descriptions of contact, home visit procedures, visit materials descriptions, and stage of change assessments. Visit Materials 1-3, Phone Call Follow-Up Materials and Staging Cards are also available. They listed in the program products page and can be accessed from the above link.



Focus Groups/Consultations Other: Theoretical Model


Fair (i.e., low, poor, not clear or detailed enough for any replication)

Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the small media intervention (visit materials and postcards): CHE Manual: “During the first 6 months of the project the first phase of the project concentrated on community analysis to identify elements of the target population, the community and health care systems that will influence the intervention. Four focus groups were conducted to collect impressions about clinical breast exams, mammograms and follow-up care, educational materials and barriers to behavior change. This will help refine identified concepts that will provide the foundation of the educational program. “ “Two types of advisory committees were formed for the project. The Medical



24

Advisory Committee consists of medical professionals from the area. A community advisory group consisting of women from the target population were also recruited. Each group will meet quarterly with project staff to provide reactions to project issues including community relations and appropriateness of educational materials to be used in the homes of women in Robeson County.” Source 1: “The Transtheoretical Model (TTM) (40) was used to judge each woman's stage of readiness to obtain a mammogram and to deliver tailored intervention materials, e.g., messages on postcards.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the small media intervention (visit materials and postcards): Implementation Guide: “Using existing ROSE project materials, the project staff develop site-specific intervention plans and modifies materials and protocols if needed” The Lay Health Advisor “Coordinates the mailing of two postcard reminders that address the woman’s stage of change in relation to obtaining a mammogram and offers assistance setting up a mammogram appointment”




Evaluation Method: Not Reported

Description: No evaluation information available

Program Evaluation:

RTIPS RE-AIM Scores

Research Integrity 4.1 Not Provided Intervention Impact 3.0

Dissemination Capability 3.0

Scoring Scheme: 1.0=low; 5.0=high


Website Links: Program Information Main Article: Source 1: Paskett,E.; Tatum,C.; Rushing,J.; Michielutte,R.; Bell,R.; Long,Foley K.; Bittoni,M.; Dickinson,S.L.; McAlearney,A.S.; Reeves,K. (2006). Randomized trial of an intervention to improve mammography utilization among a triracial rural population of women. Journal of the National Cancer Institute, 98 (17), 1226-1237.

Additional Articles: McAlearney, A.S., Reeves, K.W., Tatum, C., & Paskett, E.D. (2007). Cost as a barrier to screening mammography among underserved women. Ethnicity & Health, 12 (2), 189-203. Katz, M.L., Kauffman, R.M., Tatum, C.M., & Paskett, E.D. (2008). Influence of church












25

attendance and spirituality in a randomized controlled trial to increase mammography use among a low-income, tri-racial, rural community. Journal of Religion & Health, 47 (2), 227-236.





26

Resource Profile 3: SPARCS Program Implementation Guide

Shenson et al. (2001)


Program:

Mammography Promotion and Facilitated Appointments through Community-based Influenza Clinics Mammography Promotion and Facilitated Appointments Through Community-Based Influenza Clinics was developed by a community-based disease prevention organization called Sickness Prevention Achieved through Regional Collaboration (SPARC). Paid or volunteer outreach workers, preferably with a background in health, are recruited and trained to enroll women in the project at the influenza clinics and hand out brochures and other promotional items. The outreach workers forward the participants' contact information to the mammogram providers to schedule mammogram appointments.

Population: White women (50+), not of Hispanic or Latino origin

Setting: Clinical and Community-based

Country: United States – Connecticut


Intervention:

Small Media Client Reminder This is a multicomponent intervention that consists of brochures and other promotional materials as well as a phone call follow-up reminder to schedule mammogram appointments


The SPARCS (Sickness Prevention Achieved through Regional Collaboration) Program Implementation Manual is a guide to access mammograms from community flu shot clinics. It contains all the materials needs to implement the program including steps for program planning, recruitment, training outreach workers, phone call reminder procedures and template materials.



Pilot-testing



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the small media and client reminder intervention (program promotional material & phone call reminder): SPARCS Program Implementation Manual: ” SPARC’s Flu/Mammography project is based on a simple premise: if the rate which women obtain mammograms declines with age, while their risk for breast cancer increases with age, then reaching out to large groups of older women and making it easy for them to schedule a mammogram appointment can contribute to a greater number of women being screened. So, we asked, where can sizable numbers of older women be found? The answer: at annual public flu clinics. How can the appointment making process be





27

eased? By having the provider initiate a phone call to schedule an appointment or by making mammography appointments at flu clinics. With this in mind, in 1997 SPARC piloted an innovative approach to promoting mammography among women age 50 and older.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the small media and client reminder intervention (program promotional material & phone call reminder): The manual itself is an implementation guide. SPARCS Program Implementation Manual: ”Implement project at flu clinics. Periodically forward names of women requesting mammograms to participating providers. Complete referrals of women for mammograms.“ (Pg 7) “It is the responsibility of the mammogram provider to telephone the women to arrange for an appointment. It is recommended that a minimum of 3 attempts are made to reach her. If an order is required from her PCP, the mammogram provider should arrange to have one faxed to its facility.” (Pg 13) “The letter includes points that each facility should address when telephoning women recruited by the project. This includes reminding the woman that when she attended a flu clinic recently she signed up to arrange for a mammogram appointment. This reminder is important because sometimes a woman may not receive this phone call from up to 6 or more weeks following the flu clinic.” (Pg 14)






Program Evaluation:

RTIPS RE-AIM Scores



Dissemination Capability 5.0 Adoption 100.0%



Website Links: Program Information Main article: Shenson D, Cassarino L, DiMartino D, Marantz P, Bolen J, Good B, Alderman M. (2001, February). Improving access to mammograms through community-based influenza clinics. A quasi-experimental study. American Journal of Preventive Medicine, 20 (2), 97-102



http://www.ncbi.nlm.nih.gov/pubmed?Db=PubMed&Cmd=ShowDetailView&TermToSearch=11165449





28

Resource Profile 4a: Maximizing Mammography Participation Training Manual

Taplin et al. (2000)


Program:

Maximizing mammography participation Maximizing Mammography Participation uses a reminder postcard, a reminder telephone call, or a motivational telephone call to encourage women to schedule and keep mammography appointments. The reminder postcard and reminder call serve as a means for inviting women to schedule a mammogram.

Population: American Indian, Asian Black and White (not of Hispanic or Latino origin) adult women (age: 50-79), unscreened or under-screened individuals

Setting: Clinical

Country: United States – Seattle, Washington


Intervention: Client Reminder Participants receive a reminder phone call.


The Training Manual provides the study protocol to deliver the client reminder postcard and phone calls as well as a guide for motivational interviewers regarding breast cancer counseling and mammogram appointment scheduling.



Other: Theoretical framework



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the client reminder intervention (reminder phone call): Source 1: “Conceptual framework and intervention. Our study was based on a heuristic conceptual framework that combined aspects of the theory of reasoned action, social learning theory, and the Precede/Proceed model for planning care. Our framework includes consideration of predisposing and enabling characteristics that predict intention and behavior in other studies. Predisposing characteristics include 1) personal and behavioral factors, such as demographic characteristics, perceived risk, and past health behavior (including prior mammography, use of Pap smears, and smoking) and 2) cognitive and affective factors, such as beliefs about mammography, values, perceptions of what others want them to do (social norm), and affect (emotional response to mammography). Enabling characteristics of the environment include two considerations: logistics and health care system support. Logistics include providing information about the location of the centers, details regarding parking, methods of finding transportation, and help with scheduling appointments. Health care system support includes benefit packages, mailed recommendations, and reminders. Once a behavior occurs, it has an outcome for the individual that either positively or negatively reinforces the behavior and influences



29

the predisposition to repeating the behavior in the future. This conceptualization of a continuous interaction between individuals and their environment is consistent with social learning theory.” Maximizing Mammography Participation Training Manual: “We have drawn from three main theories in designing this phone counseling protocol: the Theory of Reasoned Action, the Stages of Change (or Transtheoretical Model) and strategies of Motivational interviewing. Although we cannot predict precisely what the concerns of each woman called will be, research conducted here at Group Health Cooperative and other places around the country has shown that there are several important factors that influence a woman's willingness to get a mammogram. These factors are described in the expanded Theory of Reasoned Action, which provides a "menu" of topics that can be discussed in each phone call. The factors include: attitude, or beliefs about mammography, affect, or feelings about getting a mammogram, social normative influences, or what others think about the person's getting a mammogram, facilitating conditions, or practical considerations regarding the logistics of getting the test, an perceived susceptibility or beliefs about the risk of breast cancer. “


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the client reminder intervention (reminder phone call): Implementation Guide: See Program Implementation steps 1-3. “Step 1: The program manager recruits and trains telephone counselors, introduces them to the program protocols and how to conduct motivational interviews (See the Maximizing Mammography Participation Training Manual, Call Script, Call Instructions, Caller Documentation Description and Caller Documentation) Step 2: Identify women between 50 and 79… and have not scheduled a mammogram in the two months following receipt of a post card reminder. In the tested program this was done through an automated record. See Resources section of the Maximizing Mammography Participation Training Manual. Step 3: Schedule a call with eligible women, during which it is possible to schedule a mammogram. The purpose of the call was to give women an opportunity to ask questions and discuss concerns about mammography with a supportive and knowledge able health educator… but a simple reassuring call with the capacity to schedule the examination may be equally effective.”






Program Evaluation:

RTIPS RE-AIM Scores







30


Website Links: Program Information Main Article: Source 1: Taplin SH, Barlow WE, Ludman E, MacLehos R, Meyer DM, Seger D, Herta D, Chin C, Curry S. (2000). Testing Reminder and Motivational Telephone Calls to Increase Screening Mammography: a Randomized Study. Journal of the National Cancer Institute, 92(3), 233-242. Additional Articles: Fishman P, Taplin S, Meyer D, Barlow W. (2000). Cost-Effectiveness of Strategies to Enhance Mammography Use. Effective Clinical Practice, 3(5), 213-220. Ludman EJ, Curry SJ, Meyer D, Taplin SH. (1999). Implementation of Outreach Telephone Counseling to Promote Mammography Participation. Health Education & Behavior, 26(5), 689-702.












31

Resource Profile 4b: Caller instructions



Program:



Setting: Clinical





The Caller Instructions lists simple steps and checks to execute the mammography calling program.






Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the client reminder intervention (reminder phone call): Source 1: “Conceptual framework and intervention. Our study was based on a heuristic conceptual framework that combined aspects of the theory of reasoned action, social learning theory, and the Precede/Proceed model for planning care. Our framework includes consideration of predisposing and enabling characteristics that predict intention and behavior in other studies. Predisposing characteristics include 1) personal and behavioral factors, such as demographic characteristics, perceived risk, and past health behavior (including prior mammography, use of Pap smears, and smoking) and 2) cognitive and affective factors, such as beliefs about mammography, values, perceptions of what others want them to do (social norm), and affect (emotional response to mammography). Enabling characteristics of the environment include two considerations: logistics and health care system support. Logistics include providing information about the location of the centers, details regarding parking, methods of finding transportation, and help with scheduling appointments. Health care system support includes benefit packages, mailed recommendations, and reminders. Once a behavior occurs, it has an outcome for the individual that either positively or negatively reinforces the behavior and influences the predisposition to repeating the behavior in the future. This conceptualization of a



32

continuous interaction between individuals and their environment is consistent with social learning theory.”








Program Evaluation:

RTIPS RE-AIM Scores





Website Links: Program Information Main Article: Source 1: Taplin SH, Barlow WE, Ludman E, MacLehos R, Meyer DM, Seger D, Herta D, Chin C, Curry S. (2000). Testing Reminder and Motivational Telephone Calls to Increase Screening Mammography: a Randomized Study. Journal of the National Cancer Institute, 92(3), 233-242. Additional Articles: Fishman P, Taplin S, Meyer D, Barlow W. (2000). Cost-Effectiveness of Strategies to Enhance Mammography Use. Effective Clinical Practice, 3(5), 213-220.










33

Ludman EJ, Curry SJ, Meyer D, Taplin SH. (1999). Implementation of Outreach Telephone Counseling to Promote Mammography Participation. Health Education & Behavior, 26(5), 689-702.





34

Resource Profile 4c: Caller Script



Program:



Setting: Clinical





The Caller Script outlines the call content to be provided in order to schedule a mammography appointment as part of a breast cancer screening program. Various information prompts are provided according to common responses and frequently asked questions.






Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the client reminder intervention (reminder phone call): Source 1: “Conceptual framework and intervention. Our study was based on a heuristic conceptual framework that combined aspects of the theory of reasoned action, social learning theory, and the Precede/Proceed model for planning care. Our framework includes consideration of predisposing and enabling characteristics that predict intention and behavior in other studies. Predisposing characteristics include 1) personal and behavioral factors, such as demographic characteristics, perceived risk, and past health behavior (including prior mammography, use of Pap smears, and smoking) and 2) cognitive and affective factors, such as beliefs about mammography, values, perceptions of what others want them to do (social norm), and affect (emotional response to mammography). Enabling characteristics of the environment include two considerations: logistics and health care system support. Logistics include providing information about the location of the centers, details regarding parking, methods of finding transportation, and help with scheduling appointments. Health care system support includes benefit packages, mailed recommendations, and reminders. Once a behavior occurs, it has an outcome for the



35

individual that either positively or negatively reinforces the behavior and influences the predisposition to repeating the behavior in the future. This conceptualization of a continuous interaction between individuals and their environment is consistent with social learning theory.” “The motivational call represents a more elaborate health care system support that also was designed to address predisposing characteristics of women and enabling factors in the environment. We developed the motivational call based on the framework described above and principles of motivational interviewing. Development and implementation of the call are described in detail elsewhere. We drafted responses to expected cognitive and affective factors regarding mammography, as well as perceived risks, and anticipated logistic considerations.” Source 2: “Counselors used a motivational style that encouraged the participants to express their unique concerns. Suggested scripts were tailored to be appropriate to women’s intentions and to the questions/concerns voiced. Protocols for providing information and addressing concerns were based on a “menu” of topics derived from the theory of reasoned action (e.g., affect such as embarrassment, fear of pain, fear of malignancy; facilitating conditions such as concerns about transportation or screening center location; influences of significant others; attitudes and beliefs) that have been found to predict mammography participation (31). The motivational approach focused on understanding the patients’ decision-making process and on assisting their movements toward obtaining mammograms by discussing pros and cons of obtaining a mammogram, beliefs, feelings, logistics, and the like in a non-confrontational and empathic way.










36

Program Evaluation:

RTIPS RE-AIM Scores





Website Links: Program Information Main Article: Source 1: Taplin SH, Barlow WE, Ludman E, MacLehos R, Meyer DM, Seger D, Herta D, Chin C, Curry S. (2000). Testing Reminder and Motivational Telephone Calls to Increase Screening Mammography: a Randomized Study. Journal of the National Cancer Institute, 92(3), 233-242. Additional Articles:

Source 2: Ludman EJ, Curry SJ, Meyer D, Taplin SH. (1999). Implementation of Outreach Telephone Counseling to Promote Mammography Participation. Health Education & Behavior, 26(5), 689-702.

Fishman P, Taplin S, Meyer D, Barlow W. (2000). Cost-Effectiveness of Strategies to Enhance Mammography Use. Effective Clinical Practice, 3(5), 213-220.












37

Resource Profile 4d: Caller Documentation Description



Program:



Setting: Clinical





The Caller Documentation description acts as a data dictionary for the caller documentation spreadsheet, which provides a tracking system for call logs as well as a layout to enter pertinent information obtained from the call. The documentation description lists expected values in order to maintain consistency when filling out the document. The spreadsheet can also be accessed from the above link.






Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the client reminder intervention (reminder phone call): Source 1: “Conceptual framework and intervention. Our study was based on a heuristic conceptual framework that combined aspects of the theory of reasoned action, social learning theory, and the Precede/Proceed model for planning care. Our framework includes consideration of predisposing and enabling characteristics that predict intention and behavior in other studies. Predisposing characteristics include 1) personal and behavioral factors, such as demographic characteristics, perceived risk, and past health behavior (including prior mammography, use of Pap smears, and smoking) and 2) cognitive and affective factors, such as beliefs about mammography, values, perceptions of what others want them to do (social norm), and affect (emotional response to mammography). Enabling characteristics of the environment include two considerations: logistics and health care system support. Logistics include providing information about the location of the centers, details regarding parking, methods of finding transportation, and help with scheduling appointments. Health care system support includes benefit packages, mailed



38

recommendations, and reminders. Once a behavior occurs, it has an outcome for the individual that either positively or negatively reinforces the behavior and influences the predisposition to repeating the behavior in the future. This conceptualization of a continuous interaction between individuals and their environment is consistent with social learning theory.”








Program Evaluation:

RTIPS RE-AIM Scores





Website Links: Program Information Main Article: Source 1: Taplin SH, Barlow WE, Ludman E, MacLehos R, Meyer DM, Seger D, Herta D, Chin C, Curry S. (2000). Testing Reminder and Motivational Telephone Calls to Increase Screening Mammography: a Randomized Study. Journal of the National Cancer Institute, 92(3), 233-242.








39

Additional Articles: Fishman P, Taplin S, Meyer D, Barlow W. (2000). Cost-Effectiveness of Strategies to Enhance Mammography Use. Effective Clinical Practice, 3(5), 213-220. Ludman EJ, Curry SJ, Meyer D, Taplin SH. (1999). Implementation of Outreach Telephone Counseling to Promote Mammography Participation. Health Education & Behavior, 26(5), 689-702.







40

Resource Profile 5: Implementation Guide

Vasquez et al. (2002)


Program:

Breast Health Education Among Hispanic Elderly Woman The intervention is a culturally sensitive health promotion pilot program, developed to promote the early detection of breast cancer in women aged 65 or older living in Puerto Rico. The program delivers three education sessions to elderly participants in Spanish, and a 1-day training to primary care professionals.

Population: Hispanic or Latino elderly women (65+)

Setting: Clinical and community

Country: Puerto Rico


Intervention:

Client Reminder This program is a multicomponent intervention, in which the client reminder aspect is a phone reminder.


The Implementation Guide contains details regarding program administration, delivery, and evaluation. It includes client reminder specific information related to the coordination of medical appointments among health care providers, sending appointment reminders, and providing transportation.

‘Manual Para Las Facilitadoras’ is a useful Spanish language manual that provides detailed intervention guidance to program facilitators. The manual includes an overview of research results, learning processes in older women, implementation guidance for three breast health education sessions, teaching and evaluation methods, and two instructional booklets. The manual is also available in the tool list, however it is written in Spanish and therefore was ineligible to have a separate resource profile.



Focus Groups Other: Theoretical framework



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the client reminder intervention (phone reminders): Source 1: “The 4-year project provided insight into personal (knowledge, skills, attitudes, demographics) and external barriers (health care system) that influence compliance with recommended breast cancer screening practices, which were addressed in the health promotion programme (Sánchez-Ayéndez et al., 1998). Focus groups were formed with professional and non-professional elderly women in metropolitan and non-metropolitan areas in order to explore knowledge, beliefs and practices about breast cancer and BCS (Sánchez-Ayéndez et al., 1997). Wording,



41

beliefs, knowledge and attitudes expressed by the 60 women who participated in the seven groups were considered in the design of a questionnaire appropriate for elderly Puerto Rican women. The questionnaire was used for a survey, using a sample stratified by socioeconomic level and area of residence of 500 women of 65 years and above. The questionnaire had been validated previously for consistency and reliability (Suárez-Pérez et al., 1998).” “Research findings were used to design and implement a culturally sensitive pilot health promotion programme for early detection of breast cancer in women aged 65 years and above in Puerto Rico. An appropriate theoretical framework based on health promotion theories, gerontology and andragogy principles served as a foundation for the development of the programme. Research results, such as wording utilized by the women who participated in the focus groups and barriers for BCS identified by these women in the national survey, were considered in the design. The programme intended to minimize the barriers for breast cancer screening and increase the elderly women's compliance with the recommended guidelines.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the client reminder intervention (phone reminders): Implementation Guide: Step 2 of the Program Implementation section. “Step 2: Program participants are referred by the Health Educator for external support services to facilitate access to clinical breast examination and mammography services. Services provided by external Support Service Provider include: - Assistance in setting up appointments for CBE and mammography services - Phone reminders of appointment dates and times 2 days before appointments - Transportation to and from appointments”






Program Evaluation:

RTIPS RE-AIM Scores





Website Links: Program Information Main Article:

Source 1: Vazquez M, Ayendez M, Perez E, Almodovar H, Calderon Y. (2002). Breast cancer health promotion model for older Puerto Rican women: Results of a pilot programme. Health Promotion International, 17 (1), 3-11.







42

Additional Articles: Sanchez-Ayendez, M., Suarez-Perez, E., Vazquez, M. O., Velez-Almodovar, H., & Nazario, C. M. (2001). Knowledge and beliefs of breast cancer among elderly women in Puerto Rico. Puerto Rico Health Sciences Journal, 20 (4), 351-359.

Oliver-Vazquez, M., Sanchez-Ayendez, M., Suarez-Perez, E., & Velez-Almodovar, H. (1999). Planning a breast cancer health promotion: Qualitative and quantitative data on Puerto Rican elderly women. International Journal of Health Promotion & Education, 6 (4), 16-19.









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Resource Profile 6a: Intervention Flowchart

Chaudhry et al. (2007)


Program:

Proactive System to Improve Breast Cancer Screening The Proactive System to Improve Breast Cancer Screening is a method that can be used by primary care practices to increase screening rates among their patient base by providing a series of reminders to patients to schedule a mammography.

Population: Adult women (age: 40-75)

Setting: Clinical – Primary Care Practices



Intervention:

Client Reminder The client reminder intervention includes a series of reminders including a personalized letter or email, a second mailing and telephone call reminder if necessary.


The Intervention Flowchart is a one-page algorithm that provides a visual representation the steps needed for appropriate implementation of this intervention. A reminder letter template is also available and can be accessed from the above link. The one-page letter is a personalized with the patient’s and office’s confirmation. While reminding the recipient to contact the office to schedule a mammogram, the letter also provides a brief explanation of a mammogram and reason why this and other preventative measures should be considered.



Not reported


N/A

Description: No development information available


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the client reminder intervention (personalized reminder mailings and phone call): Intervention Flowchart itself acts as an implementation resource. Implementation Guide: See Program Implementation Steps 1-5 for a more detailed version of the program procedures. “Step 1: The Appointment Coordinator identified patients who are due for a mammogram within 3 months and provides these patients’ names and contact information to the Patient Correspondence Coordinator.





44

Step 2: The Patient Correspondence Coordinator sends each identified patient the brochure The Road to Better Health, along with a personalized reminder letter by U.S. postal mail. Step 3: Two months prior to each patient’s mammogram due date, the Appointment Coordinator checks to see if a mammogram appointment has been made. - If yes, the intervention is concluded. - If no, the Appointment Coordinator contacts the Patient Correspondence Coordinator and requests sending the materials again by U.S. postal mail. Step 4: One month prior to each patients mammogram due date, the Appointment Coordinator checks to see if a mammogram appointment has been made. - If yes, the intervention is concluded. - If no, the Appointment Coordinator contacts the Physician Team to request a telephone contact. Step 5: A member o the Physician Team calls the patient and uses the Telephone Script to provide an additional reminder of the impending mammogram due date and an opportunity to schedule an appointment.”






Program Evaluation:

RTIPS RE-AIM Scores

Research Integrity 3.1 Reach

Intervention Impact 3.0 Effectiveness

Dissemination Capability 5.0 Adoption

Scoring Scheme: 1.0=low; 5.0=high Implementation


Website Links: Program Information Main Article: Chaudhry R, Scheitel SM, McMurtry EK, Leutink DJ, Cabanela RL, Naessens JM, Rahman AS, Davis LA, Stroebel RJ. (2007). Web-based proactive system to improve breast cancer screening: a randomized controlled trial. Archives of Internal Medicine, 167 (6), 606-611.







45

Resource Profile 6b: Telephone Script Chaudhry et al. (2007)


Program:

Proactive System to Improve Breast Cancer Screening The Proactive System to Improve Breast Cancer Screening is a method that can be used by primary care practices to increase screening rates among their patient base by providing a series of reminders to patients to schedule a mammography.

Population: Adult women (age: 40-75)

Setting: Clinical – Primary Care Practices



Intervention:

Client Reminder The client reminder intervention includes a series of reminders including a personalized letter or email, a second mailing and telephone call reminder if necessary.


The Telephone Script provides guidelines for contacting patients by telephone to remind them to schedule an annual mammogram. A reminder letter template is also available and can be accessed from the above link. The one-page letter is a personalized with the patient’s and office’s confirmation. While reminding the recipient to contact the office to schedule a mammogram, the letter also provides a brief explanation of a mammogram and reason why this and other preventative measures should be considered.



Not reported


N/A



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the client reminder intervention (personalized reminder mailings and phone call): Implementation Guide: See Steps 1-5 of Program Implementation for a more detailed version of the intervention procedures. “Step 1: The Appointment Coordinator identified patients who are due for a mammogram within 3 months and provides these patients’ names and contact information to the Patient Correspondence Coordinator. Step 2: The Patient Correspondence Coordinator sends each identified patient the brochure The Road to Better Health, along with a personalized reminder letter by U.S. postal mail.




46

Step 3: Two months prior to each patient’s mammogram due date, the Appointment Coordinator checks to see if a mammogram appointment has been made. - If yes, the intervention is concluded. - If no, the Appointment Coordinator contacts the Patient Correspondence Coordinator and requests sending the materials again by U.S. postal mail. Step 4: One month prior to each patients mammogram due date, the Appointment Coordinator checks to see if a mammogram appointment has been made. - If yes, the intervention is concluded. - If no, the Appointment Coordinator contacts the Physician Team to request a telephone contact. Step 5: A member o the Physician Team calls the patient and uses the Telephone Script to provide an additional reminder of the impending mammogram due date and an opportunity to schedule an appointment.”






Program Evaluation:

RTIPS RE-AIM Scores

Research Integrity 3.1 Reach

Intervention Impact 3.0 Effectiveness

Dissemination Capability 5.0 Adoption

Scoring Scheme: 1.0=low; 5.0=high Implementation


Website Links: Program Information Main Article: Chaudhry R, Scheitel SM, McMurtry EK, Leutink DJ, Cabanela RL, Naessens JM, Rahman AS, Davis LA, Stroebel RJ. (2007). Web-based proactive system to improve breast cancer screening: a randomized controlled trial. Archives of Internal Medicine, 167 (6), 606-611.







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Resource Profile 7. Vietnamese Outreach Worker Manual

Resource Profile 8. Chinese Outreach Worker Manual

Resource Profile 9. Cambodian Outreach Worker Manual

Cervical Screening Resources


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Resource Profile 7: Vietnamese Outreach Worker Manual

Taylor et al. (2010)


Program:

The Vietnamese Women’s Health Project The Vietnamese Women's Health Project is a home visitation intervention by female lay health workers for Vietnamese American women aged 20 to 79 who have not followed guidelines for interval Pap testing. Health workers provide basic information about cervical cancer and Pap tests through the use of several materials.

Population: Vietnamese American adult women (age: 20-79), unscreened or under-screened individuals

Setting: Community, Home-based



Intervention:

Small Media Interventions include: Vietnamese-language DVD (with English subtitles) and a pamphlet (with both Vietnamese and English text). The intervention also employs several visual aids (a gynecologic anatomy diagram, a graph depicting cervical cancer incidence rates by race/ethnicity, and a figure illustrating how cervical cancer progresses).


The Outreach Worker Manual operationalizes the distribution, use and explanation of diagrams, graphs, photos, videos, pamphlets and other visual aids during home visits. The program brochure and video are available and can be accessed from the above link. Other visual aids are provided in the manual.



Focus Groups/Consultations Pilot-testing Other: Qualitative study/interviews



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the small media intervention (DVD, pamphlet, and several visual aids): Source 1: “Educational Materials: We used findings from an earlier qualitative study to develop culturally and linguistically appropriate materials for use in the cervical cancer control intervention using lay health workers. Our material development has been described in detail elsewhere (Source 2). Project materials included a Vietnamese-language DVD (with English subtitles) and a pamphlet (with both Vietnamese and English text). These materials provided basic information about cervical cancer and the Pap test (within the context of Vietnamese traditional beliefs about women’s health) and emphasized the importance of Pap testing for all women



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(including those who are asymptomatic, not currently sexually active, or postmenopausal). Several visual aids were also developed by the project: a graph showing cervical cancer incidence rates by race/ethnicity, a gynecologic anatomy diagram, and a figure showing how cervical cancer progresses.” “Lay Health Workers: Two lay health workers were selected, both of them fluently bilingual ethnic Vietnamese women who had grown up in Vietnam and were conversant with Vietnamese culture. These women were married with children, which would help traditional Vietnamese participants feel comfortable and confident about discussing reproductive concerns with them. Neither of the lay health workers was a certified health professional. The lay health workers were trained to act as role models, give social support, and provide tailored responses to each woman’s individual barriers to Pap testing (e.g., believing that Pap testing is unnecessary for asymptomatic women).”

Source 2: “Twenty-five qualitative interviews and 5 focus groups were conducted with Vietnamese women… Interviews and focus groups revealed unanticipated information about sociocultural influences on women's beliefs about risk factors for cervical cancer. These data were utilized to develop culturally appropriate outreach materials.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the small media intervention (DVD, pamphlet, and several visual aids): This Outreach Worker Manual documents implementation procedures: “The outreach worker should always offer to show the DVD/video and provide the pamphlet. The DVD/video should also be left with the participant, regardless of whether it was shown during the home visit. If a woman refuses a home visit, the outreach worker should offer to leave the DVD and pamphlet.” (Pg 23) “Outreach worker materials (eg. the black and white photographs) should be used, as necessary. For example, if a woman has questions about female anatomy the outreach worker could show her the anatomical diagram. If she does not believe Vietnamese women get cervical cancer, the cervical cancer graph should be used.” (Pg 24)





Description: No tool evaluation information available

Program Evaluation:

RTIPS RE-AIM Scores






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Website Links: Program Information Main Article: Source 1: Taylor VM, Jackson JC, Yasui Y, Nguyen TT, Woodall E, Acorda E, Li L, Ramsey S. (2010). Evaluation of a cervical cancer control intervention using lay health workers for Vietnamese American women. American Journal of Public Health, 100 (10), 1924-1929. Additional Article: Source 2: Burke NJ, Jackson JC, Lam DH, et al. Good health for New Years: development of a cervical cancer control outreach program for Vietnamese immigrants. J Cancer Educ. 2004;19(4):244–250. Scoggins, J. F., Ramsey, S. D., Jackson, J. C., & Taylor, V. M. (2010). Cost effectiveness of a program to promote screening for cervical cancer in the Vietnamese-American population. Asian Pacific Journal of Cancer Prevention: APJCP, 11 , 717-722.






http://www.ncbi.nlm.nih.gov/pubmed/?term=Burke+Jackson+Lam







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Resource Profile 8: Chinese Outreach Worker Manual



Program:

The Chinese Women’s Health Project The Chinese Women's Health Project aims to decrease the incidence of invasive cervical cancer among women of Chinese ethnicity by increasing the frequency and regularity of Pap testing. Outreach workers visit women of Chinese ethnicity at home, acting as role models, providing social support, and serving as cultural mediators between women and health care facilities.

Population: Chinese adult women (19), unscreened or under-screened individuals

Setting: Home-based

Country: United States – Seattle, Washington; Canada – Vancouver, British Columbia


Intervention:

Small Media The outreach workers use visual aids, including an education-entertainment video, motivational pamphlet, fact sheets, and an educational brochure.


The Outreach Worker Manual operationalizes the distribution, use and explanation of diagrams, graphs, photos, videos, pamphlets and other visual aids during home visits. Other resources such as fact sheets, brochures and videos for this program are available in both English and Chinese and can be accessed from the above link.



Multi-stakeholder Other: Qualitative study, Model



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the small media intervention (visual aids): Source 1: “We used findings from a qualitative study (Source 2) to develop culturally and linguistically appropriate materials for use in both of the experimental interventions. We also included an educational brochure, developed by the Federation of Chinese American and Canadian Medical Societies, which provides basic facts about cervical cancer and Pap testing. All written materials included both Chinese and English text. Cervical cancer screening barriers identified by our qualitative work (Source 2) (e.g., beliefs concerning the necessity of Pap testing for asymptomatic, sexually inactive, and postmenopausal women) were systematically addressed in the video. Culturally and linguistically appropriate print materials have been successfully used in disease prevention programs targeting minority groups and can enhance the effectiveness of video presentations. Therefore, we developed a motivational pamphlet featuring drawings of women by a Chinese artist. The pamphlet addressed



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barriers to cervical cancer screening (e.g., lack of physician recommendation) through testimonials from Chinese women and included a question and answer section. The fact sheets addressed linguistic and financial barriers to health care access and were tailored to Seattle and Vancouver, unlike the other materials.” “Following a model developed by the Community House Calls program, the outreach workers were trained to act as role models, to provide social support, and to serve as cultural mediators between women and health care facilities (25). They were also trained to use visual aids (e.g., a speculum and Pap testing kit) and provide tailored responses to each woman's individual barriers to cervical cancer screening (26).” Source 2: “We completed 87 unstructured interviews (43 in Seattle and 44 in Vancouver) with Chinese women. To verify information collected during one-to-one interactions, nine focus groups were conducted (four in Seattle and five in Vancouver), the focus groups comprised 30 women some who had been previously interviewed individually, joined by others who had not. The qualitative data participants were recruited by community advisors, coalition members, and clinic medical interpreters as well as Chinese women’s social networks. Many of the interviewees had received Pap tests. All the interviews and focus group sessions were conducted in a Chinese dialect by bicultural Chinese-American or Chinese-Canadian female interviewers who were fluent in Cantonese and/or Mandarin as well as English.” Video “Video is increasingly being used as a medium for health promotion, and is particularly useful for cancer education in immigrant communities because of low literacy levels and high rates of VCR owner- ship (27, 28). Additionally, culturally sensitive audio- visual presentations allow recommended behaviors to be modeled in appropriate and supportive contexts, incorporating both cognitive and affective influences (28, 29). They also allow for cultural context to be displayed in a manner that assumes those sending the message understand the daily lives of the target audience; cultural barriers can be acknowledged and addressed quickly. Four versions of the video were produced. A Cantonese version and a Mandarin version, as well as both versions with English subtitles. An increasing body of information supports an entertainment context for the delivery of health education messages (27, 30). Therefore, the video is in an education–entertainment (“soap opera”) format which has been successfully used in health promotion efforts targeting ethnic minority groups in North America as well as audiences in developing countries (30, 31). The video script was developed with two working groups to review content, the community coalition described earlier, and Fairchild Television. These were not the same people that were interviewed, but a separate group of 28 Mandarin and Cantonese speaking Chinese individuals. Fairchild Television is a corporation operating the only two trans-Canadian all Mandarin and all Cantonese television and radio stations. Their expertise in developing materials for the North American Chinese-speaking market is considerable. Once the general ideas were approved by a focus group, these two groups worked interactively until a final script and eventually a final product was produced that was acceptable to lay, professional, and media sectors of the community. The video story line focuses on an older, less acculturated Chinese woman’s discomfort and anxieties about persistent pelvic symptoms, and how she was encouraged to get gynecologic care by family and friends. Cultural attitudes, approaches, and barriers to timely care are identified and addressed through


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interactions with her daughter, friends, a Chinese herbalist, and health care providers at a Western clinic. The video provides cultural context so the audience knows that their traditional values are accepted and understood. For example, references are made to “the sit- ting month” and the process of replenishing qi and blood using herbal soups common to Chinese medical therapeutics. The significance of milestone birthdays, references to modesty, and the tension between generations over traditional practices are incorporated into the story. In this way the fabric of every day life for Chinese women is recognized. In turn, this is intended to send the message to our target audience that the video producers and outreach workers understand the routine issues of their lives and feel that Pap testing is relevant. The qualitative work identified the central themes to be included. More examples of how we used the qualitative data to develop the video are given in Table I. Written Materials “Culturally and linguistically appropriate print materials have been successfully used in disease prevention programs targeting minority groups, and can enhance Pap testing and smoking cessation (32, 33). A motivational pamphlet, featuring drawings of women by a Chinese artist as well as Chinese and English text, was developed for this project. Multiple barriers to screening are addressed through testimonials from Chinese women together with relevant facts (Table II). In addition, a question and answer section is used to address other barriers including lack of physician recommendation, perceptions that Pap testing should be done only by gynecologists, and concerns about embarrassment as well as pain and discomfort. We also used a simple, factual pamphlet about cervical cancer and Pap testing that was recently developed by the Federation of Chinese-America and Chinese-Canadian Medical Societies. Finally, the project developed fact sheets for use in each of the study cities. The Seattle fact sheet provides information about clinics that offer Chinese dialect interpreter services and health insurance coverage for Pap testing. Similarly, the Vancouver fact sheet provides information about Chinese-Canadian physicians as well as a local Pap testing clinic specifically for Asian women, and a statement indicating the medical services plan of British Columbia pays for cervical cancer screening.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the small media intervention (visual aids): The Outreach Worker Manual documents implementation procedures: “The outreach worker should always offer to show the video and provide the pamphlets as well as the fact sheet. The video should also be left with the participant, regardless of whether it was shown during the home visit. If a woman refuses a home visit, the outreach worker should offer to leave the video, pamphlets, and the fact sheet. All women should be given a stamped, return envelope and asked to mail the video within one month (unless the video is not provided either as part of the home visit nor educational material package). Outreach workers should use their own judgment with respect to the content of each home visit and timing of the video showing.” “Outreach worker materials (eg. the black and white photographs) should be used, as necessary. For example, if a woman has questions about female anatomy, the outreach worker could show her the anatomical diagram; If she does not believe



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Chinese women get cervical cancer, the cervical cancer and Pap testing graphs could be used.” Implementation Guide: Step 3 of the Program Implementation section “Step 3: At home, review educational materials. - show A New Pathway to Women’s Health video. - review information presented in video and answer questions. - distribute and review Prevention of Cervical Cancer- the Pap Test and Pap Testing: A New Step on the Path to Women’s Health brochures.”






Program Evaluation:

RTIPS RE-AIM Scores





Website Links: Program Information Main Article:

Source 1: Taylor VM, Hislop TG, Jackson JC, Tu SP, Yasui Y, Schwartz SM, Teh C, Kuniyuki A, Acorda E, Marchand A, Thompson B. (2002). A Randomized Controlled Trial of Interventions to Promote Cervical Cancer Screening among Chinese Women in North America. Journal of the National Cancer Institute, 94(9), 670-677. Additional Articles:

Source 2: Jackson JC, Do H, Chitnarong K, Tu SP, Marchand A, Hislop G, Taylor VM. (2002). Development of cervical cancer control interventions for Chinese immigrants. Journal of Immigrant Health, 4, 147-157.

Taylor VM, Hislop TG, Jackson JC, Tu SP, Yasui Y, Schwartz SM, Teh C, Kuniyuki A, Acorda E, Marchand A, Thompson B. (2002). A Randomized Controlled Trial of Interventions to Promote Cervical Cancer Screening among Chinese Women in North America. Journal of the National Cancer Institute, 94(9), 670-677. Taylor VM, Hislop TG, Jackson JC, Tu SP, Yasui Y, Schwartz SM, Teh C, Kuniyuki A, Acorda E, Marchand A, Thompson B. (2002). A Randomized Controlled Trial of Interventions to Promote Cervical Cancer Screening among Chinese Women in North America. Journal of the National Cancer Institute, 94(9), 670-677.



















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Resource Profile 9: Cambodian Outreach Worker Manual



Program:

The Cambodian Women’s Health Project The neighborhood-based program aims to increase cervical cancer screening rates among Cambodian American women, aged 18 years and older. This multi-faceted program is delivered by bilingual, bicultural, female Cambodian outreach workers. Workers serve as role models, provide social support, and serve as cultural mediators between women and health care facilities.

Population: Cambodian American adult women (19), unscreened or under-screened individuals

Setting: Community and home-based



Intervention:

Small Media The outreach workers use visual aids, including an education-entertainment video, motivational pamphlet, fact sheets, and an educational brochure.


The Outreach Worker Manual operationalizes the distribution, use and explanation of diagrams, graphs, photos, videos, pamphlets and other visual aids during home visits. The Cambodian ‘Preservation of Traditions’ video is also available and can be accessed from the above link.



Focus Groups/Consultations Pilot-testing Other: Qualitative study/interviews



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the small media intervention (visual aids): Source 1: Video Development “Use of Qualitative Data: Effective cancer prevention requires a thorough understanding of a community's ethnocultural attitudes and practices.16 To ensure cultural and linguistic appropriateness, we used qualitative methods during the development of our video. The qualitative paradigm applies anthropologic research methods to elicit the "insider's" point of view, and provides a contextual understanding of cultural values and their relationships. Because ethnographic approaches allow participants to discuss a wide range of topics, unencumbered by a rigid format, they facilitate the identification of new and unanticipated information. Additionally, qualitative data-collection methods encourage an in-depth interaction between researchers and participants, fostering rapport and trust. Therefore, these



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techniques are especially suited to the exploration of sensitive topics such as gynecologic issues. Unlike more structured methods, ethnographic approaches to data collection follow an iterative process. This means that each interview or focus group introduces new information to be validated and then assumed during subsequent data collection. Qualitative methods also allow questions to be reframed according to the cultural and linguistic framework of the target population as the data are collected. We conducted interviews of Cambodian women and four focus groups (to verify the information obtained during one-to-one interactions with the women). The women were recruited by Cambodian community advisors and clinic interpreters as well as through participants' social networks. All qualitative information was taped, transcribed, and coded (independently by five individuals) for thematic content. Our earlier interviews attempted to elicit the Cambodian model of gynecologic health. We were taught concepts and aspects of female anatomy considered significant to Cambodian women. Respondents described appropriate preventive behaviors and an array of chronic gynecologic illnesses considered to be consequences of failing to observe traditional preventive routines. This approach allowed us to identify relevant words and phrases commonly used by Cambodian women, and facilitated an understanding of how Cambodian women's family and societal roles affect care-seeking behavior. Later interviews were more refined, with an increasing focus on specific issues related to cervical cancer, including Pap-testing barriers and facilitators.” Script Development “Lefebre and Rochlin have stressed the importance of working with citizen advisory panels and pretesting with members of the target group.20 Our script was developed collaboratively by the project staff (which included two Cambodian Americans), a community coalition member who served as a consultant, and two community advisors from the target population. The development process required negotiating contradictory opinions and individual preferences, and multiple script revisions were necessary to accommodate a slowly emerging consensus. Our final script and the associated story boards were formally pretested at a coalition meeting (the majority of coalition members are younger, bicultural women) and with a focus group of older, less acculturated women.10 No substantive comments or suggestions for change were received at the pretesting stage.” Translation: “Although the script was initially written in English, Cambodian concepts that do not have direct American equivalents were written into the script using the Khmer terms. For example, the term "sor sai kjai," which refers to aspects of the postpartum period, was incorporated into the English-language script. The script was independently translated from English into Khmer by two medical interpreters, and then back-translated into English (by a third individual) to ensure lexical equivalence 21.” Source 2: “We completed 42 unstructured interviews with Cambodian American women from the target neighborhoods. To verify information collected during our one-to-one interactions, we also conducted four focus groups. The ethnography participants were recruited by our community advisors, clinic medical interpreters, and Cambodian women’s social networks. All the interviews and focus group were conducted by an experienced Thai American ethnographer and one of two Khmer language interpreters. The ethnographic data were systematically audiotaped,


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transcribed, and coded (independently by five individuals) for thematic content. Inconsistencies were reviewed and discussed by the coders until consensus was reached. Anthropologic approaches to data collection follow an iterative process. This means that each interview and focus group introduces new information to be validated and then assumed during subsequent data collection. While assumptions about sampling and data retrieval that allow for statistical analysis are not met, this approach allows questions to be reframed as the data are collected, according to the linguistic and cultural framework of the target group. Since cervical cancer is an unfamiliar concept for many Cambodian women, particularly those from rural areas, our earlier interviews focused on the more familiar aspects of gynecologic health (e.g., knowledge of female anatomy). Women’s health issues of importance to Cambodians were identified and each mentioned issue was discussed in terms of causation, prevention, biomedical and traditional treatments, and implications. Later interviews were more refined with an increasing focus on specific issues related to cervical cancer such as knowledge of risk factors, beliefs about Pap testing, and barriers to health care access.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the small media intervention (visual aids): Outreach Worker Manual: “The outreach worker should always offer to show the video. The outreach workers should use their own judgment with respect to the content of each home visit and timing of the video showing. However possible introductory comments and questions are provided below.” (Pg 19) “Outreach worker materials (e.g. black and white photographs) should be used as necessary. For example, if a woman has questions about female anatomy, the outreach worker could show her the anatomical model: if she says she does not believe Cambodian women get cervical cancer, the cervical cancer and Pap testing graphs can be used” (Pg 19) “At some point during the home visit, the outreach worker should discuss the refrigerator magnet that was included with the introductory mailing. - If the woman remembers getting the magnet, ask her if she has written her clinic phone number in the space provided. If not, ask: why don’t we do that now? - If the woman does not remember getting the magnet, offer another one and write her clinic phone number in the space provided.” (Pg 20)






Program Evaluation:

RTIPS RE-AIM Scores






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Website Links: Program Information Main Article: Taylor VM, Jackson JC, Yasui Y, Kuniyuki A, Acorda E, Marchand A, Schwartz SM, Tu S-P, Thompson B. (2002). Evaluation of an outreach intervention to promote cervical cancer screening among Cambodian American Women. Cancer Detection and Prevention, 26, 320-327. Additional Articles: Taylor VM, Jackson JC, Schwartz SM, Yasui Y, Tu S-P, Thompson B. (1998). Cervical Cancer Control in a Cambodian American Population. Asian American and Pacific Islander Journal of Health, 6(2), 368-377. Source 1: Mahloch J, et al. (1999). Bridging Cultures through the Development of a Cambodian Cervical Cancer Screening Video. Journal of Cancer Education, 14, 109-114.

Source 2: Jackson JC, et al. (2000). Development of a Cervical Cancer Control Intervention Program Targeting Cambodian American Women. Journal of Health, 25, 359-377.
















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Resource Profile 10. Health Educator’s Manual

Resource Profile 11. Implementation Guide

Resource Profile 12. Instructor Materials

Resource Profile 13. Physician Oriented Implementation Protocol

Resource Profile 14. Call Script

Colorectal Screening Resources


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Resource Profile 10: Health Educator’s Manual

Tu et al. (2006)


Program:

Colorectal Cancer Screening in Chinese Americans Project The Colorectal Cancer Screening In Chinese Americans Project is a clinic-based educational program aimed at promoting FOBT screening among lower-income and less-acculturated Chinese Americans.

Population: Low-income, less-acculturated Chinese American adults (age: 50-79)

Setting: Clinical

Country: United States – Atlanta, Georgia


Intervention:

Small Media Educational materials include a motivational video on CRC screening (produced in Cantonese and dubbed into Mandarin), bilingual CRC motivational pamphlet, and a bilingual CRC informational pamphlet from the Federation of Chinese American and Canadian Medical Societies.


The Health Educator’s Manual contains background information and operationalizes the use of educational intervention materials including a video, pamphlets and other visual aids. Informational brochures, pamphlets, FOBT instructions and a video are available and can be accessed from the above link.



Other: Qualitative Interviews



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the small media intervention (educational materials): Source 1: “Qualitative interviews: The intervention involves development of an educational and motivational video and pamphlet. To produce culturally and linguistically appropriate materials, we began with a qualitative component to elicit information about the FOBT beliefs and behavior from our target Chinese American clinic population. Thirty Chinese Americans were recruited from ICHS and interviewed by multilingual and bicultural research staff. The interviewees were aged between 50 and 79 years and able to speak Cantonese, Mandarin, or English. By design, half of the participants were men. Of the 30 interviewees, 19 (63%) described their English language ability as “poor” or “none”; 14 (47%) reported any past experience with FOBT.

Semi-structured interviews began with open-ended questions, such as What kinds of



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treatments have you received for health problems? and What have you heard about cancer of the colon and rectum? Following those questions, interviewers asked directed probes to elicit further detail about particular responses. Before the end of each interview, interviewers showed sample FOBT kits and probed interviewees‟ understanding and past experience with FOBT. Each interview lasted approximately an hour and was audiotaped with the consent of the interviewee. Interviews were translated into English (to audiotape) by interviewers who were certified medical translators and then transcribed by an English-speaking research assistant. After English language transcripts were reviewed by interviewers for accuracy and annotated for nonverbal content, six coders (five female and one male) with various professional training, ethnicity, and Chinese language competence (Table 1) reviewed each transcript. We developed an initial set of content codes by adaptation of the health behavior framework (previously known as the adherence model) (Bastani, Maxwell, Bradford, Prabhu Das, & Yan, 1999)… Subsequently, these descriptive content codes were grouped together thematically and used to aid the development of intervention materials.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of small media intervention (educational materials): The Health Educator’s Manual: documents implementation procedures: “The health educator should always offer to show the video and provide the pamphlets as well as the FOBT instruction sheet. If there isn’t enough time to watch the video at the clinic, the health educator should offer to schedule a special clinic visit for this. If the patient does not want to view the video at the clinic or schedule time to come back to the clinic, the video should be offered to the patient to take home. If the patient takes the video home, he or she should be given a stamped, return envelope and asked to mail the video within one month. The health educator should use their own judgment with respect to the content of each home visit and timing of the video showing.” (Pg 34) “Health educator materials materials (eg. diagram and graph) should be used, as necessary. For example, if a person has questions about the colon or rectal anatomy, the health educator could show the anatomical diagram; if the person says they do not believe Chinese people get colon cancer, the colorectal cancer graph could be used to show home many Chinese, in comparison to other Asian populations, get cancer.” (Pg 35)






Program Evaluation:

RTIPS RE-AIM Scores






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Website Links: Program Information Main Article: Tu,S.P.; Taylor,V.; Yasui,Y.; Chun,A.; Yip,M.P.; Acorda,E.; Li,L.; Bastani,R. (2006). Promoting culturally appropriate colorectal cancer screening through a health educator: a randomized controlled trial. Cancer, 107(5), 959-966.

Additional Articles: Source 1: Tsai, J. H.-C., Choe, J. H., Lim, J. M. C., Acorda, E., Chan, N. L., Taylor, V. M, & Tu, S.-P. (2004). Developing culturally competent health knowledge: Issues of data analysis of cross-cultural, cross-language qualitative research. International Journal of Qualitative Methods, 3 (4), 1-14. Yip, M.-P., Tu, S.-P., Chun, A., Yasui, Y., Taylor, V. M. (2006). Participation in colorectal cancer screening among Chinese Americans. Asian Pacific Journal of Cancer Prevention, 7, 645-650. Choe,J.H.; Tu,S.P.; Lim,J.M.; Burke,N.J.; Acorda,E.; Taylor,V.M. (2006). "Heat in their intestine": colorectal cancer prevention beliefs among older Chinese Americans. Ethnicity & Disease, 16(1), 248-254.





http://www.ualberta.ca/~iiqm/backissues/3_4/pdf/tsai.pdf











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Resource Profile 11: Implementation Guide

Denberg et al. (2006)


Program:

Effect of a Mailed Brochure on Appointment Keeping for Screening Colonoscopy In an effort to reduce non-adherence to screening colonoscopy, the referring physician's office mails patients a one-page, two-sided brochure shortly after they receive referrals for a colonoscopy procedure. The brochure aims to educate patients about CRC and colonoscopy, address most common questions and concerns, and remind them to schedule a procedure.

Population: Hispanic, Latino, Black and White adults (50+), asymptomatic men and women

Setting: Clinical (primary care practices – ambulatory and family medicine)



Intervention:

Small Media Client Reminder This is a multicomponent intervention in which a brochure acts as both a small media and client reminder intervention


The Implementation Guide provides information on program administration, delivery, implementation and evaluation. The guide specifies procedures to identify, personalize and mail the brochure to program participants. The Patient Brochure is also available and can be accessed from the above link.



Focus Groups/Consultations Other: Literature Search/Systematic Review



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the small media and client reminder intervention (brochure): Source 1: “In an effort to reduce non-adherence to screening colonoscopy, we developed a 1-page, 2-sided brochure to be mailed to patients shortly after receiving referrals for the procedure. The brochure was meant to educate patients about CRC and colonoscopy; to address their most common questions and concerns, which were identified by our previous research and that of others (3, 5); and to remind them to schedule a procedure.


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the small media and client reminder intervention (brochure):



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Implementation Guide: See steps 1-3 of the Program Implementation section. “Step 1: identify potential program participants: men and women aged 50 years and older who received referrals for screening colonoscopy from the primary care physician. Step 2: Personalize ‘Preventing Colon Cancer’ brochure to include primary care physician’s name and contact information for the endoscopy lab scheduling unit. Step 3: Mail personalized brochure to program participants within 10 days of referral.”






Program Evaluation:

RTIPS RE-AIM Scores





Website Links: Program Information Main Article: Source 1: Denberg, T. D., Commbes, J. M., Byers, T. E., Marcus, A. C., Feinberg, L. E., Steiner, J. F., & Ahnen, D. J. (2006). Effect of a mailed brochure on appointment-keeping for screening colonoscopy: A randomized trial. Annals of Internal Medicine, 145, 895-900.








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Resource Profile 12: Instructor Materials

Maxwell et al. (2010)


Program:

Filipino American Health Study The Filipino-American Health Study is a multicomponent, colorectal cancer (CRC) screening intervention consisting of a small-group educational session delivered by trained Filipino-American health educators (nurses). The intervention makes use of take-home print materials, a free fecal occult blood test (FOBT) kit, a follow-up reminder letter to the participant, and a letter to each participant's medical provider.

Population: Filipino-Americans (age: 50-70), unscreened or under-screened individuals

Setting: Community, religious establishments, urban/inner city



Intervention:

Small Media Client Reminder This multicomponent intervention uses print materials including a summarized CRC screening document and a copy of the American Cancer Society brochure (English and Taglog). Participants also receive a personalized reminder letter to obtain an FOBT yearly.


The Instructor Materials booklet provides print materials, reminder letter template, presentation slides and sample forms. It provides instructions on when to show specific print materials during educational sessions. Program materials for the participant are also available and can be accessed from the above link.



Multi-stakeholder Focus Groups/Consultations



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the small media and client reminder intervention (print materials and reminder letter): Source 1: “The multi-component intervention was developed with input from key informants and community members who participated in three focus groups. The Health Behavior Framework [8–9] guided the intervention content and format… we attempted to influence individual factors of the Health Behavior Framework that are usually associated with cancer screening, including knowledge, attitudes, barriers, social norms and support, communication with provider, and cultural factors. The print materials were previously reviewed by the community advisors for appropriateness as to reading level, clarity, comprehensiveness, interest level, and appearance”



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Description: No implementation information available


N/A




Program Evaluation:

RTIPS RE-AIM Scores







Main Article:

Source 1: Maxwell AE, Bastani R, Danao LL, Antonio C, Garcia GM, Crespi CM. (2010). Results of a community-based randomized trial to increase colorectal cancer screening among Filipino Americans. American Journal of Public Health, 100 (11), 2228-2234. Additional Articles: Maxwell, A. E., Bastani, R., Crespi, C. M., Danao, L. L., & Cayetano, R. T. (2011). Behavioral mediators of colorectal cancer screening in a randomized controlled intervention trial. Preventive Medicine, 52 (2), 167-173. Maxwell, A. E., Crespi, C. M., Danao, L. L., Antonio, C., Garcia, G. M., & Bastani, R. (2011). Alternative approaches to assessing intervention effectiveness in randomized trials: Application in a colorectal cancer screening study. Cancer Causes & Control, 22 (9), 1233-1241.














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Resource Profile 13:

Physician Oriented Implementation Protocol Myers et al. (2004)


Program:

Physician-Oriented Intervention Program on Follow-Up in Colorectal Cancer Screening The Physician-Oriented Intervention program aims to increase the recommendation and thorough follow-up for patients aged 50 years and older with an FOBT positive result. The program increases physician awareness of patient eligibility for CDE by providing reminders and feedback.

Population: Primary care physicians of Asian, Black, White and Hispanic adults (50+)

Setting: Clinical

Country: United States – Pennsylvania and New Jersey


Intervention:

Client Reminder The reminders are patient-specific forms sent to physicians when a patient has had an FOBT positive result in the last 60 days.

Resource

Description: The Implementation Protocol provides step-by-step procedures on how to conduct the physician intervention program.


Key Development

Steps: Other: Theoretical model

Completeness of

Reporting: Fair (i.e., low, poor, not clear or detailed enough for any replication)

Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the client reminder intervention (reminder forms): Source 1: “For this study, we developed a combined reminder– feedback and educational outreach intervention in accordance with the Diagnostic Evaluation Model or DEM. This model, which is based on Social Cognitive Theory [35] and the Theory of Reasoned Action [36], defines conceptual dimensions related to physician behavior. As shown in Fig. 1, the model includes the following factors: physician practice environment and characteristics, practitioner background and experience, physician cognitive and psychological representations, physician social support and influence, patient characteristics, and physician intention. Elsewhere, it has been suggested that these factors may be useful in predicting physician behavior related to colorectal cancer screening [37] and CDE recommendation and performance [38]. We hypothesized that a combined CDE reminder–feedback and educational outreach intervention would affect practice-level CDE recommendation and performance (i.e., primary outcomes) by influencing physician cognitive representations related to colorectal cancer screening and CDE, psychosocial representations of colorectal cancer screening and CDE, and intention to recommend and perform CDE for FOBT patients (i.e., secondary outcomes).



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Members of the research team developed the reminder–feedback component of the intervention… The other feature of this intervention component was a mailed CDE feedback report. This report, which was sent to practice PCPs on a semiannual basis, identified patients who had had a screening FOBT result during the prior 6 months. It also provided the patient’s FOBT result date and CDE status as reported on the ICA form and in MCO administrative data. This intervention component was designed to make physicians aware of patients who were eligible for CDE.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the client reminder intervention (reminder forms): The Implementation Protocol provides step-by-step procedures. See step 2. “… PCPs were asked to provide the patient’s CDE recommendation and performance status and also indicate whether CDE was recommended and preformed, and when applicable, provide the examination dates and diagnosis reached. If the patient did not have a CDE, the PCP was asked to provide a reason. ii. PCPs that did not return the form in 30 days were mailed a second copy of the ICA form. iii. A practice –specific CDE feedback report was also produced every six months and was sent to each PCO, which listed patients in the practice with a screening FOBT+ result during the prior six months, patients FOBT+ result date, and his/her CDE status.”

Completeness of

Reporting: Good (i.e., moderately clear, somewhat replicable)



Description: No tool evaluation information available

Program

Evaluation:

RTIPS RE-AIM Scores






Main Article: Source 1: Myers RE, Turner B, Weinberg D, Hyslop T, Hauck WW, Brigham T, Rothermel T, Grana J, Schlackman N. (2004). Impact of a Physician-Oriented Intervention on Follow-Up in Colorectal Cancer Screening. Preventive Medicine, 38, 375-381. Additional Articles: Myers RE, Turner B, Weinberg, Hauck WW, Hyslop T, Brigham T, Rothermel T, Grana J, Schlackman N. (2001). Complete Diagnostic Evaluation in Colorectal Cancer










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Screening: Research Design and Baseline Findings. Preventive Medicine, 33, 249-260. Turner B, Myers RE, Hyslop T, Hauck WW, Weinberg D, Brigham T, Grana J, Rothermel T, Schlackman N. (2003). Physician and Patient Factors Associated with Ordering a Colon Evaluation After a Positive Fecal Occult Blood Test. Journal of General Internal Medicine, 18, 357-363. Myers RE, Hyslop T, Gerrity M, Schlackman N, Hanchak N, Grana J, Turner BJ, Weinberg D, Hauck WW. (1999). Physician Intention to Recommend Complete Diagnostic Evaluation in Colorectal Cancer Screening. Cancer Epidemiology, Biomarkers and Prevention, 8, 587-593.











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Resource Profile 14: Call Script

Mosen et al. (2010)


Program:

Automated Telephone Calls Improve Completion of Fecal Occult Blood Testing

Automated Telephone Calls Improve Completion of Fecal Occult Blood Testing is an automated telephone intervention to increase CRC screening using an FOBT home test kit.

Population: Alaskan Native, American Indian, Asian, Black, Hispanic, Latino, White and Pacific Islander adults (age: 51-80) with average risk and due for screening

Setting: Clinical



Intervention:

Client Reminder Participants receive two types of reminder phone calls. One is a general reminder phone call (type 1) that provides a brief overview of CRC and encourages the use of a home FOBT kit, whereas the second is a follow-up reminder call (type 2) to return FOBT kits for those participants who requested a FOBT stool card kit but failed to return it.


The Call Script provides content for the client reminder message for the initial call, automated message and 3-month follow-up call. The content is available in both English and Spanish. Mailed FOBT Materials are also available and can be accessed from the above link.



Not Reported


N/A



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the client reminder intervention (phone call reminders): Implementation Guide: See Steps 3-5 of the Program Implementation section. Specific information on type 1 and 2 phone call reminders is provided. “Step 3: The general automated call (Type 1) is placed by working with an automated calling company. Patients who request FOBT kits are mailed cards and instructions. Step 4: Patients who do not complete FOBT screening receive up to two reminder calls, 6 weeks apart, identical to the first automated call (Call Type 1). Step 5: Using an automated calling company, an automated call (Type 2) is placed to participants who requested FOBT kits but did not return the completed cards within 4-5 weeks of the request.”




71






Program Evaluation:

RTIPS RE-AIM Scores






Website Links: Program Information Main Article: Mosen DM, Feldstein AC, Perrin N, Rosales AG, Smith DH, Liles EG, Schneider JL, Lafata JE, Myers RE, Kositch M, Hickey T, Glasgow RE. (2010). Automated telephone calls improved completion of fecal occult blood testing. Medical Care, 48 (7), 604-610.







72

Resource Profile 15a. FoCas Outreach Plan

Resource Profile 15b. FoCas Outreach Plan of Action

Resource Profile 16. Project SAFe Program Tool Kit

Breast & Cervical Screening

Resources


73

Resource Profile 15a: FoCas Outreach Plan



Program:

The Forsyth County Cancer Screening Project (FoCas) The Forsyth County Cancer Screening Project (FoCas) is designed to (a) identify barriers to breast and cervical cancer screening faced by low-income women and health care providers and (b) address these barriers in a comprehensive program to help improve participation in breast and cervical cancer screening among low-income women.

Population: Low-income African-American adult women (40+)

Setting: Clinical



Intervention:

Small Media Several print materials were employed in this program including flyers, postcards, bulletin inserts and brochures.


The Outreach Plan discusses the seven approaches utilized in the FoCas program, including small media interventions through church campaigns and direct mail. All print materials are available and can be accessed from the above link.



Multi-stakeholder Focus Groups/Consultations Other: Survey



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the <intervention type> intervention (<specific intervention>): Source 1: “To develop effective interventions, results from the baseline women’s survey, the health care provider survey, additional focus groups, and input from the Community Advisory Board were used. These sources provided information on barriers, attitudes, current breast and cervical cancer screening practices, and optimum strategies for delivering health education messages. The development of the multicomponent clinic-based and community-based interventions are described elsewhere” Source 2: “In order to develop effective interventions it was necessary to identify the barriers, attitudes, and current screening practices of both the population and the providers. This was done in Phase 1 of the project. The baseline survey of knowledge, attitudes, barriers, and use of breast and cervical cancer screening among women in the population was conducted by face-to-face, interviewer-administered surveys of



74

women age 40 and over who lived in the subsidized housing communities of both counties.” Source 3: “A pictorial representation of a woman progressing through the steps of obtaining a mammogram was chosen as a strategy to educate women about mammography. The use of pictures reduced the need for reading and allowed the use of African American models who would be identified as similar to the target population. Focus groups consisting of women from the target population identified several components that would maximize the value of the photoessay: 1) include a woman of the same age and cultural background as the target population; 2) show the entire process of getting a mammogram, from entering the clinic to leaving; 3) include a picture showing the actual mammogram being taken; and 4) add a minimal amount of text to supplement the pictures. In addition, a message reinforcing the value of the three detection modalities for breast cancer screening—mammography, clinical breast examination (CBE), and breast self-examination (BSE)—needed to be included. A 73-year-old African American woman who resided in one of the housing communities and was a patient at Reynolds Health Clinic was recruited to be the "model" for the photoessay. After obtaining written consent from the model to be photographed, several photos were taken of her entering the clinic, registering at the front desk, entering the elevator, arriving at the mammography unit, getting a mammogram, and leaving the clinic. A total of 108 photos were taken by a professional photographer. These photos were reviewed in proof from by the study staff and members of our Community Advisory Board. Twenty-seven pictures were chosen to be in the photoessay, as these were judged to be the best photographs, convey the intended message, and allude a positive impression about breast cancer screening. Members of the Community Advisory Board suggested that brief text be added to each picture. A brief passage of text explaining each photo was placed under it. The photos, text, and title ("A Visit for a Mammogram") were mounted on a three-panel standing display unit. The unit folds and is easily transported, while the items are mounted with Velcro fasteners. Four photos, with text, from the display are included in Figure 1. The entire photoessay was then reviewed by members of the Community Advisory Board, members of the medical staff at the Reynolds Health Clinic, and a sample of women from the target population who had attended an education class. No substantive comment or suggestion for change was received.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the small media intervention (print materials): Implementation Guide: See steps 1,3 and 4 of the Program Implementation section. “Step 1: Recruit program participants… Example of program advertisements used in the media campaign are: In-reach Flyers, Church Program Materials, and Monthly Class Announcements. Step 3: … For additional resources for educational session, see … Class and Community Brochures, Church Program Materials, Newsletter, and Birthday Card. Step 4: Conduct the clinic in-reach program (as needed). See In-reach Flyers and the methods section of reference articles.”





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Program Evaluation:

RTIPS RE-AIM Scores

Research Integrity 3.1 Not Provided Intervention Impact:

Cervical Cancer Breast Cancer

4.0 2.0




Website Links: Program Information Main Article: Source 1: Paskett ED, Tatum CM, D'Agostino R, Rushing J, Velez R, Michielutte R, Dignan M. (1999). Community-Based Interventions to Improve Breast and Cervical Cancer Screening: Results of the Forsyth County Screening (FoCaS) Project. Cancer Epidemiology, Biomarkers & Prevention, 8, 453-459.

Additional Articles Source 2: Paskett ED, McMahon K, Tatum CM, Velez R, Shelton B, Case LD, Wofford J, Moran W, Wymer A. (1998).Clinic-based interventions to promote breast and cervical cancer screening. Preventative Medicine. 27(1):120-128

Source 3: Paskett ED, Tatum C, Wilson A, Dignan M, Velez R. (1996). Use of a Photoessay to Teach Low-Income African American Women about Mammography. Journal of Cancer Education, 11 (4), 216-220.

The National Cancer Institute Cancer Screening Consortium for Underserved Women. (1995). Breast and Cervical Cancer Screening among Underserved Women. Archives of Family Medicine, 4 , 617-624.






http://www.ncbi.nlm.nih.gov/pubmed?term=Clinic-based%20interventions%20to%20promote%20breast%20and%20cervical%20cancer%20screening










76

Resource Profile 15b: FoCas Outreach Plan of Action



Program:

The Forsyth County Cancer Screening Project (FoCas) The Forsyth County Cancer Screening Project (FoCas) is designed to (a) identify barriers to breast and cervical cancer screening faced by low-income women and health care providers and (b) address these barriers in a comprehensive program to help improve participation in breast and cervical cancer screening among low-income women.

Population: Low-income African-American adult women (40+)

Setting: Clinical



Intervention:

Small Media Several print materials were employed in this program including flyers, postcards, bulletin inserts and brochures.


The Outreach Plan of Action provides intervention development and implementation information that to reproduce the cancer screening program. All print materials used in the intervention are available and can be accessed from the above link.



Multi-stakeholder

Focus Groups/Consultations Other: Survey



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the <intervention type> intervention (<specific intervention>): Source 1: “To develop effective interventions, results from the baseline women’s survey, the health care provider survey, additional focus groups, and input from the Community Advisory Board were used. These sources provided information on barriers, attitudes, current breast and cervical cancer screening practices, and optimum strategies for delivering health education messages. The development of the multicomponent clinic-based and community-based interventions are described elsewhere” Source 2: “In order to develop effective interventions it was necessary to identify the barriers, attitudes, and current screening practices of both the population and the providers. This was done in Phase 1 of the project. The baseline survey of knowledge, attitudes, barriers, and use of breast and cervical cancer screening among women in



77

the population was conducted by face-to-face, interviewer-administered surveys of women age 40 and over who lived in the subsidized housing communities of both counties.” Source 3: “A pictorial representation of a woman progressing through the steps of obtaining a mammogram was chosen as a strategy to educate women about mammography. The use of pictures reduced the need for reading and allowed the use of African American models who would be identified as similar to the target population. Focus groups consisting of women from the target population identified several components that would maximize the value of the photoessay: 1) include a woman of the same age and cultural background as the target population; 2) show the entire process of getting a mammogram, from entering the clinic to leaving; 3) include a picture showing the actual mammogram being taken; and 4) add a minimal amount of text to supplement the pictures. In addition, a message reinforcing the value of the three detection modalities for breast cancer screening—mammography, clinical breast examination (CBE), and breast self-examination (BSE)—needed to be included. A 73-year-old African American woman who resided in one of the housing communities and was a patient at Reynolds Health Clinic was recruited to be the "model" for the photoessay. After obtaining written consent from the model to be photographed, several photos were taken of her entering the clinic, registering at the front desk, entering the elevator, arriving at the mammography unit, getting a mammogram, and leaving the clinic. A total of 108 photos were taken by a professional photographer. These photos were reviewed in proof from by the study staff and members of our Community Advisory Board. Twenty-seven pictures were chosen to be in the photoessay, as these were judged to be the best photographs, convey the intended message, and allude a positive impression about breast cancer screening. Members of the Community Advisory Board suggested that brief text be added to each picture. A brief passage of text explaining each photo was placed under it. The photos, text, and title ("A Visit for a Mammogram") were mounted on a three-panel standing display unit. The unit folds and is easily transported, while the items are mounted with Velcro fasteners. Four photos, with text, from the display are included in Figure 1. The entire photoessay was then reviewed by members of the Community Advisory Board, members of the medical staff at the Reynolds Health Clinic, and a sample of women from the target population who had attended an education class. No substantive comment or suggestion for change was received.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the small media intervention (print materials): The Outreach Plan of Action provides implementation information. See Phase 2 and the Additional Implementation section of the document for more details. “1. Materials selected, reviewed, developed & distributed. Develop or order church fans, magnets, fly swatters, (review materials from Cervical Cancer Project). Maintain regular input from women in cohort & CAB. 2. Produce community video (Hispanic, Jan). Identify local African American artists for culturally appropriate advertising.”





78




Program Evaluation:

RTIPS RE-AIM Scores

Research Integrity 3.1 Not Provided Intervention Impact:

Cervical Cancer Breast Cancer

4.0 2.0




Website Links: Program Information Main Article: Source 1: Paskett ED, Tatum CM, D'Agostino R, Rushing J, Velez R, Michielutte R, Dignan M. (1999). Community-Based Interventions to Improve Breast and Cervical Cancer Screening: Results of the Forsyth County Screening (FoCaS) Project. Cancer Epidemiology, Biomarkers & Prevention, 8, 453-459.

Additional Articles: Source 2: Paskett ED, McMahon K, Tatum CM, Velez R, Shelton B, Case LD, Wofford J, Moran W, Wymer A. (1998).Clinic-based interventions to promote breast and cervical cancer screening. Preventative Medicine. 27(1):120-128

Source 3: Paskett ED, Tatum C, Wilson A, Dignan M, Velez R. (1996). Use of a Photoessay to Teach Low-Income African American Women about Mammography. Journal of Cancer Education, 11 (4), 216-220.

The National Cancer Institute Cancer Screening Consortium for Underserved Women. (1995). Breast and Cervical Cancer Screening among Underserved Women. Archives of Family Medicine, 4 , 617-624.
















79

Resource Profile 16: Project SAFe Program Toolkit

Ell et al. (2007)


Program:

Project SAFe (Screening Adherence Follow-Up) The Project SAFe program is a system of patient navigation counseling and case management designed to help women overcome barriers to timely breast and cervical cancer screening and follow-up after receiving an abnormal test results. The service involves a structured interactive telephone assessment of screening-adherence risk, health counseling, and follow-up services, including patient tracking, appointment reminders, and referral to community resources.

Population: Low-income, ethnic minority women (19+) with abnormal mammograms and pap smears

Setting: Clinical



Intervention:

Client Reminder All women receive appointment scheduling, reminders, and follow-up calls at 6 and 12 months that provide a reinforcing educational message about the value of follow-up and subsequent rescreening.


The Project SAFe Program Toolkit provides information on patient navigation and case management, which includes an overview the program implementation strategies as well as specific client reminder administrative steps and a monitoring & evaluation guide.



Other: Theoretical model



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the client reminder intervention (phone call follow-up): Source 1: “The SAFe model (Fig. 2) combines intervention elements used in previous studies (Ell et al., 2002a; Freeman et al., 1995; Freeman-Wang et al., 2001; Kerner et al., 2003; Lauver et al., 1999; Lerman et al., 1992; Miller et al., 1994), including structured telephone-based patient-centered adherence risk assessment, health education and psychosocial counseling, systems navigation assistance, patient tracking and reminders, and referral to community resources. The focus on individual cognitive/affective dimensions was grounded in the Health Belief Model (HBM) (Becker et al., 1974), while attention to environmental factors was guided by Socio-cultural Explanatory Theory” Project SAFe Program Toolkit: “Controlled clinical trials had demonstrated the




80

efficacy of interactive health education counseling and systems navigation for improving abnormal screening follow-up adherence.” (Pg 6)


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the client reminder intervention (phone call follow-up): The Implementation Guide: Steps 1-5 of the Program Implementation section provide details on how use the small media materials. Steps 1 and 2 are provided below. “Step 1: identify and reach eligible participants. - Connect with hospitals or clinics to become a recommended resource for women receiving abnormal test results. - Additional community outreach, through community groups, nonprofits, and other organizations may also help identify eligible participants.” “Step 2: After the participant has been informed of abnormal test results, the Patient Navigator contacts the participant (telephone or face to face) and provides scripted initial health education support, and risk assessment. Key tasks for the initial contact include: - Establish rapport - Provide health education and emotional support - Finding out about participant problems, needs, and capacities - Problem-solving - Linking to another helper if needed…”






Program Evaluation:

RTIPS RE-AIM Scores

Research Integrity 4.1 Not Provided

Intervention Impact 3.5




Website Links: Program Information Main article: Ell K, Vourlekis B, Muderspach L, Nissly J, Padgett D, Pineda D, Sarabia O, Lee PJ. (2002). Abnormal Cervical Screen Follow-Up among Low-Income Latinas: Project SAFe. Journal of women's health & gender-based medicine, 11 (7), 639-651. Additional article(s): Source 1: Ell, K., Vourlekis, B., Lee, P-J., & Xie, B. (2007). Patient navigation and case








81

management following an abnormal mammogram: A randomized clinical trial. Preventive Medicine, 44 , 26-33. Ell K, Vourlekis B, Nissly J, Padgett D, Pineda D, Sarabia O, Walther V, Blumenfield S, Lee PJ. (2002, August). Integrating Mental Health Screening and Abnormal Cancer Screening Follow-Up: An Intervention to Reach Low-Income Women. Community Mental Health Journal, 38 (4), 311-325. Ell, K., Padgett, D., Vourlekis, B., Nissly, J., Pineda, D. Sarabia, O., Walther, V., Blumenfield, S., & Lee, P-J. (2002). Abnormal mammogram follow-up: A pilot study in women with low income. Cancer Practice, 10 (3), 130-138.











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Resource Profile 17a. Prevention Care Management Manual

Resource Profile 17b. Prevention Care Manager Training Outline

Breast, Cervical & Colorectal

Screening Resources


83

Resource Profile 17a: Prevention Care Management Manual

Dietrich et al. (2006)


Program:

Prevention Care Management Prevention Care Management (PCM) is a centralized telephone care management system designed to increase cancer (breast, cervical, and colorectal) screenings among women. Women who are not up-to-date for cancer screenings receive phone calls from prevention care managers

Population: Black, Hispanic and Latino adult women (age: 50-69)

Setting: Clinical, urban/inner city



Intervention:

Client Reminder The intervention includes several reminder phone calls, in which case managers provide support, address screening barriers, schedule appointments and arrange transportation.


The Prevention Care Management Manual contains a structured script for community health managers to follow during phone calls. The manual provides operational information for the managers to schedule appointments, provide accurate information about screenings, prompt women with appointment reminder calls and letters, provide directions to screening facilities, and help women find a means of transportation to appointments. Notable tools available within this resource: Introduction Script (Page 10) Follow-up Plan (Page 23) Barriers to Cancer Screening Tests, and Appropriate Responses (Page 27)



Other: Theoretical framework, patient interviews



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the client reminder intervention (phone call reminder): Source 1: “Used interviews to explore the perceptions of barriers and facilitators of colorectal, cervical, and breast cancer screening among 187 low-income, primarily minority women in four New-York-City-based community/migrant health centers” Source 2: “Interviews: Patients were asked open-ended questions designed to explore the barriers and facilitators of cancer screening behavior based on the PRECEDE- PROCEED framework. According to this framework, factors affecting



84

human behaviors are classified into predisposing, enabling and reinforcing categories, thus, making it possible to group the specific features of a given health behavior according to the types of interventions available in health education and health promotion. This framework issued to guide the development of health promotion interventions targeted at improving human behaviors in different healthcare settings. Each patient interview was divided into sections focusing on a particular screening test [mammogram, Pap test, home fecal occult blood test or sigmoidoscopy]. Patients who had never had a screening were asked a different set of questions than those who had been previously screened (Table 1). Patients who had been previously screened were only asked about facilitators, while patients who had not been screened were questioned about barriers and potential facilitators that might encourage them to be screened. All patients were then asked if they planned to have that screening test in the future, and if not, barriers were assessed.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the client reminder intervention (phone call reminder): Prevention Care Management Manual: See section 5 for information on how to implement the intervention. There are implementation instruction on how to identify participants, how to make initial contact with participants, mailing procedures and how to conduct follow-up calls.






Program Evaluation:

RTIPS RE-AIM Scores





Website Links: Program Information Main Article: Source 1: Dietrich,A.J.; Tobin,J.N.; Cassells,A.; Robinson,C.M.; Greene,M.A.; Sox,C.H.; Beach,M.L.; DuHamel,K.N.; Younge,R.G. (2006). Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial. Annals of Internal Medicine, 144(8), 563-571. Additional Articles:

Source 2: Ogedegbe, G., Cassells, A. N., Robinson, C. M., DuHamel, K. N., Tobin, J. N., Sox, C. H., & Dietrich, A. J. (2005). Perceptions of barriers and facilitators of cancer early detection among low-income minority women in community health centers. Journal of the National Medical Association, 97(2), 162-170.












85

Beach, M. L.; Flood, A. B.; Robinson, C. M.; Cassells, A. N.; Tobin, J. N.; Greene, M. A.; Dietrich, A. J. (2007). Can language-concordant prevention care managers improve cancer screening rates?. Cancer Epidemiology, Biomarkers and Prevention, 16(10), 2058-2064. Dietrich, A. J., Tobin, J.N., Cassells, A., Robinson, C. M., Reh, M., Romero, K.A., Flood, A.B., & Beach, M.L. (2007). Translation of an efficacious cancer-screening intervention to women enrolled in a Medicaid managed care organization. Annals of Family Medicine, 5(4), 320-327.










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Resource Profile 17b: Prevention Care Manager Training Outline

Dietrich et al. (2006)


Program:

Prevention Care Management Prevention Care Management (PCM) is a centralized telephone care management system designed to increase cancer screenings among women. Women who are not up-to-date for cancer screenings receive phone calls from prevention care managers

Population: Black, Hispanic and Latino adult women (age: 50-69)

Setting: Clinical, urban/inner city



Intervention:

Client Reminder The intervention includes several reminder phone calls, in which case managers provide support, address screening barriers, schedule appointments and arrange transportation.


The Prevention Care Manager Training Outline acts as a guide for managers to facilitate the program. The outline often refers back to the specific pages in the program management manual.



Other: Theoretical framework, patient interviews



Description: The following are excerpts taken from the program’s articles and other resources pertaining to the development of the client reminder intervention (phone call reminder): Source 1: “Used interviews to explore the perceptions of barriers and facilitators of colorectal, cervical, and breast cancer screening among 187 low-income, primarily minority women in four New-York-City-based community/migrant health centers” Source 2: “Interviews: Patients were asked open-ended questions designed to explore the barriers and facilitators of cancer screening behavior based on the PRECEDE- PROCEED framework. According to this framework, factors affecting human behaviors are classified into predisposing, enabling and reinforcing categories, thus, making it possible to group the specific features of a given health behavior according to the types of interventions available in health education and health promotion. This framework issued to guide the development of health promotion interventions targeted at improving human behaviors in different healthcare settings. Each patient interview was divided into sections focusing on a particular screening test [mammogram, Pap test, home fecal occult blood test or sigmoidoscopy]. Patients who had never had a screening were asked a different set of questions than those who had been previously screened (Table 1). Patients who



87

had been previously screened were only asked about facilitators, while patients who had not been screened were questioned about barriers and potential facilitators that might encourage them to be screened. All patients were then asked if they planned to have that screening test in the future, and if not, barriers were assessed.”


Description: The following are excerpts taken from the program’s articles and other resources pertaining to the implementation of the client reminder intervention (phone call reminder): Prevention Care Management Manual: See section 5 for information on how to implement the intervention. There are implementation instruction on how to identify participants, how to make initial contact with participants, mailing procedures and how to conduct follow-up calls.






Program Evaluation:

RTIPS RE-AIM Scores





Website Links: Program Information Main Article: Source 1: Dietrich,A.J.; Tobin,J.N.; Cassells,A.; Robinson,C.M.; Greene,M.A.; Sox,C.H.; Beach,M.L.; DuHamel,K.N.; Younge,R.G. (2006). Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial. Annals of Internal Medicine, 144(8), 563-571. Additional Articles:

Source 2: Ogedegbe, G., Cassells, A. N., Robinson, C. M., DuHamel, K. N., Tobin, J. N., Sox, C. H., & Dietrich, A. J. (2005). Perceptions of barriers and facilitators of cancer early detection among low-income minority women in community health centers. Journal of the National Medical Association, 97(2), 162-170.

Beach, M. L.; Flood, A. B.; Robinson, C. M.; Cassells, A. N.; Tobin, J. N.; Greene, M. A.; Dietrich, A. J. (2007). Can language-concordant prevention care managers improve cancer screening rates?. Cancer Epidemiology, Biomarkers and Prevention, 16(10), 2058-2064. Dietrich, A. J., Tobin, J.N., Cassells, A., Robinson, C. M., Reh, M., Romero, K.A., Flood, A.B., & Beach, M.L. (2007). Translation of an efficacious cancer-screening intervention to women enrolled in a Medicaid managed care organization. Annals of Family Medicine, 5(4), 320-327.




















88

Appendix A. Additional Resources

Appendix B. Legend for Resource Profile

Appendices


89

Appendix A. Additional Resources

The following are additional resources identified through the search activities of the project and that

may be of interest to those working “in-the-field” of cancer screening program planning,

implementation, maintenance and evaluation:

RE-AIM

http://www.re-aim.org/

Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM)

A model for the planning, evaluation, reporting and review of translational research and practice

Protocol: Using What Works

http://cancercontrol.cancer.gov/use_what_works/start.htm

Adapting evidence-based programs to fit your needs

Program Adaptation Guidelines

http://rtips.cancer.gov/rtips/reference/adaptation_guidelines.pdf

Guidelines for choosing and adapting programs

The Guide to Community Preventive Services: What works to promote health

http://www.thecommunityguide.org/index.html

A free, on-line resource to assist users in choosing programs and policies to improve health and prevent disease in

the community

Cancer Control P.L.A.N.E.T. (Canada)


Plan, Link, Act, Network with Evidence-based Tools (P.L.A.N.E.T.)

An on-line resource centre that offers public health professionals comprehensive cancer control planning

Cancer Control P.L.A.N.E.T. (USA)

Plan, Link, Act, Network with Evidence-based Tools (P.L.A.N.E.T.)


Website with links to comprehensive cancer control resources for public health professionals

http://www.re-aim.org/

http://cancercontrol.cancer.gov/use_what_works/start.htm

http://rtips.cancer.gov/rtips/reference/adaptation_guidelines.pdf

http://www.thecommunityguide.org/index.html




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Appendix B. Legend for Resource Profile

Resource Profile <#> <Resource Name>

<First Author of Resource/Program Publication><Year of Resource/Program Publication>

I. GENERAL INFORMATION A summary of the overall program from which the resource is from, to provide contextual detail II. RESOURCE INFORMATION A description of the resource, the type of intervention, and a direct link to the actual resource III. DEVELOPMENT INFORMATION Information excerpts pertaining to the development of the resource, the actual intervention and/or the program The research team assessed the available information for completeness of reporting and provided a rating of Excellent, Good, or Fair IV. IMPLEMENTATION INFORMATION Information for how to implement the resource and/or intervention The research team assessed the available information for completeness of reporting and provided a rating of Excellent, Good, or Fair V. EVALUATION INFORMATION Information regarding evaluation of the resource* and/or intervention Each program in RTIPs is evaluated and we included these scores here; as of 2012, the RTIPs administrator moved to the RE-AIM scoring system and prior to that used their own RTIPs evaluation system. For more information please visit http://rtips.cancer.gov/rtips/reference/fact_sheet.pdf and

http://rtips.cancer.gov/rtips/faq.do .

(*we found evaluation information for only one of the 23 resources [Campaign Material List (Earp et al, 2002)])

VI. ADDITIONAL INFORMATION This section includes direct links to the main page of the respective resource’s program in RTIPs (resource is accessible from there) and the resource’s related articles

http://rtips.cancer.gov/rtips/reference/fact_sheet.pdf

http://rtips.cancer.gov/rtips/faq.do

Cancer Screening Interventions Resources Reference Package

Documents

Transcript of Cancer Screening Interventions Resources Reference Package