1/30/2012 Nuts and Bolts of CBPR Workshop 1/27/2012 Better Breast - - PDF document

▶
1 30 2012
SMART_READER_LITE
LIVE PREVIEW

1/30/2012 Nuts and Bolts of CBPR Workshop 1/27/2012 Better Breast - - PDF document

Oct 30, 2022 223 likes •398 views

1/30/2012 Nuts and Bolts of CBPR Workshop 1/27/2012 Better Breast and Cervical Cancer Control for Korean American Women: A Community Partnership to Address Health Disparities Hae-Ra Han, RN, PhD, FAAN The Johns Hopkins University School of

slide-1
SLIDE 1

1/30/2012 1

Hae-Ra Han, RN, PhD, FAAN

The Johns Hopkins University School of Nursing Baltimore, MD

Better Breast and Cervical Cancer Control for Korean American Women: A Community Partnership to Address Health Disparities

Nuts and Bolts of CBPR Workshop 1/27/2012

National Cancer Institute (CA129060)

Purposes of this presentation

To introduce The Healthy Korean Americans 2020, a community-academic partnership to address health disparities faced by the community; and To review the progress of The Healthy Korean Americans 2020 focusing on cancer control

slide-2
SLIDE 2

1/30/2012 2

The Healthy Korean Americans 2020

Source: Han HR et al. J Immigr Minor Health. 2007;9(2):137-46.

Korean Resource Center (501 c)

Kim B. Kim

CEO/President Chung K. Pak

Commissioner, Governor’s Commission

  • n Asian-Pacific American Affairs

Young D. Cha

President (1st), National Association of Korean American Pharmacists

Yang Kon Kim

Professor, Towson University

Executive Council

Hae-Ra Han

Associate Professor Johns Hopkins University

Ohoe Kim

Professor, Towson University

Sang Kyun Shin

Franklin Sq. Hospital

  • St. Joseph Hospital
slide-3
SLIDE 3

1/30/2012 3

Asian Americans

Growing fast

  • 3.8 million in 1980  16 million in 2010 (biggest increase)

Korean Americans (KA) are one of the fastest growing subgroups, especially in major metropolitan areas

  • KA is the second largest minority in the greater Baltimore area

Korean Population in the US 1940-2010

200,000 400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1,600,000 1,800,000 1940 1950 1960 1970 1980 1990 2000 2010 Population Year

Year Population 1940 8,568 1950 10,000 1960 25,000 1970 69,130 1980 354,593 1990 798,849 2000 1,076,872 2010 1,600,000

slide-4
SLIDE 4

1/30/2012 4 Major Barriers to Adequate Health Care

Adequate Health Care

Individual

  • Language
  • health literacy
  • Fear or being intimidated

by main health care system

Psychological

  • Feeling of marginalization
  • Loss of self-confidence
  • Role conflict r/t dependency on others
  • “Do not want to be a burden to family”
  • Depression

Environmental/financial

  • Safety
  • Cost of medication
  • Access to health care
  • US Census – 11% (23.1 million) of the total population (>= 5 yrs)

spoke a language other than English in 1980 to 14% (31.8 million) in 1990 to 18% (47.0 million) in 2000.

  • American Community Survey – 19.7% (54.9 million) in 2006

Source: U.S. Census Bureau. Available from http://factfinder.census.gov/servlet/STTable?-geo_id=01000US&- qr_name=ACS_2006_EST_G00_S1601&-ds_name=ACS_2006_EST_G00_

8.7 47.3 33 48.7 70 29.7

10 20 30 40 50 60 70 80

% Having English difficulty

Language spoken at home

Health literacy

“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions” (U.S. Department of Health and

Human Services. Health literacy definition. Washington, DC: U.S. Department of Health and Human Services; 2000)

A major determinant of positive health behavior and outcomes

slide-5
SLIDE 5

1/30/2012 5 Unequal cancer burden faced by KA women

KAs face an unequal cancer burden related to the significant language, health literacy, and cultural barriers. KA women are experiencing rapid increases in breast cancer incidence and have the second highest incidence of cervical cancer nationally.

Breast and cervical cancers diagnosed at significantly later stages than those of whites The least likely racial/ethnic group to receive early breast and cervical cancer screening

여성의 건강이 가족 건강으로 직결됩니다

Source: Han HR. Better Breast Health for Korean American Women 2005- 2007 (CA110939)

Better Breast and Cervical Cancer Control for KA Women

Purpose: To assess the effects of a health literacy-focused cancer control intervention delivered by trained CHWs on 1) obtaining mammogram and Pap tests and 2) health literacy in non- adherent KA women Design: RCT with a delayed intervention Sample: 560 KA women ages 21-64

slide-6
SLIDE 6

1/30/2012 6

Study design

SAMPLING SITES AND CHW RECRUITMENT/TRAINING Random Sample/Assignment of Churches (n=28) CHW Recruitment/Training (n=40) RECRUITMENT & ENROLLMENT of KA WOMEN TREATMENT GROUP Churches (n=10) CHWs (n=10-15) Participants (n=280) Structured Intervention CONTROL GROUP Churches (n=10) CHWs (n=10-15) Participants (n=280)

  • In-class health literacy education by

CHWs

  • CHW follow-up counseling
  • CHW navigation assistance for 6 months
  • Data collection for 6 months
  • Early detection pamphlet
  • Data collection for 6 months

Delayed Intervention

  • In-class health literacy education

by CHWs

  • CHW follow-up counseling
  • CHW navigation assistance

DATA ANALYSIS & DISSEMINATION

Study Process

Preparation

Recruitment Education Reinforcement

Study Process

Preparation

  • Intervention

material development & refinement

  • Focus group

meetings

Recruitment

  • Churches
  • Community

Health Workers

  • Participants

Education

  • CHW

education

  • Participants

Reinforcement Telephone Counseling Navigational Services

slide-7
SLIDE 7

1/30/2012 7

Focus group meetings

Aim: To develop and refine Picture Guide Book, health messages

slide-8
SLIDE 8

1/30/2012 8 Participants

  • Health literacy picture guide book & DVD
  • Computerized tailored health message booklet
  • Community Resource Book

Preparation

  • Material

development & refinement

  • Focus group

meeting

Recruitment

  • Churches
  • Community

Health Workers

  • Participants

Education

  • CHW

education

  • Participants

Reinforcement Telephone Counseling Navigational Services

slide-9
SLIDE 9

1/30/2012 9

Bethel Presb.Church

Nam, KS

25

Lee, YH

31

Yale Presbyterian Church

Jung,EH

15

KoAmerican Church of Philippi

Chin, HK

30

St.Andrew Kim Korean Catholic Church

Kang, Lucia

32

Choi, YM

13

New Covenant Fellowship Church

Kim,Kay

15

Yale Presbyterian Church

Jung,EH

36

Washington Spencerville Korean SDA Church

Yoon, MW

7

Holy Korean Martyrs Catholic Church

Kim,Soon

13

Korean Presb.of Baltimore

Pak,YS

20

Korean Meth.Church of Love

Lim,SS

19

Glen Burnie Korean Presb.Church

Jang, JM

12

CHW Participant (N)

4 Counties in Maryland Churches (N=11) CHWs (N=13) Participants (N=278)

Korean Central Presbyterian Church

Cho,SH

20

Suh, Grace

25

CHW Participant (N)

St.Paul chung Catholic Church

Park, IK

10

McDonald, MJ

20

St.Paul chung Catholic Church

Park, IK

10

McDonald, MJ

20

The Light Global Mission Church

Kim, JS

20

International Calvary Church

Chong,CS

23

The Church of All Nations

Kim,MJ

25

Church of Disciples

Chausse,ES

18

Northern VA. Korean Presbyterian church

Ko,SH

10

Washington Eden Presb.church

Jang,JM

10

The Korean Presbyterian. Church of Washington

Kim,MS

15

Young Saeng Korean Presbyterian Church

Kim,YM

20

New Covenant Fellowship Church

Rhee,JS

26

2 Counties in Virginia (Loudoun, Fairfax) Churches (N=12) CHWs (N=15) Participants (N=282)

Demographic characteristics – All females in their late 40s with at least a high school level of education None had formal health education background except one (retired RN)

slide-10
SLIDE 10

1/30/2012 10

Preparation stage

  • Material

development & refinement

  • Focus group

meeting

Recruitment Stage

  • Churches
  • Community

Health Workers

  • Participants

Education

  • Participants

Reinforcement Stage Telephone Counseling Navigational Services

slide-11
SLIDE 11

1/30/2012 11

42.5% 36.7% 20.8%

  • No. of education

109

Preparation stage

  • Material

development & refinement

  • Focus group

meeting

Recruitment Stage

  • Churches
  • Community

Health Workers

  • Participants

Education Stage

  • CHW

education

  • Participants

Reinforcement Monthly Telephone Counseling Navigational Assistance Sessions Number of participants Number of attempts to contact participants Total number

  • f minutes of

counseling 1st 274 427 4088 2nd 257 412 4628 3rd 215 332 3408 4th 176 282 2227 5th 167 241 1576 6th 110 109 1093

Total 1,199 1,803 17,020

slide-12
SLIDE 12

1/30/2012 12

65 36 36 6

  • 1---------5

Satisfaction

  • 1---------5

Helpfulness

4.51 4.52

Preliminary findings

slide-13
SLIDE 13

1/30/2012 13

10 20 30 40 50 60

Mammogram Pap smear

54.1 56.8

9.9 9.2

Intervention Control

E d u c a t i

  • n

E d u c a t i

  • n
slide-14
SLIDE 14

1/30/2012 14

Diff (3mon-base) M (SD) Diff (6mon-base) M (SD) F p Intervention 7.99 (9.77) 11.85 (10.33) 23.05 .000 Control 4.65 (8.68) 8.10 (9.89) Intervention 5.48 (6.57) 7.67 (6.76) 125.58 .000 Control 1.20 (3.79) 2.28 (4.28) Intervention 1.88 (3.39) 3.16 (3.65) 13.00 .000 Control 1.33 (2.72) 2.00 (2.74) Intervention 0.68 (2.01) 0.59 (2.21) 6.91 .009 Control 0.18 (2.02) 0.25 (1.81) Intervention 8.06 (8.97) 11.50 (9.76) 105.83 .000 Control 2.71 (5.85) 4.53 (5.75)

Familiarity

Comprehension

REALM 12

Numeracy + Vital Total Health Literacy

Intervention group 8 times Control group  4times

slide-15
SLIDE 15

1/30/2012 15

Lessons learned

 CHWs successfully provided an intervention that increased KA women’s adherence to breast and cervical cancer screening.  When designing an intervention for linguistically isolated immigrant women, incorporating essential health literacy skills into an intervention program may be important to maximize the impact of the intervention.  The navigation assistance provided by trained CHWs proved to be a key factor in obtaining the resources for and promoting the utilization of preventive healthcare services.

Community Need & Asset Assessment

1

  • Continue to keep checking the pulse of

community

2

Infrastructure Building

3

Intervention

Development Implementation & Dissemination

  • Extend the CBPR network to other

communities

  • Incorporate state of the art, theory-based and

technology-assisted interventions

Next steps

Collaborators

Co-PI: Korean Resource Center Kim B. Kim SON: Miyong Kim Benita Walton-Moss SPH: Jean Ford Debra Roter SOM: Hochang B. Lee CHW Coordinators: Jeonga Ahn/Hyekyung Chin

slide-16
SLIDE 16

1/30/2012 16

Questions & Comments