Community Health Advisors Research Articles

"We want that personal touch”: Dilemma of digitalization of healthcare based on community health worker experiences of depersonalization in healthcare.

261 Background: Advancements in digital technology is increasingly shaping healthcare delivery with a potential to address disparities by improving access to, enhancing communication with, and streamlining of healthcare management. Increased digitalization could also contribute to depersonalization from healthcare systems, particularly in individuals with low digital health literacy. We examined Community Health Advisors (CHAs) perceptions on community level experiences with technology in cancer care. Methods: University of Alabama at Birmingham and the University of South Alabama CHAs participated in semi-structured interviews exploring their experiences and perspectives on health and technology literacy challenges. Interviews were audio-recorded, transcribed, and inductively analyzed using NVivo and a constant comparative method leading to key representative themes and exemplary quotes. Results: Thirty-two CHAs, predominantly women (94%) and Black or African American (94%), participated in interviews. CHAs underscored multifaceted interactions of technology and healthcare. CHAs discussed the theme of navigating digital health interfaces alongside patient-provider relationships could result in depersonalization. They illuminated on barriers to and mitigation of depersonalization in healthcare engagement in the community. CHAs also discussed the theme of addressing health literacy as an underlying facet of mitigating depersonalization and low digital health literacy. They situated the feelings of depersonalization in relation to patient views on discomfort with digital services, medical mistrust, and provider cultural illiteracy impacting comprehension and engagement with health information and services. CHAs recommended acknowledging the community level discomforts with technology and healthcare, prioritizing human interaction alongside technology, and tailoring of healthcare services to diverse community needs, and linking to existing community infrastructure. Conclusions: Guided efforts focused on existing community infrastructure and integration of humanistic elements could aid in reducing depersonalization and improving digital health literacy.

Exploration of digital health literacy in the deep south.

385 Background: As technological advances are implemented in healthcare, cancer patients with low digital health literacy are at risk for inequities. Understanding the community’s comfort with using and teaching technology skills can be foundational for the application of digital healthcare tools. Methods: A cross-sectional survey was administered prior to community conversations about digital health literacy to understand community comfort with technology. Surveys measured self-reported personal comfort performing, personal comfort teaching, and perceived county-comfort completing technology-based tasks. Participants rated their comfort level on a 5-point Likert scale (1= not at all, 2 = slightly, 3 = somewhat, 4 = moderately, 5 = completely). Mean scores were calculated and mean comfort levels were compared across healthcare providers, lay navigators, community health advisors (CHAs), and community members using one-way ANOVA tests. Tukey's HSD post-hoc tests were used to explore group differences. Results: Between 8/2023-4/2024, 164 participants across Alabama and Mississippi completed the pre-survey, including 32 healthcare providers, 17 lay navigators, 31 community health advisors (CHAs), and 84 community members. The sample was primarily female (90%), Black (74%), and from Alabama (84%). ANOVA tests revealed significant group differences between personal comfort levels (p<0.001) comfort teaching (p<0.001), and perception of county-level comfort in technology-based tasks (p=0.043) with lay navigators and healthcare providers reporting higher personal comfort and comfort teaching others technology-based tasks compared to community members (post-hoc Tukey’s HSD). Conclusions: Digital health literacy gaps remain, with lay and clinical providers potentially overestimating comfort with technology. Baseline technology skills must be addressed as healthcare increases reliance on technology. Personal Comfort p-value Comfort Teaching Others p-value Perception of County Comfort p-value Using Search Engines 3.61 4.72 4.76 4.23 <.0001 2.95 4.19 4.88 3.48 <.0001 2.52 3.16 3.82 3.13 0.043 Searching Online for Health-Related Information 3.49 4.66 4.71 4.06 2.90 4.03 4.71 3.35 2.46 2.69 3.29 2.97 Scanning QR codes 2.80 4.47 4.65 3.77 2.55 3.84 4.76 3.13 2.38 2.44 2.71 2.81 Logging into their Patient Portal 3.27 4.44 4.59 3.87 2.75 3.94 4.76 3.03 2.44 2.59 3.00 2.65 Sending their Care-Team a Message 3.05 4.38 4.65 3.74 2.63 3.91 4.82 3.03 2.37 2.44 2.71 2.58 Personal comfort, comfort teaching, perception of community comfort with technology; 7/17 tasks shown; C = community, H = hospital, L = lay navigator, CHAs = community health advisors.

A randomized controlled trial of a tailored navigation intervention to promote breast and cervical cancer screening among intergenerational Southeast Asian women

BackgroundCancer is the leading cause of death for Southeast Asian women in the U.S. Southeast Asian women have significantly high rates of breast and cervical cancers, yet are least likely to obtain regular mammography and Pap testing of all racial/ethnic groups in the U.S. ObjectivesThe purpose of this study is to compare a tailored navigation intervention delivered by bilingual and bicultural Community Health Advisors to information and reminder only to increase age-appropriate breast and cervical cancer screening completion among Southeast Asian women. MethodsThe Southeast Asian Women's Health Project study will enroll 232 Cambodian, Filipino, Lao, and Vietnamese women who are not up to date with their breast and cervical cancer screenings. Women randomized to navigation will receive the intervention for 10 weeks. Women in the information group will be mailed information on mammography and Pap testing only. All participants will be contacted post-enrollment to assess screening completion. DiscussionWe will examine intervention efficacy, predictors of each intervention group, and the influence of intergenerational exchange of breast and cervical cancer screening information between mothers and daughters. We will disseminate study results locally to the community, nationally at conferences, and through peer-reviewed journals.

Multi-level barriers to digital health literacy in the Deep South.

203 Background: Technology is increasingly used to facilitate healthcare interactions. However, poor digital literacy has the potential to create disparities amongst vulnerable populations. While health literacy has been well described, little is known about potential barriers to digital health literacy from the varied perspectives of patients, providers, and community health workers. Methods: This qualitative study explored barriers to digital health literacy among a convenience sample of (1) patients and (2) providers at two academic institutions participating in a digitally delivered remote symptom monitoring program, and (3) community health workers serving patients with cancer across the state of Alabama. Semi-structured interviews, conducted between December 2021 and May 2023, occurred over the phone, digital videoconference, and in-person and lasted approximately 30 minutes. Interviews were recorded, transcribed, and inductively content coded for recurring themes and exemplary quotes by two independent coders using NVivo software. Results: Interviews (N=47) included 19 patients with cancer, 15 providers, and 13 community health workers. Interviewees discussed varied difficulties associated with uptake of the digitally delivered remote symptom monitoring program. Patients primarily focused on discrete logistical problems with technology, while providers commented on patient attitudes toward technology and the program more broadly. Community health advisors further identified technological barriers experienced by patients, such as unfamiliarity with current technology, lack of affordability or access to technology, limited technological training, difficulty reading small digital text, and privacy concerns. For example, one community health worker reported, “They don't know how to use FaceTime on their phones. And some of them only have phones that don't have the capability of using that sort of technology. Most of them don't use e-mail at all.” Community health workers also discussed patient-provider communication barriers, including excessive use of medical jargon, provider cultural illiteracy, provider withholding of information from patients, and language barriers. One community health worker noted, “there are sometimes when... patients cannot actually understand the medical terminology. I believe that if it could just be broken down for them, that the literacy would be improved.” Conclusions: Technological- and communication-based barriers impact the uptake of digitally delivered remote symptom monitoring in patients with cancer receiving treatment in Alabama. Guided efforts focused on solving the most frequent and significant barriers including both unfamiliarity with and lack of access to technology could aid in increasing digital health literacy, thus decreasing potential inequities.

A young adult community health advisor-led intervention to increase colorectal cancer screening uptake among South Asians: A feasibility study

ObjectiveThe present study explored the feasibility and acceptability of a young adult community health advisor (YACHA)-led intervention among South Asians aged between 50 and 75 years in Hong Kong. MethodsA pilot randomized controlled trial was conducted from July to November 2022. Thirty-six eligible participants were randomized to either the YACHA-led intervention (n ​= ​19) or the control group (n ​= ​17). The study outcomes were measured at baseline and 4 weeks after baseline. ResultsA total of 36 eligible South Asian participants with a mean age of 56.00 years (SD ​= ​5.53) participated in the study. The consent rate was 100.0%, and the overall dropout rate among the participants was 11.1%. The proposed YACHA-led intervention components were implemented as planned with the intended modality and frequency. More than 90% of the participants showed the acceptance of and satisfaction with a YACHA-led intervention that they received during the month-long process of undergoing colorectal cancer screening. ConclusionsThe present study revealed that it was feasible to conduct a YACHA-led intervention to increase the utlization of colorectal cancer screening by eligible South Asians in Hong Kong. A full-scale study should be conducted to reveal its effects and to explore whether the participants would continue their participation in the colorectal cancer screening program and be screened for colorectal cancer annually or biannually, as recommended by the Hong Kong government. Trial registrationThis study was registered with the Chinese Clinical Trial Registry (ChiCTR2200058241).

From the Editors.

From the Editors.

Using Community Health Advisors to Increase Lung Cancer Screening Awareness in the Black Belt: a Pilot Study.

Disease stage at the time of diagnosis is the most important determinant of prognosis for lung cancer. Despite demonstrated effectiveness of lung cancer screening (LCS) in reducing lung cancer mortality, early detection continues to elude populations with the highest risk for lung cancer death. Consistent with the national rate, current screening rate in Alabama is dismal at 4.2%. While public awareness of LCS may be a likely cause, there are no studies that have thoroughly evaluated current knowledge of LCS within the Deep South. Therefore, we measured LCS knowledge before and after receiving education delivered by community health advisors (CHAs) among high-risk individuals living in medically underserved communities of Alabama and to determine impact of psychological, demographic, health status, and cognitive factors on rate of lung cancer screening participation. Participants were recruited from one urban county and six rural Black Belt counties (characterized by poverty, rurality, unemployment, low educational attainment, and disproportionate lack of access to health services). One hundred individuals (i) aged between 55 and 80years; (ii) currently smoke or have quit within the past 15years; and (iii) have at least a total of 30-pack-year smoking history were recruited. Knowledge scores to assess lung cancer knowledge were calculated. Paired t-test was used to assess pre- and post-knowledge score improvement. Screening for lung cancer was modeled as a function of predisposed factors (age, gender, insurance, education, fatalism, smoking status, and history of family lung cancer). Average age was 62.94 (SD = 6.28), mostly female (54%); mostly current smokers (53%). Most participants (80.85%) reported no family history of cancer. Fatalism was low, with a majority of the participants disagreeing that a cancer diagnosis is pre-destined (67.7%) and that there are no treatments for lung cancer (88.66%). Overall, lung cancer knowledge increased significantly from baseline of 4.64 (SD = 2.37) to 7.61 (SD = 2.26). Of the 100 participants, 23 underwent screening due to lack of access to primary care providers and reluctance of PCPs to provide referral to LCS. Sixty-five percent of those who were screened reported no family history of lung cancer. Regression analysis revealed no significant association between risk factors and the decision to get screened by participants. Our study demonstrates that while CHA delivered education initiatives increases lung cancer screening knowledge, there are significant structural barriers that prohibit effective utilization of LCS which needs to be addressed.

Influences on Lung Cancer Screening Initiation and Retention in Rural Alabama.

Despite the introduction of lung cancer screening using low dose computed tomography (LDCT), overall screening rates in the U.S. remain low, with certain populations including Black and rural communities experiencing additional disparities. The primary objective of this study was to understand the facilitators of lung cancer screening initiation and retention in Alabama reported by people at risk from mostly rural, mostly Black populations in Jefferson County-including the urban center of Birmingham-and 6 rural counties: Choctaw, Dallas, Greene, Hale, Marengo, and Sumter. We conducted semi-structured telephone interviews with 58 people who underwent lung cancer screening between December 2019 and January 2022. Participant responses were recorded by the interviewer for analysis. Open-ended responses were coded to identify emergent themes. The most reported influences to initiate screening were information or suggestion from a Community Health Advisor (CHAs) or the supervising county coordinator, suggestion from a friend, or consideration of a personal history of smoking. Most participants reported multiple influences. Physicians were not very influential in decisions to initiate screening, but they were extremely influential in participants' intent to continue screening, both positively and negatively. Knowing the recommended timeline for their annual scans was also a predictor of intention to continue screening. Participants screened during the COVID-19 state of emergency expressed less certainty about dates of next scans and more ambivalence about intention to continue screening. This study shows the benefit of using multiple methods to support increased awareness of and interest in lung cancer screening, particularly when educational messaging through CHAs is used. Clear guideline-based messages from healthcare providers about recommended screening is important for increasing retention. COVID-19 related implementation challenges impacted screening recruitment and retention. Future research is warranted to further explore use of CHAs in lung cancer screening.

The FAN program plan: Creating a healthy church environment for physical activity and healthy eating.

Faith, Activity, & Nutrition (FAN) helps churches create a healthier environment for physical activity (PA) and healthy eating (HE) through policy, systems, and environmental changes. The purpose of this paper is to describe the implementation, evaluation, and revision of the FAN Program Plan across a two-phase study to help churches create guidelines and policies for PA and HE. In Phase 1, church committees attended trainings led by Community Health Advisors (CHA) where they assessed current practices to PA and HE. Committees used the FAN Program Plan to outline an implementation plan to increase opportunities, programs, messages, pastor support, and guidelines/practices for PA and HE. FAN Program Plans were submitted to the research team for review. Findings from Phase 1 plans directed revisions in program materials for Phase 2, where the submission and review processes were repeated. Review of Phase 1 FAN Program Plans (53/54 churches submitted a Program Plan) revealed that church committees confused guidelines/practices with programs and had trouble differentiating programs for PA and HE from providing opportunities (i.e., building PA/HE into existing events). The CHA training, FAN church committee training, FAN Program Plan, and other documents were revised to use the term "guidelines (policies)" instead of "guidelines/practices." In addition, CHAs facilitated a training section on guidelines (policies) to committees, and a guidelines (policies) section was added in the FAN Program Plan and other program documents. These changes in Phase 2 were helpful for differentiating policies from programs and programs from opportunities in FAN Program Plans (53/115 churches submitted a Program Plan), although some confusion remained. This study underscored challenges churches may have in setting policies for PA and HE and discusses strategies to address these challenges in future faith-based initiatives.

Influence of implementation strategies on implementation outcomes in a statewide dissemination of Faith, Activity, and Nutrition (FAN).

Faith-based organizations are promising settings for implementation science because they can reach populations bearing a disproportionate burden of chronic disease. This study examined how implementation strategies influenced implementation outcomes in Faith, Activity, and Nutrition (FAN) statewide dissemination. Ninety-three (9%) of 985 invited churches enrolled; 91 (98%) and 83 (89%) completed baseline and 12-month assessments. Community Health Advisors trained and provided phone technical assistance to church committees, led by a FAN coordinator. Church committees were charged with developing plans and installing healthy eating (HE) and physical activity (PA) policies, opportunities, messages and pastor support (implementation outcomes). Structural equation modeling examined how implementation strategies influenced implementation outcomes. Nearly all (99%) FAN coordinators and 60% of pastors attended training, 57% of committees submitted program plans and 51%/54% (HE/PA) of committees met 'every few months'. Statistically significant (P < 0.05) model paths showed positive influences of strategies on implementation outcomes: pastor training on HE and PA pastor support; plan completion on HE and PA messages, PA policies and opportunities as well as FAN committee meetings and committee meetings on HE pastor support, HE policies, PA opportunities and HE and PA messages. This study advances implementation science and provides a model applicable to organizations such as worksites and schools.

Prior health promotion experience and intervention outcomes in a lay health advisor intervention.

Training lay community members to implement health promotion interventions is an effective method to educate medically underserved populations. Some trainings are designed for individuals who already have a health-related background; however, others are developed for those with no previous health promotion experience. It is unknown whether those with backgrounds in health promotion are more effective in this role than those without. This study assessed the relationship between health promotion experience among trained community health advisors (CHAs) and their self-efficacy to implement an evidence-based cancer control intervention, as well as cancer knowledge and screening behavior outcomes among intervention participants. Data were collected from 66 trained CHAs and 269 participants in CHA-led cancer awareness and early detection workshops. CHAs reported high self-efficacy to implement the intervention independent of their health promotion experience. CHA health promotion experience was neither indicative of differences in participant colorectal or breast cancer knowledge at 12 months, nor of changes in participant-reported cancer screening. However, participant prostate cancer knowledge at 12 months was greater when taught by CHAs with previous health promotion experience (P < 0.01). Prior health promotion experience of trained health advisors may not be pivotal across all contexts, but they may affect specific knowledge outcomes.

Training and Dissemination of Lung Cancer Education Curriculum Among Community Health Advisors in the Deep South: a Program Evaluation.

Lung cancer is the leading cause of cancer mortality in the USA. In the rural Black Belt region of Alabama, high rates of lung cancer incidence and mortality coupled with disproportionate lack of access to health services stresses the need for navigating high risk and disproportionately affected groups towards successfully obtaining lung cancer screenings. We utilized our well-accepted Community Health Advisor (CHA) model for education and awareness. This study seeks to evaluate the results of the Alabama Lung Cancer Awareness, Screening, and Education (ALCASE) training on CHAs, program evaluation, and lessons learned. A total of 202 participants were eligible and enrolled for CHA training. One hundred thirty CHAs were included for the final analyses. Descriptive statistics were computed; differences in pre-test and post-test scores were compared across demographic characteristics of the participants using paired t-test/one-way ANOVA. Of the 130 CHAs, 46% were 65years or older; 98% were African Americans, and 87% were female; 17% of participants were cancer survivors. The mean post-test scores were 2.2 points greater than mean pre-test scores, and the difference was significant (mean (SD): pre-test = 20.8 (2.8) versus post-test = 23 (2.2); p = 0.001). No notable difference in pre-test and post-test scores were observed by CHA's demographic characteristics except by their county of residence or work (p = 0.0019). We demonstrate the capability and value of successfully recruiting and training motivated community members to be able to serve educators to better reach medically underserved and historically excluded communities.

Assessing the effectiveness of a community health advisor plus screen to save educational intervention on stool-based testing adherence in an African American safety net clinic population: study protocol for a randomized pragmatic trial

BackgroundColorectal cancer (CRC) is the second most deadly cancer affecting US adults and is also one of the most treatable cancers when detected at an earlier clinical stage of disease through screening. CRC health disparities experienced by African Americans are due in part to the later stage of diagnosis, suggesting the importance of improving African Americans’ CRC screening participation. The national Screen to Save (S2S) initiative employs a community health educator to deliver CRC screening education which can be tailored for specific populations, and such approaches have increased CRC screening rates in disadvantaged and racial/ethnic minority populations.Methods/designIn this trial emphasizing stool-based CRC screening, focus groups informed the development of an adapted S2S video and brochure tailored for African Americans and identified preferred motivational text messages for a multicomponent community health advisor (CHA) intervention. A CHA hired from the community was trained to deliver a 6-week CRC educational intervention consisting of an initial face-to-face meeting followed by 5 weeks of calls and texts. Interested eligible persons are enrolled primarily through recruitment by two partnering community health centers (CHCs) and secondarily through various outreach channels and, after consenting and completing a baseline survey, are randomly assigned to one of two study arms. The CHCs are blinded to study arm assignment. Intervention arm participants receive the brochure and CHA intervention while participants assigned to the control group receive only the brochure. All participants receive a stool-based CRC screening test from their health center, and the primary outcome is the completion of the screening test at 12 months. Secondary objectives are to estimate the effect of the intervention on mediating factors, explore the effect of moderating factors, and perform a cost-effectiveness analysis of the CHA intervention.DiscussionThe TUNE-UP study will enhance understanding about CRC screening in African Americans obtaining primary health care through CHCs and is one of the very few studies to examine a CHA intervention in this context. A better understanding of the mechanisms by which the intervention affects patient beliefs and behaviors will help focus future research while the exploratory cost-effectiveness analysis will inform CHCs’ decision-making about implementing a CHA program to increase screening and reduce cancer health disparities.Trial registrationClinicalTrials.govNCT04304001. Registered on March 11, 2020.

M.I.C.A.H. Project HEAL: Sustainability of a Faith-Based Community Health Advisor Training Program in Urban Underserved Communities in the USA.

Faith-based organizations (FBOs) can play an important role in improving health outcomes. Lay community health advisors (CHAs) are integral to these efforts. This paper assesses the sustainability of a CHA training program for congregants in African-American and Latino FBOs and subsequent implementation of educational workshops. The program is unique in that a health care chaplain in an academic medical center was central to the program's development and implementation. Forty-eight CHAs in 11 FBOs were trained to teach workshops on cardiovascular health, mental health, diabetes, and smoking cessation. Two thousand four hundred and forty-four participants attended 70 workshops. This program has the potential to be a model to educate individuals and to address health inequities in underserved communities. Health care chaplains in other medical centers may use this as a model for enhancing community engagement and education.

Using community health advisors to increase lung cancer screening awareness in the Black Belt: A pilot study.

117 Background: Disease stage at the time of diagnosis is the most important determinant of prognosis for lung cancer. Despite demonstrated effectiveness of lung cancer screening (LCS) in reducing lung cancer mortality, early detection continues to elude populations with the highest risk for lung cancer death. Consistent with the national rate, current screening rate in Alabama is dismal at 4.2%. While public awareness of LCS may be a likely cause there are no studies that have thoroughly evaluated current knowledge of LCS within the Deep South. Therefore, we measured (LCS) knowledge before and after receiving education delivered by Community Health Advisors (CHAs) among high-risk individuals living in medically-underserved communities of Alabama and to determine impact of psychological, demographic, health status and cognitive factors on rate of lung cancer screening participation. Methods: Participants were recruited from one urban county and six rural Black Belt counties (characterized by poverty, rurality, unemployment, low educational attainment and disproportionate lack of access to health services).100 individuals (i) aged between 55 to 80 years (ii) Currently smoke or have quit within the past 15 years. (iii) Have at least a total of 30-pack-year smoking history were recruited. Knowledge scores to assess lung cancer knowledge were calculated. Paired t-test was used to assess pre and post knowledge score improvement. Screening for lung cancer was modeled as a function of predisposed factors (age, gender, insurance, education, fatalism, smoking status, and history of family lung cancer). Results: Average age was 62.94(SD = 6.28), mostly female (54%); mostly current smokers (53% ). Most participants (80.85%) reported no family history of cancer. Fatalism was low, with a majority of the participants disagreeing that a cancer diagnosis is pre-destined (67.7%) and that there are no treatments for lung cancer (88.66%). Overall, lung cancer knowledge increased significantly from baseline of 4.64(SD = 2.37) to 7.61(SD = 2.26). Of the 100 participants, only 23 underwent screening due to lack of access to primary care providers and reluctance of PCPs to provide referral to LCS. 65% of those who were screened reported family history of lung cancer. Regression analysis revealed no significant association between risk factors and the decision to get screened by participants. Conclusions: Our study demonstrates that while CHA delivered education initiatives increases lung cancer screening knowledge, there are significant structural barriers that prohibit effective utilization of LCS which needs to be addressed.

Community based screening for sickle haemoglobin among pregnant women in Benue State, Nigeria: I-Care-to-Know, a Healthy Beginning Initiative

BackgroundHaemoglobin genotype screening at prenatal care offers women an opportunity to be aware of their genotype, receive education on sickle cell disease (SCD) and may increase maternal demand for SCD newborn screening. In developed countries, most pregnant women who access prenatal care and deliver at the hospital receive haemoglobin genotype screening. In settings with low prenatal care attendance and low hospital deliveries, community-based screening may provide similar opportunity for pregnant women. We assessed the feasibility and acceptability of integrating haemoglobin genotype screening into an existing community-based HIV program.MethodsOnsite community-based integrated testing for HIV, hepatitis B virus and haemoglobin electrophoresis, were conducted for pregnant women and their male partners. Community Health Advisors implementing the NIH and PEPFAR-supported Healthy Beginning Initiative (HBI) program provided education on SCD, collected blood sample for haemoglobin electrophoresis and provided test results to participants enrolled into the HBI program. We concurrently conducted a cross-sectional study using a pretested, semi-structured, interviewer administered questionnaire to collect demographic data and assess awareness of individual haemoglobin “genotype” among HBI pregnant women participants.ResultsIn this study, 99.9% (10,167/10,168) of pregnant women who received education on SCD accepted and completed the survey, had blood drawn for haemoglobin electrophoresis and received their results. A majority of participating pregnant women (97.0%) were not aware of their haemoglobin “genotype”. Among the participants who were incorrect about their haemoglobin “genotype”, 41.1% (23/56) of women who reported their haemoglobin “genotype” as AA were actually AS. The odds of haemoglobin “genotype” awareness was higher among participants who were in younger age group, completed tertiary education, had less number of pregnancies, and attended antenatal care. Overall prevalence of sickle cell trait (AS) was 18.7%.ConclusionsIt is feasible to integrate haemoglobin “genotype” testing into an existing community-based maternal-child program. Most pregnant women who were unaware of their haemoglobin “genotype” accepted and had haemoglobin genotype testing, and received their test results. Increasing parental awareness of their own haemoglobin “genotype” could increase their likelihood of accepting newborn screening for SCD.

Twenty Years of Leading the Way among Cohort Studies in Community-Driven Outreach and Engagement: Jackson State University/Jackson Heart Study.

Background: History has recorded the tremendous concerns and apprehension expressed by African Americans about participating in research studies. This review enumerates the collaborative techniques that were utilized by the Jackson State University (JSU) Jackson Heart Study (JHS) community-focused team to facilitate recruitment and retention of the JHS cohort and to implement health education and health promotion in the JHS communities. Methods: This review describes the evolution of the JSU JHS community initiatives, an innovative community-driven operation, during the period 1999–2018. Results: JSU JHS community-focused investigators published approximately 20 manuscripts, including community-led research and publications with community lead authors and co-authors, research and publications in collaboration with other JHS staff, through other JSU-funded projects. The JSU JHS community-focused unit also initiated the JHS Community Training Activities, developed the Community Health Advisory Network (CHAN), and trained and certified 137 Community Health Advisors. In addition, the JSU JHS community-focused unit developed the Collaborative Community Science Model (CCSM) that symbolized its approach to community engagement and outreach, and a Trust Scale for ascertaining African Americans’ willingness to engage in biomedical research collaborations. Conclusion: This review offers educators, public health professionals, and research investigators a useful starting point for the development, selection, or improvement of techniques to motivate, inspire, and engage community residents in a community–academia partnership that yielded maximum benefits in the areas of health education, health promotion and interventions, and biomedical research. Substantial, meaningful community engagement is possible when prioritizing elimination of health disparities and long-term improvement in health care access in the target populations.

Factors associated with colorectal cancer screening in a peer-counseling intervention study in partnership with African American churches.

Colorectal cancer (CRC) mortality is 47% higher in African American men and 34% higher in African American women compared to non-Hispanic white men and women. This analysis assessed factors associated with CRC screening among 163 African American participants of a peer-counseling intervention study (2016-2018). In a one-group pre/post-test pilot study, trained Community Health Advisors (CHAs) at 9 African American churches in Los Angeles (LA) promoted CRC screening via one-on-one counseling, print materials and telephone reminder calls. Participants completed telephone surveys 3-6months after the intervention. We fit bivariate and multivariate mixed effects logistic regression models to assess correlates, including participants' demographic characteristics, access to care, cancer-related knowledge and attitudes and receipt of CHA counseling of (1) discussion of CRC screening with provider and (2) receipt of CRC screening during follow-up. After controlling for gender and education, receipt of CHA counseling (OR 3.77) was significantly associated with discussing CRC screening with a provider during follow-up but not with CRC screening. Instead, a routine check-up in the past 12months (OR 4.47) and discussion of CRC screening with a provider (OR 3.07) were significantly associated with CRC screening during follow-up. Residence in South LA (OR 0.38) was significantly associated with lack of CRC screening. Findings confirm the important role of health care providers and suggest that residence in South LA constitutes an additional barrier to CRC screening. Further research and additional resources are needed to address disparities in the uptake of CRC screening among African Americans, especially in South LA.

Abstract PO-035: Factors associated with colorectal cancer screening in a peer-counseling intervention study in partnership with African American churches

Abstract Background: Colorectal cancer (CRC) mortality is 47% higher in African American men and 34% higher in African American women compared to non-Hispanic white men and women. Methods: Nine African American churches in Los Angeles (LA) participated in a one-group pre/post-test pilot study to promote cancer screening (2015-2018). Each church identified 5 Community Health Advisors (CHAs) who received training to recruit study participants ages 50 to 75; assess participants’ adherence to cancer screening guidelines of the U.S. Preventive Services Task Force; and provide one-on-one counseling for participants who were not adherent. Participants completed telephone surveys 3 months after the intervention. The goal of this analysis was to understand CRC screening outcomes among 163 African American participants who were baseline non-adherent to CRC screening guidelines. We fit bivariate and multivariate mixed effects logistic regression models to assess correlates of (1) discussion of CRC screening with provider and (2) receipt of CRC screening during follow-up. Results: 49% of respondents reported that they discussed CRC screening with a provider during the follow-up period and 28% of respondents reported receipt of CRC screening. Respondents who reported that they were counseled by a CHA were more than twice as likely to discuss CRC screening with their provider as those who reported that they did not receive the intervention (54% versus 24%, p&amp;lt;0.005). Those who had a regular doctor, who had more than 3 health care visits in the past 3 months and who had a routine check-up in the past 12 months were also significantly more likely to discuss CRC screening with a provider (all p&amp;lt;.001). Females were almost twice as likely as males to receive CRC screening during the follow-up period than males (35% versus 18%, p&amp;lt;.02) and South LA residents were significantly less likely to receive CRC screening than participants outside of South LA (22% versus 38%, p&amp;lt;.02). Those who had a routine check-up in the past 12 months were also significantly more likely to report receipt of CRC testing during the follow-up period (all p&amp;lt;0.01). Those who had discussed CRC screening with a provider were significantly more likely to obtain CRC screening (p&amp;lt;.001). Knowledge of CRC screening guidelines was low overall but significantly higher among those who received CRC screening than among their counterparts who did not receive screening (p&amp;lt;.02). In multivariable analyses, receipt of CHA counseling (OR 3.77) was significantly associated with discussing CRC screening with a provider during follow-up but not with CRC screening. Residence in South LA (OR 0.38) was significantly associated with lack of CRC screening. Conclusions: Findings confirm the important role of health care providers and suggest that residence in South LA constitutes an additional barrier to CRC screening. Further research and additional resources are needed to address disparities in the uptake of CRC screening among African Americans, especially in South LA. Citation Format: Annette E. Maxwell, Aziza Lucas-Wright, Cindy Chang, Rhonda Santifer, Catherine M. Crespi. Factors associated with colorectal cancer screening in a peer-counseling intervention study in partnership with African American churches [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-035.

Abstract A020: Utilizing a community navigator's approach to improve breast and cervical cancer screening in the Deep South

Abstract This presentation illustrates a community-based intervention utilizing community navigators to identify, recruit. and work to eliminate barriers to improve breast and cervical cancer screening in underserved communities in the Deep South. Background: The UAB Comprehensive Cancer Center built an academic-community infrastructure called the Deep South Network for Cancer Control via funding from the National Cancer Institute Center to Reduce Cancer Health disparities from 2000-2016. The Deep South Network (DSN) utilized a Community Health Advisors (CHA) model combined with community engagement and coalition building to conduct community outreach and community-based cancer disparity research in medically underserved communities in Alabama and Mississippi. Through the utilization of the CHA model, cancer mammography screening rates among the Medicare population saw a 17% difference between AA women and Caucasian from 1999 to 2014. Purpose: To utilize the DSN model to train community navigators to identify and recruit rarely or never screened women for breast and cervical cancer screening. Community Navigators with support of the CHAs work to address client barriers to improve screening. Through a collaboration with the Alabama Breast and Cervical Cancer Early Detection Program (ABCCEDP), UAB Community Navigators delivered a community intervention to address barriers to breast and cervical cancer screening. Methodology: The intervention was delivered in eight Alabama counties: seven rural and 1 urban over a 12-month period. Each county had a paid, community-based navigator who received 8-hour training on navigating clients for clinical services. Community Navigators delivered community-based education and identified and addressed barriers to increase cancer screening. Conclusion: At the end of the 12-month intervention, the community navigators held 212 events such as health fairs and community presentations in public housing and faith-based groups that yielded a reach of 16,038 individuals. Of these events, 273 women indicated an interest in or need for these screenings with 83 % of them between ages 40-54. Navigators worked through client barriers to see an overall significant increase of 5% in women enrolled in the ABBCECP compared to previous years in the nine counties Citation Format: Clauda M. Hardy, Kumari Seetela, Tara Bowman, Katherine Norris, Nancy Wright. Utilizing a community navigator's approach to improve breast and cervical cancer screening in the Deep South [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A020.