Gem M. Le, MHS Stephen J. McPhee, MD Ginny Gildengorin, PhD Ky Q. Lai, MD, MPH
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Transcript of Gem M. Le, MHS Stephen J. McPhee, MD Ginny Gildengorin, PhD Ky Q. Lai, MD, MPH
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REACH Lay Health Worker Intervention Program:A Community-Based Model to Promote Breast
Cancer Screening Among Vietnamese-American Women
Gem M. Le, MHS
Stephen J. McPhee, MD
Ginny Gildengorin, PhD
Ky Q. Lai, MD, MPH
Khanh Q. Le, MD, MPH
Tung T. Nguyen, MD
Thoa Nguyen
Vietnamese Community Health Promotion ProjectDivision of General Internal Medicine
University of California, San Francisco
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Acknowledgements
• Funded by the Centers for Disease Control and Prevention’s REACH 2010 Program
Grant # U50/CCU 922156-05
• Supported by the Vietnamese REACH for Health Initiative Coalition, Santa Clara County, CA
• UCSF Vietnamese Community Health Promotion Project (VCHPP)
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Background
There are disparities in breast cancer screening and early detection among Vietnamese American women
• Low breast cancer re-screening rates documented in Vietnamese
Lay health workers (LHWs) have been shown to be effective in promoting cancer screening
Our previous research has documented success in the use of LHWs in improving cervical cancer screening in Vietnamese
Lam TK, McPhee SJ, Mock J et al. “Encouraging Vietnamese-American Women to Obtain Pap Tests Through Lay Health Worker Outreach and Media Education,” Journal of General Internal Medicine, 2003;18(7):516-24.
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Methods: Study Description Recruited 5 community-based organizations
(CBOs) in Santa Clara County, California
Trained 50 Lay Health Workers (LHWs) to conduct outreach activities to 1,100 Vietnamese women (age 40 or older) whom they recruited from their social networks
Controlled intervention trial: women randomized either to intervention or control groups
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VCHPP Central Coordinating
Organization
1st LHW AGENCY
2nd LHW AGENCY
3rd LHW AGENCY
4th LHW AGENCY
5th LHW AGENCY
Community Collaboration
• UCSF Vietnamese Community Health Promotion Project (VCHPP) collaborated with 5 community-based agencies over 3 years
• Each agency recruited 10 LHWs
• Each LHW recruited 22 women who were randomized into intervention and control (delayed intervention) groups
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Methods: Study Description
Intervention group women:
Received education regarding breast cancer, mammograms and clinical breast exams in 2 small group sessions led by LHWs using a standardized curriculum and flip chart
Control group women:
Received 1 LHW small group session after the post-intervention survey was completed
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Methods: Study Design
EACH LHW AGENCY
(n=5)
LHWs (n=10)
Control Group (n=110)
Women (n=220)
Intervention Group (n=110)
RECRUIT
RECRUIT
INTERVENTION DELAYED
INTERVENTION
Total anticipated sample
Intervention: 550
Control: 550
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Methods: Study Description
Mass media campaign regarding breast cancer occurred in Santa Clara County at the same time
Both intervention and control group women were exposed to this background media
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Evaluation
Pre- and post-intervention telephone questionnaires completed by participants
Data analysis is now complete for 4 of the 5 agencies
Statistical tests used:• Matched-pair analysis
• McNemar’s chi-square test to detect the difference in the changes between intervention and control groups
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CBO Lay Health Worker Agencies
First LHW Agency:Catholic Charities, John XXIII Multi-Service Center
Active period: 10/01/04 - 07/31/05
Second LHW Agency: Immigrant Resettlement and Cultural Center
Active period: 03/01/05 - 12/31/05
Third LHW Agency:Vietnamese Voluntary Foundation, Inc.
Active period: 08/01/05 - 05/31/06
Fourth LHW Agency: Asian Americans for Community Involvement
Active period: 12/01/05 - 10/01/06
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Training Sessions for Lay Health Workers
Education about breast cancer, mammograms, and clinical breast exams
Methods for recruiting participants Methods for conducting small group
education sessions Role playing Each LHW received a total of 9 hours of
training
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Characteristics of Lay Health Workers
Mean age (4 agencies): 57.3 years Range: 22-67 years Women were employed, housewives, or
students
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Small Group Education Sessions
Setting: LHW agencies, participants’ homes, or LHWs’ homes
Size: 4 - 6 women per session Support: LHW Agency and Vietnamese
Community Health Promotion Project
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Implementation
LHWs conducted 354 small group sessions for the first 4 agencies
During the intervention period, LHWs telephoned each participant ~5-6 times over the ~4 month period between the 2 sessions
Appreciation ceremony conducted following completion of intervention to get feedback from LHWs
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Results: Participant Demographics
Control
(n=440)
Interven-tion
(n=440)
p-value
Age in years (mean) 57.3
57.2 0.81
Years in U.S. (mean) 13.8 13.2 0.24
% Poor English proficiency 96.8 97.5 0.69
% Less than high school education
58.0 57.6 0.95
% Unemployed 65.7 67.1 0.72
% Married 69.9 72.3 0.46
% Uninsured 18.8 20.9 0.79
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Ever Heard of Breast Cancer? (% Yes)
91%87%
100%90%
0%
20%
40%
60%
80%
100%
Control (Media Only) Intervention* (LHW+Media)
PrePost
*p < 0.0001
% change**: 2.8% vs. 8.9% **p = 0.006
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Ever Heard of Mammogram? (% Yes)
94%94%100%97%
0%
20%
40%
60%
80%
100%
Control Intervention*
PrePost
*p = <0.0001
% change: 2.2% vs. 5.4%
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Ever Had Mammogram? (% Yes)
86%90%93%93%
0%
20%
40%
60%
80%
100%
Control^ Intervention*
PrePost
^p = 0.03 *p < 0.0001
% change: 2.7% vs. 6.7%
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Had Last Mammogram WithinPast Year? (% Yes)
50%59%
73%
63%
0%
20%
40%
60%
80%
100%
Control^ Intervention*
PrePost
^p = 0.03 *p < 0.0001
% change**: 4.5% vs. 22.1% **p = 0.0004
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Plan Mammogram Within 12 Months? (% Yes)
75%76%
96%
76%
0%
20%
40%
60%
80%
100%
Control Intervention*
PrePost
*p < 0.0001
% change**: 0.2% vs. 21.1% ** p < 0.0001
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Ever Thought About Getting a Mammogram? (% Yes)
72%
44%
91%
56%
0%
20%
40%
60%
80%
100%
Control^ Intervention
PrePost
^p = 0.004 (n=25)
% change: 12.0% vs. 19.0%
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Ever Heard of Clinical Breast Examination (CBE)?
(% Yes)
77%75%
99%86%
0%
20%
40%
60%
80%
100%
Control^ Intervention*
PrePost
% change**: 10.9% vs. 22.8% **p = 0.0003
^p < 0.0001 *p < 0.0001
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Ever Had a CBE?(% Yes)
67%72%
87%
79%
0%
20%
40%
60%
80%
100%
Control^ Intervention*
PrePost
% change**: 7.3% vs. 19.8% **p = 0.0003
^p = 0.0005 *p < 0.0001
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Had a CBE Within Past Year?(% Yes)
37%46%
65%
51%
0%
20%
40%
60%
80%
100%
Control^ Intervention*
PrePost
% change**: 5.1% vs. 27.8% **p < 0.0001
^p = 0.028 *p < 0.0001
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Plan a CBE Within 12 Months?(% Yes)
70%75%
91%
73%
0%
20%
40%
60%
80%
100%
Control Intervention*
PrePost
% change**: -1.2% vs. 20.7% **p < 0.0001
*p < 0.0001
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Thought of Getting a CBE?(% Yes)
48%48%
56%52%
0%
20%
40%
60%
80%
100%
Control^ Intervention*
PrePost
% change: 4.0% vs. 8.0%
^p < 0.0001 (n=25) *p < 0.0001 (n=32)
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Age Women Should Start Mammograms?(% 40 Years)
27%30%
72%
31%
0%
20%
40%
60%
80%
100%
Control Intervention*
PrePost
% change**: 0.9% vs. 45.3% **p < 0.0001
*p < 0.0001
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Age Women Should Start CBEs?(% 40 Years)
22%23%
68%
24%
0%
20%
40%
60%
80%
100%
Control Intervention*
PrePost
% change**: 0.9% vs. 45.9% **p < 0.0001
*p < 0.0001
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Multiplier Effect: Participants’ Sharing of Information about Mammograms
437
1,215
1,640
0
500
1,000
1,500
2,000
Participants in theintervention
Family Friends
Num
ber
of p
eopl
e
Median number of people shared information per participant:
3.0 4.0
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Multiplier Effect: Participants’ Sharing of Information about CBEs
437
1,215
1,644
0
500
1,000
1,500
2,000
Participants in theintervention
Family Friends
Num
ber
of p
eopl
e
Median number of people shared information per participant:
3.0 4.0
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Implications
Researchers can work in partnership with community-based organizations to utilize lay health worker outreach effectively to reduce health disparities
LHWs can use their cultural knowledge, sensitivity, and social networks to reach out to underserved women in their communities
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Conclusions Lay health worker outreach is feasible and
effective among Vietnamese American women in improving breast cancer:
• Awareness• Knowledge • Receipt of screening by mammography and
CBE Intervention produced a multiplier effect:
LHWs and participants told family members and friends about mammograms and CBEs
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Future: Sustainability
Completion of current project will demonstrate the increased capacity of the Vietnamese community to promote and sustain lay health worker outreach education
Planned future projects (e.g., targeting colorectal cancer or cardiovascular risk factors) will include the 50 LHWs, who have developed new skills in effective lay health education