Lorna H. McNeill, PhD, MPH Assistant Professor, Department of Health Disparities Research University...
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Transcript of Lorna H. McNeill, PhD, MPH Assistant Professor, Department of Health Disparities Research University...
Lorna H. McNeill, PhD, MPHAssistant Professor, Department of Health Disparities ResearchUniversity of Texas M.D. Anderson Cancer Center
Cancer-related health disparities Project CHURCH aims and study
designLessons learned
Cancer-related health disparities Cancer is the 2nd leading cause of death for
racial/ethnic minorities in Texas. One-third of all cancer deaths are
attributed to lifestyle factors such as diet, overweight and obesity, and physical inactivity, and thus can also be prevented.
Regular screenings to detect breast, cervical, prostate, and colorectal cancer can catch cancer early and reduce death.
African Americans in Texas are making progress in some areas (reduction in heavy drinking)
In recent years, cigarette smoking, physical inactivity, and overweight and obesity are increasing among African Americans in Texas and fruit and vegetable consumption is declining.
Cancer screening for colorectal cancer has remained stable; mammograms by African American women over 40 has declined
Philanthropy fundingDevelop common research study
that would benefit junior faculty All faculty are Co-Is
Provide service to the community
Black churches have promoted health, education, business, and political activism within the African American community.
In general, African American churches include health services and programs to their membership.
They have been an effective partner for health promotion efforts, including cancer, diet and physical activity research.
70% of African American regularly attend church. Families have been members for generations;
increases our ability to locate participants in later years.
Windsor Village United Methodist Church▪ One of the largest UMCs and in Houston; ~
15, 0oo members▪ Active church with over 100 ministries,
engaged in health & social-related services▪ Engaged pastor and congregation▪ Long-term relationship with M.D. Anderson
Creating a Higher Understanding of
Cancer Research and Community Health Research study: investigate the role of
behavioral, social, and environmental factors on minority health and cancer-related disparities among African Americans
Long term goal: use this knowledge to help African Americans in the Houston area reduce their risk for cancer and improve quality of life
Prospective, longitudinal cohort study Investigate the role of behavioral, social,
and environmental factors on minority health and health disparities in cancer.
N= 1501 church members Follow them for 2 years; 3 data collection
points:▪ Baseline▪ 12 months▪ 24 months
Goal was to include as many persons as possible
Eligible: Be age 18 and above Must live in Houston area Must have a working telephone number Must attend church
Individual compensation ($30 Visa debit card)
Health information, including mailed newsletters (4 per year)
$4000 annually to churchLimited patient navigation servicesChurch activitiesFuture benefits – grant dollars,
additional collaborators
Aim 1: Develop and organize a research collaboration with Windsor Village United Methodist Church to implement the African American Cancer Prevention Project;
Aim 2: Recruit and survey ~1501 church members to identify factors associated with cancer health disparities in African Americans and follow them for an additional 2 years;
Aim 3: Share research findings with the church community;
Aim 4: Provide referrals to the church community for health-related services;
Aim 5: Develop and evaluate interventions to improve cancer prevention among African Americans in Houston.
Pastor Kirbyjon H. Caldwell M.D. Anderson Board of Visitors At least 4 meetings over 2 years –
developing trust Questions:▪ How does this benefit the church body▪ Why was Windsor Village selected▪ Will the congregation get care at M.D.
Anderson
Community Advisory board M.D. Anderson Department of Health Disparities
Research faculty, church leaders, and church members. Discussed study design Assisted with recruitment procedures Assisted with developed the questionnaire Assisted with retention of participants
Met at least 6 times over the 1st year The advisory board identified challenges and
barriers to implementing the study appropriately. Engaged and meaningful participation; used CBPR
principles Goal to increase the relevance of the study to their
members
Project CHURCH Kick-Off Pastor Caldwell introduced me to
congregation and allowed me to speak Health fair – recruited 500 participants in 1
day Study telephone number and email account Video announcements during church services Ushers handed out recruitment postcards Icon and recruitment information included on
church website
Setting We have paid/donated office space
located at the church; participants complete the survey in this office
Anchors us to the church and the community
Shared preliminary findings with Pastor Caldwell and Advisory board
Creating a booklet to share with participants and congregation Decided not to share data publicly until
church had data first
We provide patient navigation services to Project CHURCH participants and the entire church
This year we are working with their cancer ministry to identify persons in need; we are also implementing an evaluation of our navigation services
Work with church to develop interventions based on survey findings and/or bring other resources based on need
Internal Philanthropy
$875,000
Houston Endowment
$1M
NIH (R21)$434,500
Grant with a Yellow Border is Pending
African American
Cancer Prevention
Program
Anecdotal; many reasons Cancer family history Service to God and mankind- doing
something that will benefit others Most did not even know they would be
compensated Many thought they had to give blood and still
wanted to participate Survey allowed us to work on building
relationship first; now we can ask for more invasive tasks/procedures, i.e., DNA
Great customer service Survey quick and easy
Collect DNA - Saliva 95% participation rate
Accelerometer data (physical activity) N=500 agreed to participate
Additional data Financial strain Living will Rotating data
Getting there... Met accrual goals early – 6 months vs. 12
months 95% retention rate: Goal 70% Received additional funding
Ongoing process… Sharing findings with congregation Long-term relationship▪ Lots of trust, but still need to prove oneself
Retention is closely linked to satisfaction Begins with recruitment materials (non
coercive), consent signing (need to understand the study and what is expected)
Treating participants with respect▪ Great customer service
Communication between research staff▪ Respond to complaints quickly
Attention to factors such as transportation etc.
Source: Cheryl Oncken, M.D., MPH
Communication with staff Offer convenient physical access and
appointment times Newsletters Provide written or telephone contacts
between visits Project CHURCH participants received notices
about program activities first Financial compensation Above all—make it relevant!!!
Source: Retention of asthmatic patients in a longitudinal clinical trial
Study population and setting should be appropriate for the research question being asked
Recruitment methods can be very effective; need to be prepared for response
Individual financial compensation is not enough of a benefit – need to make a connection to a value
Long-term commitment
Windsor Village pastor, congregation, advisory board
Project CHURCH staffHealth Disparities research faculty