CSR Home>Cancer Health Disparities Poster
An Evaluation of a Multi-Site National Community-Based Participatory
Research Initiative to Address Cancer Health Disparities
John Foster-Bey, Tiffani Jeffries, Lynn D. Disney, Marcia Salazar, and Timothy J. Willis; CSR, Incorporated funded by the National Cancer Institute (NCI) as the National Evaluator
Community Network Programs to Reduce Cancer Health Disparities
Goal: To reduce cancer health disparities among racial/ethnic minorities and underserved populations.
Strategy: Use community-based participatory education, training, and research.
Resources: NCI awarded $95 million in 5-year grants to 25 institutions participating in the CNP that began in May 2005.
Impetus of CNP Program
Problem: Addressing cancer health disparities
Approach: To use a community-based participatory research method to engage both medical professions and community members to work together to educate and facilitate primary and secondary cancer prevention efforts.
Solution: Provide funding to academic centers and hospitals to foster community involvement in working toward fully adopting a community-based participatory research design.
CSR’s Approach to Evaluation: Engage Stakeholders
Key stakeholders
- CNP PIs and program staff
- NCI CRCHD CNP Program Directors
- Participatory approach throughout design and implementation of evaluation
- All data collection tools are vetted through CNPs
- Collaborate closely with CNP national evaluation team at CRCHD
Cancer Interventions
Primary:
- Tobacco education and smoking cessation
- Diet, nutrition and physical activity
- Hepatitis B immunization
- HPV immunization
Secondary:
- Breast cancer screening (mammography and CBE)
- Cervical cancer screening (Pap and HPV DNA Testing)
- Colorectal cancer screening (FBOT and Sigmoidoscopy testing)
- Prostate cancer screening (PSA and DRE)
Nine Principles of Community Based Participatory Research
- Recognizes community as a unit of identity
- Builds on strengths and resources within the community
- Facilitates collaborative, equitable involvement of all partners in all phases of the research
- Integrates knowledge and intervention for mutual benefit of all partners
- Promotes a co-learning and empowering process that attends to social inequalities
- Involves a cyclical and iterative process
- Addresses health from both positive and ecological perspectives
- Disseminates findings gained to all partners
- Involves long-term commitment by all partner
Israel B, Schulz A, Parker E and Becker A. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, pp. 173-202
Sample Determinants of Disparities and Measures
| Level/Determinant of Disparities | Sample Solutions |
|---|---|
| Individual Level | |
| Lack of knowledge on cancer and cancer risks | Educational sessions at health fairs |
| Community Level | |
| Need for training of community leaders about cancer in their communities | Cancer 101 train - the - trainer sessions |
| Health Care System Level | |
| Lack of communication tools to relay cancer related messages | PSA development and dissemination |
How was CBPR implemented in CNPs?
- By forming sustainable community-researcher partnerships
- By increasing utilization of beneficial cancer health interventions
- By training junior researchers in CBPR and cancer health disparities
- By disseminating research findings through academic and non-academic/lay publications
Map of CNPs
Phase I Logic Model: Implementation of the Model
Phase II Logic Model: Initiate CBPR
Phase III Logic Model: Sustainability
CSR’s Plan for the Evaluation
- Design evaluation to measure achievement of RFA goals and objectives
- Develop logic models for each CNP Phase
- Link phase goal and objectives to activities, outputs, and outcomes
- Identify core data elements to measure achievement of objectives
- Develop data collection tools
- Develop web-based data collection tool
- Obtain CNP PI and local evaluator input
CNP National Evaluation Cycle
Methodology
Total Number of People Served by CNPs
| Cancer Health Issue | Interventiion Type | 2006 | 2007 | 2008 | 2009 |
|---|---|---|---|---|---|
| Number of People Served | |||||
| Breast Cancer | Mammography | 11,778 | 15,083 | 17,183 | 3,106 |
| Breast Cancer | Clinical Breast Exam | 267 | 1,717 | 1,862 | 1,055 |
| Cervical Cancer | HPV DNA Testing | - | 865 | 991 | 601 |
| Cervical Cancer | Pap Smears | 12,104 | 16,205 | 11,033 | 1,985 |
| Colorectal Cancer | Colonoscopy | 4,716 | 5,018 | 961 | 488 |
| Colorectal Cancer | FOBT | 3,461 | 5,388 | 4,570 | - |
| Colorectal Cancer | Sigmoidoscopy | - | 55 | 331 | 182 |
| Prostate Cancer | Digital Rectal Exam | 84 | 67 | 449 | 549 |
| Prostate Cancer | PSA | 1,293 | 3,306 | 1,375 | 627 |
| Other Cancer | Skin Cancer, Cancer Knowledge | 59 | 52 | 37 | - |
*2009 covers only a 6 month period.
Analyze and Disseminate Findings
- Extensive data cleaning
- Followup with CNPs to revise responses, as needed
- Descriptive analyses
- Analysis by funding level of CNP
- Group 1: $1 - $1.4 million
- Group 2: $700,000 - $950,000
- Group 3: $350,000 - $520,000
- Analysis by participants in a precursor program, The Special Population Networks (SPN) vs. grantees who were not SPNs
- Disseminate findings through reports, presentations, publications
Sample Implementation
| Goals and Objectives | Activities | Outputs | Outcomes | Variables |
|---|---|---|---|---|
| Phase I Goal: To develop and increase capacity building to support community based participatory education, research, and training to reduce cancer health disparities | ||||
| Create partnerships with communities experiencing cancer health disparities and with organizations working to reduce cancer disparities in these communities | Identify/form partnerships with non-clnical community-based organizations | Data on partnerships formed | Successful partnership synergy | Type of agreement signed Services provided by partner |
| Increase utilization of beneficial interventions to reduce cancer health disparities | Conduct cancer education activities to increase utilization of evidence-based interventions | Data on education activities conducted | Improvement in community's knowledge, attitudes, beliefs about cancer health disparities | Type of activity Topic of activity Location of activity |
| Cervical CancerHPV DNA Testing-865991 | ||||
| Perform the full spectrum of community-based participatory research to reduce cancer health disparities | Conduct community-based participatory research | Data on community intervention research projects implemented | Increase use of beneficial interventions by community memebers | Type of screening intervention implemented Screening rates at baseline and followup |
Reporting by Funding Level and Experience with CBPR
| Number of CNPs | Percent of Community Advisory Group (N) | Percent of Cancer Educational Activities (N) | Percent of Clinical Partnerships (N) | Percent of Non-Clinical Partnerships (N) | Percent of Junior Researchers (N) | Percent of Publications by CNPs (N) | |
|---|---|---|---|---|---|---|---|
| New to CBPR |
12 | 28 (20) | 38 (3244) | 18 (64) | 21 (282) | 22 (101) | 25 (214) |
| Past Experience with CBPR | 13 | 72 (51) | 62 (5304) | 82 (290) | 79 (1064) | 78 (363) | 75 (649) |
| Totals | 25 |
100 (71) |
100 (8548) |
100 (354) |
100 (1346) |
100 (464) |
100 (863) |
| Funding Level 1 | 6 | 55 (39 | 49 (4224) | 57 (202) | 62 (848) | 46 (214) | 61 (523) |
| Funding Level 2 | 8 | 13 (9) | 19 (1612) | 24 (84) | 21 (280) | 34 (156) | 18 (157) |
| Funding Level 3 | 11 | 32 (23) | 32 (2712) | 19(68) | 16 (218) | 20 (94) | 21 (183) |
| Totals | 25 |
100 (71) |
100 (8548) |
100 (354) |
100 (1346) |
100 (464) |
100 (863) |
Lessons Learned from the National Evaluator
The evaluation tools for measuring the outcomes of a program need to assess the use of interim measures to determine the impact in addressing cancer health disparities
- The results of the national evaluation of the CNPs allowed the program to be approved for further funding, demonstrating the need to evaluate programs throughout the course of their activities
- Because communities are diverse, it is challenging to generalize the results of CNP activities to non-CNP communities
Acknowledgements:
We would like to thank Drs. Chu, Taylor, Cooper, Canto and the rest of the staff of the NCI-CRCHD for their support. Special thanks to the 25 CNPs for their participation in this project.