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Gem M. Le, MHS Stephen J. McPhee, MD Ginny Gildengorin, PhD Ky Q. Lai, MD, MPH

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.

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Gem M. Le, MHS Stephen J. McPhee, MD Ginny Gildengorin, PhD Ky Q. Lai, MD, MPH

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  1. 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 Project • Division of General Internal Medicine • University of California, San Francisco

  2. 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)

  3. 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.

  4. 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

  5. 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

  6. 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

  7. Methods: Study Design Total anticipated sample Intervention: 550 Control: 550

  8. 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

  9. 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

  10. 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

  11. 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

  12. Characteristics of Lay Health Workers • Mean age (4 agencies): 57.3 years • Range: 22-67 years • Women were employed, housewives, or students

  13. 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

  14. 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

  15. Results: Participant Demographics

  16. Ever Heard of Breast Cancer? (% Yes) % change**: 2.8% vs. 8.9% **p = 0.006 *p < 0.0001

  17. Ever Heard of Mammogram? (% Yes) % change: 2.2% vs. 5.4% *p = <0.0001

  18. Ever Had Mammogram? (% Yes) % change: 2.7% vs. 6.7% ^p = 0.03 *p < 0.0001

  19. Had Last Mammogram WithinPast Year? (% Yes) % change**: 4.5% vs. 22.1% **p = 0.0004 ^p = 0.03 *p < 0.0001

  20. Plan Mammogram Within 12 Months? (% Yes) % change**: 0.2% vs. 21.1% ** p < 0.0001 *p < 0.0001

  21. Ever Thought About Getting a Mammogram? (% Yes) % change: 12.0% vs. 19.0% ^p = 0.004 (n=25)

  22. Ever Heard of Clinical Breast Examination (CBE)?(% Yes) % change**: 10.9% vs. 22.8% **p = 0.0003 ^p < 0.0001 *p < 0.0001

  23. Ever Had a CBE?(% Yes) % change**: 7.3% vs. 19.8% **p = 0.0003 ^p = 0.0005 *p < 0.0001

  24. Had a CBE Within Past Year?(% Yes) % change**: 5.1% vs. 27.8% **p < 0.0001 ^p = 0.028 *p < 0.0001

  25. Plan a CBE Within 12 Months?(% Yes) % change**: -1.2% vs. 20.7% **p < 0.0001 *p < 0.0001

  26. Thought of Getting a CBE?(% Yes) % change: 4.0% vs. 8.0% ^p < 0.0001 (n=25) *p < 0.0001 (n=32)

  27. Age Women Should Start Mammograms?(% 40 Years) % change**: 0.9% vs. 45.3% **p < 0.0001 *p < 0.0001

  28. Age Women Should Start CBEs?(% 40 Years) % change**: 0.9% vs. 45.9% **p < 0.0001 *p < 0.0001

  29. Multiplier Effect: Participants’ Sharing of Information about Mammograms Median number of people shared information per participant: 3.0 4.0

  30. Multiplier Effect: Participants’ Sharing of Information about CBEs Median number of people shared information per participant: 3.0 4.0

  31. 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

  32. 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

  33. 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

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