©2000 breast cancer outreach strategies: models that work for the farmworker population national...
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©2000 Breast Cancer Outreach Strategies:
Models that Work
For the Farmworker Population
National Center for Farmworker Health, Inc.
Presented by:
Alicia Gonzales-Leadership Development & Training Center
Director
&
Monica Saavedra-Embesi-Migrant Health Education Coordinator
@2006 NCFH
@2006 NCFH
National Center for Farmworker Health
National Non-profit Organization, Est. 1975 Located in Buda, TX Provide training & technical assistance to a
network of federally funded Migrant and Community Health Centers Primary Constituents Other interested organizations
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Mission Statement
To improve the health status of
farmworker families through the innovative application of
human, technical and information
resources.
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NCFH Focus Areas1. Leadership Development & Training
On-site consultation and facilitation Leadership and skills-building training Health promoter and health based trainings Migrant health orientation & training Translation & patient ed. Material development
2. Network Development & Expansion Call for Health Program-1-800-377-9968
3. Migrant Health Network Support Resource Center & Library
Houses collection of bilingual patient ed materials and FW specific resources
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Leadership Development & Leadership Development & TrainingTraining Center
Health Education Focus: Development Experience
Health Curricula Breast Cancer Oral Health HIV Diabetes
Patient Education Materials Promotora Training
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Commonly Used Outreach Strategies w/FW’s
Popular education is engaging and empowering. It works to transform not only the lives of the participants, but the whole society.
Popular Teaching Strategies Incorporate the following outreach strategies into your education delivery:
Group activities Brainstorming Role-playing Games Ice-breakers Testimonials Theater Foto-novelas
Use of Lay Health Promotor models Health Navigation Program
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Model Programs
Rural Women’s Health Project-Florida Women’s Center of Jacksonville-Jacksonville, FL The Rose-Houston, TX Cancer & Chronic Disease Consortium-El Paso, TX Multicultural Human Dev. Corporation-Lincoln, NE Kentucky Cancer Program-Louisville, KY Delaware Breast Cancer Coalition-Wilmington, DE Cultivando la Salud-Buda, TX
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Model Program
Cultivando La Salud
A Breast and Cervical Cancer
EducationProgram
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About the Cultivando la Salud Program (CLS)
1 out of 11 R & D projects funded across the U.S. by CDC (1999-2002)
Proved successful and rec’d continued funding from SGK
Focuses on Breast and Cervical Cancer Development of low literacy and culturally
appropriate educational materials Promotora Program Model Reaches hard to serve populations Proven to be effective in increasing B & C cancer
screening
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Cultivando la Salud: Breast and Cervical Cancer Program
Overview Develop, test, replicate and disseminate a
breast & cervical cancer program that will build on the promotora model.
Build capacity within health centers through training & technical assistance to implement the program. Develop and carry out educational
strategies to increase knowledge of breast & cervical cancer and improve skills and behaviors that influence screening.
Evaluation component
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To increase breast and cervical cancer screening among migrant and seasonal farmworker women aged 50 and older.
To increase capacity for Migrant and Community Health Centers.
Program Goals:
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Evaluation Underwent extensive testing in the
development, implementation, and completion phases
Conducted over 15 Focus Groups Pilot tested surveys, materials, and
implementation Trained over 30 organizations
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PROGRAM DEVELOPMENT
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Intervention Mapping
NEEDS ASSESSMENT
Identify the at-risk population, quality of life
and health problemsDistinguish environmentaland behavioral causes Review key
determinants
INTERVENTION MAP
IMPLEMENTATION
EV
ALU
AT
ION
P r o x i m a l P r o g r a mO b je c t iv e s M a t r ic e s
sp ec i f y th e p e r f o r m a n c e o b j ec t i v e s s p e c i f y i m p o r t a n t, c h a n g e a b l e d e t e r m i n a n ts d if f e r e n t i a t e th e t a r g e t p o p u l a ti o n c r e a t e m a t r i c e s o f p r o x i m a l p r o g r a m o b j ec t i v e s
T h e o r e t ic a lM e th o d s &P r a c ti c a l S tr a t e g ie s
b r a i n s t o r m m e t h o d s t o a c h ie v e p r o x i m a l p r o g r a mo b j ec t i v e s
u se t h e t h e o r e ti c a l a n d e m p i r i c a l l i t e r a t u r e t of u r t h e r d e li n e a te t h e m e t h o d s a n d th e r e l ev a n tp a r a m e te r s f o r m e th o d s
t r a n sl a t e m e th o d s i n t o st r at e g ie s
P r o g r a m D e s i g n o p e r a ti o n a l i z e t h e s tr a te g i e s i n t o p l a n sc o n si d e r i n g i m p l e m e n t o r s a n d s i te s
d e si g n i n st r u c ti o n m a t e r i a ls p r e t e st i n st r u c t i o n m a t e r i a l s w i t h th e t a r g e t g r o u p p r o d u c e t h e m a t e r i a ls
A d o p t io n &I m p le m e n t a ti o nP l a n
d e v e l o p a l i n k a g e sy s t e m sp ec i f y a d o p ti o n a n d i m p l e m e n t a ti o n
p e r f o r m a n c e o b j ec t i v e s sp e c if y d e t e r m i n an t s o f a d o p t i o n a n d
i m p l e m e n t a ti o n w r it e a n i m p l e m e n ta t i o n p l a n
M o n it o r in g &E v a l u a t io n P l a n
d e v e l o p a n e v a lu a t io n m o d e l u si n g i n f o r m a ti o nf r o m th e p r e v i o u s s t e p s o f I n t e r v e n t io n M a p p i n ga n d i n f o r m a t i o n f r o m t h e n e e d s a ss e ss m e n t .
d e v e l o p e f f e ct e v a l u a t i o n q u e s ti o n s f r o m th e n e e d sa ss e ss m e n t a n d p r o x im a l p r o g r a m o b j e c t i v em a tr i c es . R e f e r to t h e m a t r ic e s a s b l u e p r i n t s f o ri n st r u m e n t d e v e l o p m e n t .
d e v e l o p p r o c e ss ev a l u a t i o n q u e st i o n s f r o mi n te r v e n t i o n m a p p i n g m e t h o d s, st r a t e g i e s a n dim p l e m e n t a t i o n p la n s.
Outcomes Tasks
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CLS Tools & Resources
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Replication Package
Program Manual
Breast & Cervical Cancer Training Curriculum
“Tool Box” to be used by Promotoras to provide education to Farmworkers Components include:
Lesson Plans Flipchart Video Pamphlets
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Program Manual(For Program Planners)
“HOW-TO” Manual Background and
Program Description
Goals and Objectives
Program Implementation
Overview of the Program Materials
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Program Manual(Continued)
RESOURCES Promotora Job Description Recruitment & Training Management & Maintenance of
Promotora Programs Contact Forms Staffing Plan and budget Evaluation and Sample Evaluation
Tools
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B & C Training Curriculum
Lessons: Introduction to the Training Role of the Promotoras Reaching Farmworker
Women Finding Breast Cancer Early Barriers to Breast Cancer
Screening Finding Cervical Cancer Early Barriers to Pap Test
Screening Teaching Methods Practice Session Using
Program Materials Resources and Referrals Evaluation
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Promotora Tool Box
Video Flipchart Lesson Plans Breast Model
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Video
Spanish Only Portrays FW Women 50 and over at
work and home Takes the viewer step by step for the
CBE, Mammogram, Pap Test, and highlights the BSE
The FW women engage in a barriers discussion
Testimonials
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Flipchart
Comprehensive & Flexible tool
Bilingual Script for
Promotora; graphics for woman
Barriers, Exams, and Testimonials
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Lesson Plans
Step-by-Step on how to conduct a session
Comprehensive lesson plans
3 options based on time: a, b, and c
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CLS PROGRAM FOUNDATION
PROMOTORA MODEL
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PROMOTORAS IN THE FIELD
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Role of Promotoras in Cultivando La Salud
Provide B&C cancer education to women in cohort through one on one home visits
Identify & help women overcome barriers to screening
Motivate women to get screened Provide referrals to local screening providers Assist them in making and keeping their
appointments Served as link between the client and
screening service Offer other assistance as needed
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Educational Components
Promotoras conducting door-to-door outreach in farmworker areas/colonias
Using program materials, group presentations & one-on-one contacts
Referrals to B&C screening providers Follow-up
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Why the CLS Program?
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Evidence Evidence based results Tested in the community with
community members Farmworker specific Use of the promotora model
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Screening Completion- Women in Cohort
Site 1 Eagle Pass, TXIntervention
Site 2Anthony, NM
Comparison
Site 3 Merced,CA
Intervention
Site 4 Watsonville, CAComparison
Mam Cohort with follow-up
36.8% 30.8% 58.3% 28.8%
Pap Cohort with follow-up
32.4% 22.4% 76.9% 25.0%
CLS Program Results 20002
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****Intervention Effect****Intervention Comparison p value
MammographyCompletion
N=307
40.8% 29.9% .049
Pap TestCompletion
N=170
39.5% 23.6% .025
CLS Program Results 2002
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Current NCFH BC Activities
CLS Nationwide Trainings 2 day-Train the Trainer Direct Hands on Promotor Training
CLS Hays County Intervention Use of Promotor Model Rural Hispanic Community Breast Cancer Outreach & Referrals for Screening
Call for Health Program 800-bilingual toll free line Provides referrals and $ assistance for qualifying
FW patients in need of screening or treatment
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Contact Information Alicia Gonzales, Leadership Development &
Training Center Director 512-312-5469 [email protected]
Monica Saavedra-Embesi, Migrant Health Education Coordinator 512-312-5468 [email protected]
www.ncfh.org 1800-531-5120
@2006 NCFH
FINGracias