#a1-13 native navigators: engaging communities for cancer...
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#A1-13 Native Navigators: Engaging
Communities for Cancer Education
Interventions
Thursday, November 1, 2012
1:30 pm to 3:00 pm
Site PIs and Co-Investigators
Linda Burhansstipanov, MSPH, DrPH, Principal Investigator, NACR, CO
Linda U. Krebs, RN, PhD, AOCN, FAAN
Co-Investigator, OCEAN, CO
Noel Pingatore, BS, ITCMI, MI
Daniel Petereit, MD, RCRH, SD
Debra Isham, MPH, MCN, OK
Mark Dignan, PhD, UK, Lexington, KY
3
Introduction /
Background / Overview
Linda Burhansstipanov,
MSPH, DrPH
10 minutes
Native Navigators and the Cancer
Continuum Funded by National Institutes of Health
Awarded to Native American Cancer
Research Corporation; Sub contracts to:
Inter-Tribal Council of Michigan; MI
Rapid City Regional Hospital, SD
Aberdeen Area Tribal Chairman's’
Health Board, SD
Muscogee (Creek) Nation, OK
University of Kentucky, KY
Inter-Tribal Council of Michigan
5 5
Native Navigators and the Cancer
Continuum (NNACC)
Funded by the NIH, National Center on
Minority Health and Health Disparities
[NIH, NCMHD R24MD002811]
The goal is for the Partners to collaborate,
refine, expand and adapt various
navigator/community education programs
to address the Native American
communities’ and patients’ needs
throughout the continuum of cancer care.
6 6
Locations
Great Plains Tribal
Locations of the NNACC Partners -- Community based
participatory research
7
Research Question
Can a Native specific
comprehensive
Navigator-implemented
community cancer
education intervention
improve health
behaviors among
Native American
community members?
Intervention Based on:
Consensus (via Focus Groups)
Informant Interviews (prior to initiation of grant … based on CMAP / MUP)
Tailoring under the control of each Partner
What how does the local NPN help the participant in culturally appropriate manners?
Blessing of mamm van in 1 area, but not necessary in the other areas
8
9
Community Education
Workshops
Topics for 24 hours of Cancer
Continuum education conducted
in partnership with local
American Indian organizations
Prevention - Risk Reduction
Early Detection and Screening
Palliative and Hospice Care
Quality of Life / Survivorship
10
Excerpt of NPN Training topics (125 hours)
Overview of the NNACC
Confidentiality (both NIH course and certification of passing, plus 2-3 hours for study-specific issues and practice
NPN Communication
Navigating the healthcare system (accessing IHS CHS, tribal, urban, etc.)
Instruction on how to teach all of the workshops
11
MoA-O’s Collaborations
Agreements with MoA-Os
Coordinate Family Fun Events:
Baseline data collection and kick-off
3-6 month delayed Event
Follows the completion of 24-hours of education that addresses the full continuum of cancer
Disseminate findings to local communities
12
Outcome
Site-specific (tailored), Native American
Navigator/Community Educator-
implemented cancer education programs
that address the full continuum of cancer
care to:
Increase community knowledge
Increase community screening
Improve access to (timely & quality)
cancer care
Increases visibility / availability of NPN
13
Examples of Lessons
Learned (Challenges and
Innovative Solutions)
Linda U. Krebs, RN, PhD,
AOCN, FAAN
30 minutes
14
Challenges/Solutions/Lessons Learned:
IRBs
IRB processes can take
2-9 months regardless
of previously approved
tribal resolutions or
ordinances.
Plan time accordingly;
involve community;
make contacts early
15
Challenges/Solutions/Lessons Learned:
Navigator In-service Training
Start-up training took longer than anticipated
Training sessions
160 hrs for comfort/ comprehension .
200+ hrs for semi-annual updates/refreshers
Some trainings repeated as level of readiness
improved
Videotaping allowed for review of topics and
helped with staff turnover and new staff hires
16
Challenges/Solutions/Lessons Learned:
In-service Training
Webinars very effective for meetings &
trainings, but face-to-face is best.
More face-to-face sessions needed
Estimated 3 face-to-face meetings in
year 01, then 2 in year 02, and then 1
yearly
17
Challenges/Solutions/Lessons Learned:
MOA-Os
Some not fully prepared to staff events
longer registration times
difficulty tracking ARS keypads.
Rooms not big enough
Food essential but sometimes took away from presentation times
Needed to withhold final payments until all tasks (FFEs & all workshops) completed
18
Challenges/Solutions/Lessons Learned:
Community Workshops
Workshops more popular than anticipated.
Many wanted to attend more than 1 series
Some went to 1 series and then brought
family and friends to a 2nd
Those who attended multiple workshops
increased their learning, but…
Could possibly skew the data
19
Challenges/Solutions/Lessons Learned:
Community Workshops
Needed more $10 gift cards as partial
compensation for gasoline or baby-sitting
Obtained supplemental funding for one
site to support gift cards for duplicate
participants
More funds would have been beneficial as
interest in workshops increased
20
Challenges/Solutions/Lessons Learned:
Sharing Files among Partners
Power Point® slides, interactive materials, and updates had to be shared
Many refinements over grant to:
ARS questions
Notes pages and content
interactive activities (Jeopardy, Bingo, Coyote-Bear)
Accessed thru NACR password-protected page
21
Challenges/Solutions/Lessons Learned:
Audience Response System
ARS, once learned, is working well for
evaluations
Because of higher than anticipated
participation, keypads had to be loaned
to some sites
Participants love using ARS, ask for it and
always want to use it
Challenges/Solutions/Lessons Learned:
Provider Perspectives Navigator training sessions needed to be:
At a level of understanding for those
with limited medical and cancer care
knowledge
Adjusted to readiness for learning
Ongoing and frequently updated
Support and answers rapidly available
Challenges/Solutions/Lessons Learned:
Dissemination Feedback to communities, funders and
others is essential on a routine basis
Site-specific community “feedback flyers”
developed and presented at each FFE
Information shared with clinic managers,
health boards and via formal presentations
Science Advances submitted to share
innovative ideas and solutions
24
Challenges/Solutions/Lessons Learned :
Navigators & Visibility
Education Intervention is successfully
increasing the visibility of the Navigators
Many community members are talking with
the Navigators about screening and other
support
The Community likes the workshops, the
events and LOVES the Navigators!
25
Lessons Learned
Loretta Denny
Muscogee (Creek)
Nation
Lessons Learned
NNACC-MCN = effective way to
Reach the tribal community
Improve cancer risk behaviors and
Screening awareness and anecdotal data
Our tribal citizens were eager to learn and
have shared positive comments about the
program and taking part in screening
Overall increase knowledge scores: 24.6%
Native Navigators and the Cancer Continuum
The Native American population suffers higher rates
of cancer incidence and other chronic diseases
compared to
The general population in Oklahoma
AIs living in other geographic areas.
Some of the participants shared their own personal
or family ordeal with cancer.
97% felt using the ARS keypads was useful and
especially liked seeing the correct answers and
were excited when their answer was correct.
Lessons Learned
Native Navigators and the Cancer Continuum
Lessons Learned
As Navigator I have been approached while out in
the public with citizens making comments about
how much they are or have learned from the
session and would like to have more.
The most common remark is that they are going to
be more aware of preventative screening and to
make sure that their family members get them
also.
I am so glad that our (MCN) people are becoming
more involved with Cancer and cancer awareness.
29
Lessons Learned
Noel Pingatore
Intertribal Council of
Michigan, Inc.
Lessons Learned
Listen to the Community – focus on Elders
Work with Key Community Partners
(MOA’s)
Protect the Data Reports and Session info
Tailor information to local region, culture,
traditions
Collaborate with other Cancer Programs,
Institutes, and agencies on multiple levels.
Lessons Learned
Reality can screw up great work
1 NPN thought data backed-up onsite and uploaded to online evaluation database and IT reformatted hard drive = data lost
1 NPN laptop stolen when home broken into = data lost
All ITCMI data summaries UNDER-count actual data collected (but lost/unavailable)
32
Lessons Learned
Shalini Kanekar
Rapid City Regional
Hospital and GPTCHB
Northern Plains
Comprehensive Cancer
Control Program
33
Challenges faced in Rapid City and Pine Ridge
Education and knowledge levels varied in both communities
Some medical terminology was
difficult to understand
Length of the modules
Recruitment was slow in the 1st
year for Rapid City and Pine
Ridge, especially for AI men
Lack of internet connectivity
especially on Pine Ridge Karen Red Star and Kim Crawford
Solutions
MOU for both sites (Oglala Lakota College
for Rapid City and Karen Redstar in Pine
Ridge)=
high recruitment
Rapid City used several
local resources such as
Dakota Plains Legal
Services NNACC Family Fun Event, Rapid City
Solutions
The Tobacco Cessation Program at
Great Plains Tribal Chairman’s Health
Board
Such resources = fewer in Pine Ridge
NNACC Family Fun Event, Rapid City
Solutions
Cash incentive worked better than gift card
on Pine Ridge
NNACC Family Fun Event, Rapid City
Lessons Learned
AI communities recognize the growing
prevalence of cancer in their communities
and understand the significance of early
detection.
AI communities have shown interest in
gaining more knowledge on cancer and
related topics, however would prefer
shorter modules
Lessons Learned (cont.)
This project has developed CRR as a local resources who serve their communities
Online evaluation worked well for education session.
However better tracking methods needs to be developed for patient navigation for screening
Patient navigation information can be streamlined
Innovation
At Rapid City: Used a Tribal College as a
partner and local resources to bring in
expertise when needed.
At Pine Ridge the CRR was embedded
within the Indian Health Service Clinic and
had access to Walking Forward Program’s
Cancer Screening Coordinator.
40
Lessons Learned
Linda Burhansstipanov
Native American Cancer
Research Corporation
(NACR)
Lessons Learned – NACR, et al
Online evaluation program made the 1st drafts for annual progress reports feasible to do without bothering partners for data updates
Exception: programs not keeping data uploads up-to-date
All sites needed to track referrals to screening better
Needed copies of data summaries quarterly (raw data files). Previous statistician provided summaries without providing the files.
Lessons Learned – NACR, et al
Scheduled 1 annual face-to-face meeting
for all Partners and Navigators – but
needed 2
There are things
you can do well
with webinar, but
some things need
to be face-to-face
Lessons Learned – NACR, et al
NACR staff collected ARS at FFE in a
park. (Gave everyone keypad and
handout of questions and went through the
questions together).
Lessons Learned – NACR, et al
Need project coordinator >20% effort
Particularly to monitor NPN uploads to
online evaluation program
Monthly connection with all Partners’
Co-I and review Partner’s database
Use same ARS hardware and software
Community participants for multiple series
GREAT partners – we plan to continue our
partnership on future grants
45
Preliminary Findings
Linda U. Krebs, RN,
PhD, AOCN, FAAN
(20 Minutes)
Aim #1. Expand and enhance (a)
Navigator/ community education inservice
trainings and (b) modify the Native
American Community Education Workshops
to include the full continuum of cancer care.
All sites have completed this task
46
Aim #2. Implement and evaluate 24 hours
of Native American Community Education
Workshops to at least 738 unduplicated
Native Americans
All sites have completed this aim
Request for increased enrollment approved
by WIRB spring 2011 due to increased
participant interest (and REPEATS)
Original Target = 735 unduplicated
As of 10/26/2012 = 1,964 unduplicated
47
Aim #3. During years 02 through 04, the Native
American Community Education Workshops will
increase the knowledge and intended behaviors among
the Native American participants by at least 20%.
48
Table 2. Increased Knowledge and Overall Workshop Evaluation NACR ITCMI RCRH GPTCHB MCN Total Avg % of participants that answered pre-session knowledge items correctly
37.5% 44.6% 33.0% 42.5% 43.7% 40.3%
Avg % of participants that answered post-session knowledge items correctly
66.9% 61.5% 65.7% 65.7% 67.2% 65.4%
Change in % of correct responses from pre to post
29.7% 25.3% 32.7% 29.8% 24.6% 28.4%
49
Table 3. Overall Workshop Evaluation NACR ITCMI RCRH GPTCHB MCN Total Avg % of participants that rated the workshop content as "understandable"
95.2% 86.2% 78.1% 88.3% 97.4% 89.0%
Avg % of participants that responded "I agree" about the workshop providing useful information
95.6% 92.9% 76.5% 95.5% 98.1% 91.7%
Avg % of participants that answered "yes" they would recommend the workshop to others
95.7% 93.4% 82.1% 95.2% 95.1% 92.3%
Overall Workshop Evaluation by
Partner’s Sites Staff issues Yr 01;
New NPN needed more face-to-face training; GPTCHB NPN worked with her
Yr 2 Initial WS scores for RCRH NPN were low, but GREAT improvements by early Year 3
Aim #4. During years 02 through 05, Navigators
will provide one-on-one support for Native American
cancer patients and families identified in the course of
the education intervention.
50
Relies on a combination of data uploaded
to “Dissemination” tab, the “Navigation”
tab and the “NNACC” tab within each
site’s online evaluation database
Staff identification and provision of NPN
services for local AI cancer patients:
NACR = 18
ITCMI = 12
RCRH/GPTCHB= 27
MCN = 25
GENDER NACR ITCMI RCRH GPTCHB MCN Total Females 356 159 285 219 356 1375 Males 135 23 202 130 99 589 Total 491 182 487 349 455 1964
Trying to increase percentage of male participants = Average 71% females; 29% males
RCRH (41%) and GPTCHB (37%) have highest inclusion of males
Reminder: all ITCMI data are under-counts
80% AI/ANs NACR ITCMI RCRH GPTCHB MCN Total
Race / Ethnicity AI/ANs 348 121 467 293 407 1636 African American 7 3 3 3 8 24 Pacific Islander 3 2 3 10 1 19 Asian 3 1 1 1 2 7 Non-Hispanic White 44 51 6 20 29 150 Hispanic 80 4 3 13 2 103 Other 7 1 4 8 6 26 491 700 487 349 455 1964
Reminder: all ITCMI data are under-counts
Ages NACR ITCMI RCRH GPTCHB MCN Total 18-21 20 8 37 26 20 112 22-30 70 8 95 50 43 267 31-40 76 15 104 56 48 300 41-50 84 17 118 32 53 304 51-60 143 45 98 45 131 462 61-70 80 40 31 23 137 311 71-80 17 34 1 112 2 166 Over 80 2 15 3 4 20 44 Totals 491 182 487 349 455 1964
Reminder: all ITCMI data are under-counts
Aim #5. Evaluate and compare the process and
outcome measures of the Native American
community cancer education interventions and
the Navigator/Community Educators’ cancer
patient support efforts.
Relies on a combination of data uploaded
to “Dissemination” tab, the “Navigation”
tab and the “NNACC” tab within each
site’s online evaluation database
54
Overall (as of 10-7-09-2012)
Each setting is doing
something well
Each setting needs to improve
some tasks
All need to determine which
tasks are feasible for future
collaborations
55
56
Preliminary Findings
Loretta Denny
Muscogee (Creek)
Nation
Preliminary Findings
24-hour series at 4 different areas within the
tribal boundaries.
Audience Response System:
Our goal was to reach 135 unduplicated
participants total.
Reached: Site 1- 203; Site 2- 71; Site 3-
63; Site 4- 154 = 491
MOA’s and funding were provided to each
community to allow for meal preparations and
staff assistance in monitoring the program
Preliminary Findings
A series of 12 sessions were held at 4 different areas within the tribal boundaries. Each series includes several sessions on each phase of the Cancer Continuum
Use of the Audience Response System:
Our goal was to reach 135 unduplicated participants total.
Reached: Site 1- 203; Site 2- 71; Site 3- 63; Site 4- 154 = 491
MOA’s and funding were provided to each community to allow for meal preparations and staff assistance in monitoring the program
Preliminary Findings
Site 1 – Central Muscogee Creek Nation
More than 731 individuals took part in at
least 1 workshop.
Preliminary Findings
56% = 40+ years old
Average pre-workshop correct = 40.7%
Average post-workshop knowledge =66.5%.
Increase in knowledge of 25.8%.
Preliminary Findings
434+ individuals took
part 1> workshop
89.8% = 40+ years old
Site 2 – Southwestern Muscogee Creek
Nation
Preliminary Findings
Average pre-workshop correct knowledge =
44.8%
Average post-
workshop
knowledge = 69.3%
Increase in
knowledge of
24.6%
Preliminary Findings
Site 3 – Southeastern Muscogee Creek
Nation
>372 took part in at least 1 workshop
92% = 40+ years old
Average pre-workshop
knowledge = 40.5%
Average post-workshop
knowledge = 66.8%
Increase =27.7% Bear – Coyote Interactive Activity
Preliminary Findings
Site 4 – Northern Muscogee Creek Nation
707+ took part in at least 1 workshop
82% = 40+ years old
Average pre-workshop
knowledge = 42%
Average post-workshop
knowledge = 66%
Increase = 24%
Interactive Activity: Healthy Eating
65
Preliminary Findings
Noel Pingatore
Intertribal Council of
Michigan, Inc.
Preliminary Findings
Did you take any of the following actions as
a result of what you learned or heard in
one of the classes:
Of those who completed the survey:
44% Shared info with a friend or family
member
44% made changes in my lifestyle
22% Urged others to get Cancer
Screening or other health related
services
Inter-Tribal Council of Michigan
Shared Results with NICOA
Local Tribal Elder Program Coordinator referred us to NICOA’s annual meeting
Prepared and presented the project (Noel, Amanda, Mark)
We were overwhelmed with the response from elders across the country – all want to know how they can bring this program to their community.
Sample of Results
Prostate- Pre: 50.7% Post :92.7%
Increase
Cervix- Pre: 69.1% Post: 84.0%
Increase
Breast- Pre: 36.8% Post: 76.9%
Increase
Colon – Pre 54.7% Post: 84.6%
Increase 29.9%
70
Preliminary Findings
Shalini Kanekar
Rapid City Regional
Hospital and GPTCHB
Northern Plains
Comprehensive Cancer
Control Program
Frequency / Descriptive Summary data from Online Evaluation Databases
RCRH GPTCHB
Total
Number of Family Fun Events (baseline and 3-month Delayed Evaluation) 0
Number of 24-hour Education Workshop Series Completed 0
Number of participants (includes duplicates) 0
AIANs 851 699 1550
African American 6 7 13
Pacific Islander 5 24 29
Asian & South Asian 1 3 3
Non-Hispanic White 11 48 59
Hispanic 6 32 38
Other / DWTA 8 19 27
AIANs 0
African American 0
Pacific Islander 0
Asian 0
Non-Hispanic White 0
Hispanic 0
Other 0
Duplicated Females 484 592 1076
Duplicated Males 401 234 635
Unduplicated Females 285 285
Unduplicated Males 202 202
18-21 (<21) 62 89 151
22-30 158 170 328
31-40 173 189 892
41-50 197 108 890
51-60 163 153 1583
61-70 52 77 1221
71-80 2 377 572
Over 80 5 12 185
Knowledge Scores
Average percent of participants that answered pre-session knowledge items correctly 33.0% 42.5% 40.3%
Average percent of participants that answered post-session knowledge items correctly 65.7% 65.7% 65.4%
Difference between the average percentage correct for the pre- and post-session knowledge
32.7% 29.8% 28.4%
Workshop Evaluations
72
Preliminary Findings
Linda Burhansstipanov
Native American Cancer
Research Corporation
(NACR)
Excerpt from Online Evaluation: Navigation Report from NACR Database (18 patients during NNACC)
Excerpt from Online Evaluation: Navigation Report from NACR Database (18 patients during NNACC)
75
Scientific Advances and
Publications
(2 minutes)
6 Peer-Reviewed Publications that focus on
or include excerpt specific to NNACC Eschiti, Valerie, Lauderdale, Jana, Burhansstipanov, Linda,
Weryackwe, Leslie M, Sanford, Stacey C, Flores, Yvonne. Tailoring
Cancer-related Educational Modules and Goals for Comanche
Nation. Journal of Transcultural Nursing, Manuscript ID:JTN-12-
054.R1; in press.
Burhansstipanov, Linda, Clark, Richard E, Watanabe-Galloway,
Shinobu, Petereit, Daniel G. Valerie Eschiti, Linda U. Krebs and
Noel L. Pingatore, Online evaluation: Benefits and Limitations.
Journal of Cancer Education. Volume 22 / 2007 - Volume 27 / 2012.
DOI: 10.1007/s13187-012-0320-9
Burhansstipanov, Linda, Krebs, Linda U., Watanabe-Galloway,
Shinobu, Petereit, Daniel G., Pingatore, Noel L. and Eschiti, Valerie.
Preliminary Lessons Learned from the “Native Navigators and
the Cancer Continuum” (NNACC) Journal Of Cancer Education.
Volume 22/2012. February 2012 DOI: 10.1007/s13187-012-0316-5
6 Peer-Reviewed NNACC Publications (cont.)
Braun, Kathryn L., Kagawa-Singer, Marjorie, Holden, Alan E.C.,
Burhansstipanov, Linda, Tran, Jacqueline H., Seals, Brenda F.,
Corbie-Smith, Giselle, Tsark, JoAnne U., Harjo, Lisa, Foo, Mary
Anne, and Ramirez, Amelie G. Cancer Patient navigator tasks
across the Cancer Care Continuum. Journal of Health Care for
the Poor and Underserved 23 (2012): 398–413.
Eschiti, Valerie, Burhansstipanov, Linda, and Watanabe-Galloway,
Shinobu. Native Cancer Navigation: The State of the Science.
Clinical Journal of Oncology Nursing Volume 16, Number 1pp 73-82,
89 DOi.1188/12.CJON.73-82.
Tracy A. Battaglia, Tracy A.; Burhansstipanov, Linda; Murrell,
Samantha S.; Dwyer, Andrea J. and Caron, Sarah E.; Assessing
the Impact of Patient Navigation: Prevention and Early
Detection Metrics. Cancer, August 1, 2011; 3553-3564. DOI:
10.1002/cncr.26267
Planned Articles (some in process)
Seminars in Oncology Nursing on
"Navigation Service as an Intervention to
Eliminate Disparities in Cancer Care
Outcomes in Underserved Communities."
Planned Articles (some in process)
3 Project Briefs for
Healthcare providers/Academicians;
Policymakers/Tribal Leaders;
Community
Possible Peer Reviewed Articles:
AI Technology Survey
Who should be the authors from each
site?
Needs to be submitted prior to
September NNACC meeting
NACES Northern and Southern Plains
Authors: Linda B, Mark Dignan, Rick
Clark, Linda K, Tinka, Loretta
80
Possible Peer Reviewed Articles:
NNACC Overall Study Findings
Administrative Team (Noel, Shinobu,
Debra, Lisa H, Linda B, Linda K, Mark
Dignan, Rick Clark)
Needs to be completed by January 31,
2013
81
Planned Articles (outlined 7/11/12)
Native Patient Navigators provide lessons
learned to Navigators working in other AI
cancer programs
Native Patient Navigators provide rationale
for why CULTURAL PN are needed
Creating Successful partnerships
Available on NACR’s website
http://natamcancer.org/materials.html
Sci_Adv_1_FactSheets (July 2010)
Sci_Adv_2_CN_NNACC (December 2010)
Sci_Adv_3_OnlineEval (December 2010)
Sci_Adv_4_Sharefindings (December 2010)
Sci_Adv_5_MOA-Os (August 2011)
Sci_Adv_6_Nav_Training (August 2011)
Sci_Adv_7_MCN-Issues (December 2011)
No feedback from NIH, LB quit submitting them
83
Summary / Key
Points
84
85
Summary: IRB
Regional / Tribal IRBs required 4-9 months
in spite of prior tribal approvals
WIRB includes ITCMI, NACR and MCN
Future applications will require each to
have its own FWA (currently under NACR)
WIRB approval of over-sample
86
Summary: ARS
ARS, once learned, is working well for FFE and workshop evaluations
Because of higher than anticipated participation, NACR needed to loan ARS keypads to partners
Most partners have or plan to purchase more keypads
New software easily tracks “duplicate” participants
87
Summary: In-Service NPN Trainings
More than 125 hours of initial NPN training
Although webinars work well, for some
trainings no substitution for face-to-face
trainings (and observed practical exercises)
Topics for refresher sessions or new topics
(stomach, pancreatic) are identified by NPNs
or members of the administrative team
Videotaping helped when staff turn-over, but
not replacement for face-to-face practical
exercises
88
Summary: Partnerships
Community-based Participatory Research
Design among NACR, ITCMI, RCRH
(GPTCHB), MCN
Each Partner creates MoA-O with other
local AI organizations to coordinate,
implement and evaluate FFE and WS
interventions
89
Summary: NNACC Intervention Evidence-based
More popular than anticipated and very well
accepted by all of the communities
NPNs doing good job as per workshop evaluation
findings; exceeded study goal of >20% by 9%
Each site = duplicate participants from previous
workshop series (PIs had to omit from analysis)
NNACC goal was 738 unduplicated participants,
but with WIRB approval = >2,000 unduplicated AI
community members in intervention.
90
Summary: Online Evaluation
Very challenging learning curve for ALL
When get behind, very tedious to upload
data to all 3 tabs
Effectively tailors reports – but only if NPN
enters the data
Greatly assisted with generating
Series-specific summaries for
dissemination to communities
Annual PHS2590 Progress Reports
91
Summary: Dissemination
Each Partner works with local MOAs to
share study findings with local community
during post FFE
Scientific Advances posted on NACR
Website
6 peer reviewed articles as of 9-2012
4 articles outlined for peer reviewed
publications
92 92
Thank you for
inviting OUR TEAM
and allowing US to
share NNACC with
you!
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