REACH Lay Health Worker Intervention Program: A Community-Based Model to Promote Breast Cancer Screening Among Vietnamese-American Women

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REACH Lay Health Worker Intervention ProgramA
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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Acknowledgements

• Funded by the Centers for Disease Control and
  Preventions 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)

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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,
  200318(7)516-24.

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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

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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

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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

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Methods Study Design
Total anticipated sample Intervention
550 Control 550
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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

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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
• McNemars chi-square test to detect the
  difference in the changes between intervention
  and control groups

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CBO Lay Health Worker Agencies

• First LHW AgencyCatholic 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

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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

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Characteristics of Lay Health Workers

• Mean age (4 agencies) 57.3 years
• Range 22-67 years
• Women were employed, housewives, or students

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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

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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

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Results Participant Demographics
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Ever Heard of Breast Cancer? ( Yes)
change 2.8 vs. 8.9 p 0.006
p lt 0.0001
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Ever Heard of Mammogram? ( Yes)
change 2.2 vs. 5.4
p lt0.0001
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Ever Had Mammogram? ( Yes)
change 2.7 vs. 6.7
p 0.03 p lt
0.0001
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Had Last Mammogram WithinPast Year? ( Yes)
change 4.5 vs. 22.1 p 0.0004
p 0.03 p lt
0.0001
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Plan Mammogram Within 12 Months? ( Yes)
change 0.2 vs. 21.1 p lt 0.0001
p lt 0.0001
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Ever Thought About Getting a Mammogram? ( Yes)
change 12.0 vs. 19.0
p 0.004 (n25)
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Ever Heard of Clinical Breast Examination
(CBE)?( Yes)
change 10.9 vs. 22.8 p 0.0003
p lt 0.0001 p lt 0.0001
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Ever Had a CBE?( Yes)
change 7.3 vs. 19.8 p 0.0003
p 0.0005 p lt 0.0001
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Had a CBE Within Past Year?( Yes)
change 5.1 vs. 27.8 p lt
0.0001
p 0.028 p lt 0.0001
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Plan a CBE Within 12 Months?( Yes)
change -1.2 vs. 20.7 p lt
0.0001
p lt 0.0001
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Thought of Getting a CBE?( Yes)
change 4.0 vs. 8.0
p lt 0.0001 (n25) p lt 0.0001 (n32)
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Age Women Should Start Mammograms?( 40 Years)
change 0.9 vs. 45.3 p lt
0.0001
p lt 0.0001
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Age Women Should Start CBEs?( 40 Years)
change 0.9 vs. 45.9 p lt
0.0001
p lt 0.0001
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Multiplier Effect Participants Sharing of
Information about Mammograms
Median number of people shared information per
participant
3.0 4.0
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Multiplier Effect Participants Sharing of
Information about CBEs
Median number of people shared information per
participant
3.0 4.0
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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

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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

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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