An Innovative Capacity Building Approach for Preparing Tribal Community Health Representatives (CHRs) to Deliver

Colorectal Health Education, Outreach and Patient Navigation Services

Kevin English, RPh, MPH Albuquerque Area Indian Health Board, Inc.

Navajo Nation Human Research Review Board ConferenceWindow Rock, AZ

November 16, 2011

Colorectal Health Data Trends: American Indians

Cancer is leading cause of death among AI/AN women and the 2nd leading cause of death among AI/AN men.

(CDC 2006)

Colorectal cancer is the 3rd most common type of cancer among American Indian & Alaska Native men & women.

(SEER; Wiggins et al Supplement to Cancer 2008).

Colorectal Cancer is the 2nd most common type of cancer for American Indians in the Southwest.

(SEER; Wiggins et al Supplement to Cancer 2008).

Colorectal cancer is the 3rd leading cause of cancer-related death for AI/AN men & women.

(NCHS; Espey et al Cancer 2007)

Colorectal Health Data Trends: American Indians

Nationally, the death rate from colorectal cancer has been dropping for more than 20 years.

Death rates from colorectal cancer are not decreasing among American Indians/Alaska Natives

WHY NOT?

Colorectal Health Data Trends: American Indians

Late detection AI/AN men and women are more than two times

more likely to be diagnosed with late stage CRC than early stage CRC.

(SEER, Perdue et al. Supplement to Cancer 2008)

Insufficient screening Only 4% of AI/AN men and women age 50-80 who

utilize IHS obtained CRC screening in accordance with recommended guidelines.

(Day, Espey, Madden et al Dig Dis Sci 2011)

Delayed treatment

The main goals of the AAIHB Tribal Community Colorectal Health Project are to:

1. Build capacity among CHRs related to colorectal health education, outreach & patient navigation

2. Establish a multidisciplinary colorectal health task force in each participating tribe

3. Implement local colorectal health awareness and patient navigation activities

4. Share successful strategies with other tribal communities throughout the country

AAIHB Tribal Colorectal Health Program

CHR Capacity Development Approach

Three, two-day workshops: December 9/10, 2009 April 7/8, 2010 August 18/19, 2010

19 unique participants All 7 AAIHB Tribes

CHR Capacity Development Approach

KEY WORKSHOP TOPICS: Colorectal Cancer (CRC) 101 Epidemiology of CRC for AI/AN Screening Guidelines for CRC CRC Screening Procedures Bowel Preparation Colorectal Cancer Risk Factors CRC Diagnosis and Treatment Talking about sensitive health issues Theories of health behavior/communication

CHR Capacity Development Approach

TRAINING TECHNIQUES PowerPoint Videos Anatomical Models Field visit to colonoscopy facility Survivor stories Role playing Language groups Interactive games Health education materials

development/dissemination

Health education materials development/dissemination

CHR Capacity Development Evaluation

A 34-item pre-post test was administered to participants at the 3rd workshop measuring: Knowledge (15 items) Self-efficacy (11 items)

– I am confident that I can teach my community members about colorectal cancer screening

– It will be easy to add colorectal cancer screening outreach & education to my regular workload.

Norms & intentions (8 items)– I think colorectal cancer is an important health issue.– I intend to assist my community members in getting

colorectal cancer screenings.

Evaluation Analysis

Paired sample t-tests were utilized to analyze mean differences in pre-post test scores.

Mean differences were also analyzed according to training exposure To assess the impact of attendance at multiple

training sessions upon CHR capacity

Evaluation Findings

CHR Capacity Development Evaluation

Qualitative feedback was also collected related to:

Training benefits

Satisfaction with training materials/approaches

Areas for training improvement

Future capacity development needs

Qualitative Findings

“I am now knowledgeable about the different tests and how screening can prevent the progression to cancer. I understand the procedure from start to finish.”

“I understand more, so people I talk with will benefit from this.”

“I am now able to help self, family and community by having tools and knowledge to share this important information.”

“I’m prepared to discuss colorectal health, I feel confident.”

Qualitative Findings

“My favorite part was the hands-on tour and actually seeing the live instruments and setting.”

“I understand the process of colonoscopy after visiting the facility that performs the colonoscopies.”

“I enjoyed the survivor’s story; it really helped me understand colorectal screening form a personal point of view. That was helpful.”

“We have been given all of the tools, now it is up to us to organize classes and disseminate the information.”

“We can do our job by providing the education, but IHS must provide the needed services.”

Conclusions/Implication for Practice

Significant attention should be placed upon CHR capacity development.

Incorporating experiential learning activities into trainings is a preferred approach.

The use of multiple training sessions appears to confer advantages in retention of knowledge and engendering CHR confidence and motivation to intervene.

The concomitant implementation of system-level initiatives with CHR capacity development may be especially important towards improving local access to colorectal cancer control services.

Next Steps

• Develop tool kit – “Best of” CRC workshops/activities

• Provide CRC workshops for CHR programs in other IHS regions

• Develop brochures, videos, posters, etc. (English & Navajo)

• Evaluation focus groups with CHRs

• Clinic provider detailing

• Continue routine task force meetings in participating tribes

Contact Information

Kevin English – Program Director Tribal Community Colorectal Health Education and

Navigation ProgramAlbuquerque Area Indian Health Board, Inc.

5015 Prospect Ave NEAlbuquerque, NM 87110kevinenglish@aaihb.org

(917) 962-2603

This project was realized with funding from CDC’s Division of Cancer Prevention and Control in collaboration with the Indian Health Service Division of Epidemiology and

Disease Prevention