Reducing Health Disparities Through Navigation to Mammography Screening Worcester County, Massassachusetts

Good For Me, Good For My Community Kick Cancer Campaign! –Melinda Miffitt, MPH, American Cancer Society Community Executive –Michele Dilley, BS, American Cancer Society Community Executive –Catherine Nash, MPH, Women’s Health Network Community Outreach Specialist

Partners Leominster  Community Health Connections  HealthAlliance Hospital  Spanish American Center  Cleghorne Neighborhood Center Worcester  Jane Kimani  Family Health Center  YWCA  Holden Health Career Training Institute  Free Health Clinics Southbridge  Southbridge Community Connections

Project Goals & Objectives 1.Design: mammography screening events tailored to the culture and language of each target group  African women in Worcester  Latina women in Fitchburg 2.Purpose: Increase screening rates and improve quality of life through early diagnosis 3.Develop long term partnerships to eliminate health disparities

Target Population Selection CriteriaWorcesterFitchburg Low Income (Live below 185 % of FPL) 34%32% Uninsured (MA Total) Non-Hispanic Black 20.8 Hispanic 32.8 Low Mammography Screening35%43% Undocumented/ Immigrant/ Refugee 12% Refugee/Asylee 15% Latino The intervention focused on African women in Worcester and Latina women in Fitchburg because data showed these groups experienced the greatest screening disparities. We utilized the following selection criteria.

Rationale African/African American and Latina Women Experience: 1. Low Screening Rates 2. Low Rates of Insurance Coverage 3. Disparities in Mortality Rates

Despite Lower Incidence, More African American Women Die from Breast Cancer

Logic Models Outreach at Latino neighborhood centers Educational Event Presentation by Spanish speaking medical professional Visual aids Cancer survivor speaker Enrollment in BCCDP or Medicaid Food Incentives Screening Day Transportation Interpretation Logistical assistance: scheduling interpretation Transportation Manage immediate health concerns Follow-up at local hospital Treatment paid by BCCDP African Health Navigator One-on-One Latina Outreach Workers Group focus Outreach: Residences Family gatherings Churches One on one barrier specific counseling Follow-up at community health center Treatment paid by BCCDP

Mammography Day

Worcester Interventions

Results *Eligible Women ReferralsMamm Completed New WHN Enmt Med Follow up Br Ca Dx Leominster/ Fitchburg Worcester Total * Many more men and younger women (ineligible for WHN) participated in educational outreach, estimated at total, this is not reflected in the chart.

Results  100% screened from highest risk populations  90% were 1 st time screenings  High proportion of diagnoses Focused, culturally and linguistically appropriate and outreach Suggests we successfully reached women who had barriers to screening

Outcomes Major Outcomes 1. Reducing mortality rate 2. Early diagnosis and improved quality of life Keys to Success:  Focus on hardest to reach population through outreach workers  Improved quality of intervention  Positively narrowed our target population to the most underserved

Long Term Outcomes  Developed long term partnerships to eliminate health disparities  Increased enrollment in Mass Health and WHN  A positive impact from media coverage of events to increase screening among the general population  Increased awareness of importance of early detection

Community Partners Keys to Success 1.Commitment, communication and support from the ACS and the Women’s Health Network (BCCDP) staff. The women were able to trust the medical professionals and the program. 2.Transportation: Women who did not have transportation were given rides to the hospital/health center and back to their homes. 3.Cultural competence: The outreach worker was able to speak the language that women could understand and interpret for them during hospital visits. 4.Insurance: The program offered women medical insurance (Free Care) despite their immigration status. 5.Services: The women were able to get a comprehensive medical check-up, ranging from Mammogram, Pap smear, screening for diabetes, hypertension, thyroid and other illnesses.

Replication Requires a thorough knowledge of at-risk, hard-to-reach populations and: 1. Strong personal commitment by the Outreach person/staff from the target community 2. Local-language, cultural sensitivity; best would be a community member directly doing project outreach 3. Building in flexibility to adapt methods/venues and events to the target populations based on cultural preferences

Recommendations for Grants  Transparent and open bidding process for fiscal agent selection  Ensure mission match with counterpart organization(s)  More structure and benchmarks with follow- up policies throughout grant process

Thank You!