Project name:
“Integrating cancer control referrals and navigators into United Way 2-1-1”
Background:
For Americans living in poverty, cancer prevention and screening is a lower priority than meeting basic needs. When basic needs are addressed, the likelihood of engaging in these prevention behaviors increases. Strategies to eliminate cancer disparities in disadvantaged populations must recognize and address this fundamental challenge. We propose the first-ever cancer communication research partnership with United Way 2-1-1 (hereafter, 211) – a telephone information and referral system reaching millions of low-income and minority Americans every year and connecting them to locally available resources that can meet their basic needs.
Project overview:
In partnership with United Way 211 we will deliver and evaluate a cancer communication intervention to help thousands of disadvantaged adults and families to benefit from evidence-based clinical cancer control services (mammography, Pap smears, colonoscopy, HPV vaccination) and tobacco intervention (smoking cessation, smoke free home policies). This is a statewide study linking a major telephone information and referral system with local cancer control services and the patient navigation program at the Siteman Cancer Center to proactively address multiple cancer risks in a population of highly disadvantaged Americans.
Specific Aims:
The study aims are to:
1. Estimate the prevalence of need for cancer screening and prevention in a population of 211 callers and compare these rates to population data from Missouri and the U.S.
2. Evaluate effects of Tailored Cancer Communication (T) and Cancer Control Navigation (N) on use of cancer control services in a randomized trial among 211 callers.
We hypothesize that the proportion of 211 callers who obtain a needed cancer control service will:
a. differ significantly by study group as follows: T+N > N > T > CONTROL;
b. vary significantly across study groups based on the intervention dose callers receive; and
c. vary significantly across study groups based on whether callers’ original need was resolved, the extent of their basic needs, and their perception of life as manageable and predictable (i.e., sense of coherence)3
3. (Dissemination Research Aim) Determine costs to 211 and effects on quality of service by offering cancer control referrals.
Outcomes:
This study will: (1) estimate the prevalence of eligibility for cancer control referral in a population of 211 callers; (2) determine whether cancer communication interventions delivered through 211 can increase use of breast, cervical and colon cancer screening, HPV vaccination, smoking cessation and adoption of smoke free home policies; (3) determine how intensive an intervention is needed to bring about these changes; and (4) determine whether the effectiveness of these interventions is enhanced when callers’ basic needs have been addressed.
Dissemination:
Our third aim is to determine costs to 211 and effects on quality of service by offering cancer control referrals. If effective, this systems-integration approach has great potential for helping eliminate cancer disparities, and promise for national dissemination through United Way 211.
Intervention:
A large (n=7,128) random sample of callers to 211 in Missouri will complete a cancer risk assessment after receiving usual 211 service. In our pilot research, 58% of callers agreed to complete this assessment with no incentive provided. Those found to need at least one cancer control service – 85% in our pilot research – will be eligible to participate in a randomized intervention trial, and at random half will be offered an opportunity to participate. In our pilot research, 91% of those offered agreed to participate. All trial participants (n=2,784) will receive a telephone referral from 211 to needed cancer control services that are available near where they live and for free. By random assignment in a 2 x 2 factorial design, they will then receive either:
• Tailored Cancer Communication to help them act on the cancer control referral they received;
• A Cancer Control Navigator to help them overcome obstacles to obtaining needed cancer control services;
• Tailored Cancer Communication + A Cancer Control Navigator; or,
• No additional intervention (i.e., cancer control referral only, or control).
Follow-up at 1 and 4 months post cancer control referral will assess whether participants obtained a needed cancer screening or preventive service.
Project staff:
HCRL:
Matthew Kreuter, PhD, MPH, Principal Investigator
Vetta Sanders Thompson, PhD, Co-Principal Investigator
Kate Eddens Meyer, MPH, Project Manager
Kassandra Alcaraz, MPH, Data Coordinator
United Way of Greater St. Louis:
Debbie Fagin, 2-1-1 Call Center Manager
Consultants:
Mark Rank, PhD, Consultant
Ambar Rao, PhD, Consultant
Kathleen Ell, PhD, Consultant
Tracy Battaglia, PhD, Consultant
Al Marcus, PhD, Consultant
Contact information:
Kate Eddens Meyer, MPH
Project Manager
Health Communication Research Laboratory
Campus Box 1009
Washington University in St. Louis
700 Rosedale Avenue
St. Louis, MO 63112-1408
Ph: 314-935-3737
Email: keddens@gwbmail.wustl.edu
Website: http://hcrl.wustl.edu |
