Leveraging an Implementation Science Framework to Adapt and Scale a Patient Navigator Intervention to Improve Mammograph
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Leveraging an Implementation Science Framework to Adapt and Scale a Patient Navigator Intervention to Improve Mammography Screening Outreach in a New Community Melissa A. Simon 1 & Catherine A. O’Brian 1 & Jacqueline M. Kanoon 2,3 & Alnierys Venegas 3 & Stacy Ignoffo 3 & Charlotte Picard 3 & Kristi L. Allgood 3 & Laura Tom 1 & Helen Margellos-Anast 3
# American Association for Cancer Education 2019
Abstract Helping Her Live (HHL) is a community health worker-led outreach model that navigates women from vulnerable communities to mammography screening and diagnostic follow-up. The objective of this study was to evaluate HHL implementation on the southwest side of Chicago. HHL has been implemented on the west side of Chicago since 2008, where it has increased mammogram completion and diagnostic follow-up rates among Black and Hispanic women from resource poor communities. In 2014, HHL was translated to the southwest side of Chicago; implementation success was evaluated by comparing outreach, navigation request, and mammogram completion metrics with the west side. During January 2014–December 2015, outreach was less extensive in the southwest setting (SW) compared to the benchmark west setting (W); however, the proportion of women who completed mammograms in SW was 50%, which compared favorably to the proportion observed in the benchmark setting W (42%). The distribution of insurance status and the racial and ethnic makeup of individuals met on outreach in the W and SW were significantly different (p < 0.0005). This successful expansion of HHL in terms of both geographic and demographic reach justifies further studies leveraging these results and tailoring HHL to additional underserved communities. Keywords Breast cancer . Mammography . Lay navigators . Navigation . Underserved . Vulnerable
Introduction Mammography remains indispensable in breast cancer screening as the sole screening modality demonstrated to reduce breast cancer mortality [21]. Attributing the increased risk for breast cancer mortality among African American women and other underserved populations to inequitable healthcare is supported by studies demonstrating that racial and ethnic minorities in the USA, including African American, Hispanic, * Melissa A. Simon [email protected] 1
Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair, Suite 1800, Chicago, IL 60611, USA
2
Office of Community Engaged Research and Implementation Science (OCERIS), University of Illinois Cancer Center, Chicago, IL 60612, USA
3
Sinai Urban Health Institute, Sinai Health System, Chicago, IL 60608, USA
Asian, and Native American women, are less likely than White women to receive adequate mammography screening with respect to both its frequency and its quality [15, 22]. Further, the inadequate screening of underserved populations likely contributes to observations that racial/ethnic minorities are less likely than their White counterparts to be diagnosed at
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