3E. Outreach Core Principal Investigators: Octaviana Trujillo, PhD, Professor, NAU Teshia Solomon, PhD, Associate Professor, UACC Introduction: Despite underreporting, epidemiologic data support that American Indians (AI) in the Southwest have higher rates than the non-Hispanic white (NHW) population for several cancer types, including liver, stomach, gallbladder and kidney. AI in the southwest are more likely to be diagnosed with late stage cancers than NHW, especially the "screenable" cancers of cervix, colorectal and breast, and survival is lower in AI than NHW as a result. In addition, screening rates for AI are often lower than NHW. Contributing factors to these disparities include social determinants, cultural beliefs and values, health care system policies, and lack of information about cancer, embedded in a history of oppression leading to distrust of science and medicine.[3-4] The Partnership for Native American Cancer Prevention (NACP) Community Outreach Core has been working to build relationships with AI communities in Arizona to address cancer disparities since 2002. During the 2009-2013 project period, with our partners, we implemented activities to educate AI communities to take action to prevent and control cancer. In collaboration with the Hopi Tribe, Navajo Nation/Flagstaff community, and the Tohono O'odham Nation we provided 369 documented activities reaching almost 62,000 people ranging from low impact activities, like cancer awareness, to higher impact, clinical education. While we collaborate with our training and research cores through our Cancer 101 trainings and conferences to disseminate research findings to the community and build relationships for the development of tribally-directed research projects, our program is not itself a research program. NACP has however conducted seven faculty research projects and two student research projects with our partner Nations to address community concerns. During the 2014-2019 project period, we will include three new aims that build on the achievements of our current program to take NACP Outreach activities from just impacting individual knowledge to influencing policy and systems, that includes community-led research/intervention projects. We will use a Community Based Participatory Research (CBPR) approach and utilize the Community Readiness Model (CRM) that provides each participating community with documented progress in capacity development to implement cancer prevention and control (CPC) programs. While each community will lead its own unique initiatives appropriate for its level of readiness, and within its cultural practices, there are common activities across them. Over the next five years, community readiness to adopt cancer interventions across socio-ecological levels[7-8] and to conduct research will be assessed, and implementing activities leading to progression, in collaboration with our three partner tribes, three urban partners, and five new Tribes. We will also provide resources and technical assistance to our AI partners to implement community-led CPC projects through a small grants initiative to further develop the infrastructure at the community level to implement or enhance patient navigation systems, cancer survivor support groups, men's cancer education programs, and/or other CPC programs. To further support their capacity building, we will develop, test and implement cultural competency training.
Specific Aims :
Our aims reflect the success and growth experienced over the past 3 years and we plan to use a culturally sensitive approach in partnership with our AI communities to achieve the following aims.
AIM 1 : In collaboration with our Tribal/community partners we will assess their current level of readiness to implement cancer program activities (from lower impact awareness and education to higher impact clinical practice and policy changes), track progression, and provide feedback.
AIM 2 : We will develop, implement and evaluate a toolkit and training program that can be delivered through multiple modalities (in-person and/or electronically) to provide an AIAN cultural competency training specific on cancer for healthcare providers, and researchers.
AIM 3 : Five community projects will be developed by and for Southwest AIAN communities that will support increased use of primary and secondary cancer prevention strategies. in the upcoming project period, we are excited to continue to reflect the needs and priorities expressed by our respective Tribal communities, and to expand to include urban centers, and more Tribes and organizations throughout the state to address AIAN cancer needs in a culturally competent manner.
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