Significant disparities exist between the prevention and treatment of breast cancer among Latinas and non-Latina white women. An important factor appears to be the difference in access to evidence-based health information between these groups of women. Dissemination of language-, literacy-, and culturally appropriate prevention and treatment messages could reduce disparities in access to evidenced-based health information and preventive care for Latinas at risk for breast cancer. RAND Health, in collaboration with Olive View-UCLA Medical Center (OVMC), a Los Angeles County Department of Health Services hospital, proposes to develop and conduct a pilot evaluation of three alternative strategies to communicate patient-targeted messages related to the CER, """"""""Comparative Effectiveness of Medications to Reduce Risk for Primary Breast Cancer in Women."""""""" The overall aim is to increase the use, impact, and implementation of the recommendations of this CER by adapting and testing innovative alternative strategies among Spanish-speaking women at risk for breast cancer. No consumer-oriented materials currently exist for this CER. This proposal has three specific aims: 1. To conduct formative research to develop language-, literacy-, culturally-, and content-appropriate evidence-based patient-oriented messages for the chosen CER. 2. To develop and pilot test the efficacy of three alternative prototypes (e.g., print media, community health worker, computer delivery) for the delivery of the messages in Spanish-speaking women. 3. To develop, in collaboration with AHRQ and other stakeholders, a plan to disseminate the results to promote the effectiveness and impact of the CER recommendations among Latina women at risk. To balance consumer-, clinical, and evidence-based perspectives, the project will employ a community advisory board of stakeholders, key informant interviews, and focus groups to assist in identifying and """"""""translating"""""""" the key messages, identifying the optimal dissemination venues, and recruiting a population of high-risk women to test the vehicles. We define translation as adapting the language, literacy level, and cultural focus of the CER's evidenced-based recommendations to target the intended audience. The available dissemination materials for this CER topic are highly technical. Thus, for this initial project, we concentrate on evaluating the relative efficacy of the translated strategies using a multi-arm randomized control trial. An important part of our project will be to develop a dissemination plan that considers alternatives for scaling up of the intervention(s) that we find to be efficacious for future evaluation of their effectiveness in the real world. RAND Health has assembled an exceptional project team with skills and experience in the evidence review process, breast cancer prevention and treatment, health communication, bilingual and bicultural implementation and evaluation methods, as well as direct experience with the population of interest.

Public Health Relevance

Lack of language-, literacy-, and culturally-appropriate evidenced-based information contributes to disparities in breast cancer health care and health between Latinas and non-Latina white women. The proposed project will pilot and compare three evidence- based patient-oriented educational prototypes targeting Latinas, for a potentially life- saving preventive treatment, and using alternative modes of delivery (print media, community health worker, computer delivery).

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Special Emphasis Panel (ZHS1-HSR-C (02))
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Cravens, Catherine
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Rand Corporation
Santa Monica
United States
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