The PI joined the NIMHD DIR in mid-November 2017 as Scientific Director. She transferred an active RCT of a stress management program for rural Latina breast cancer survivors to Steven Gregorich, PhD, at UCSF. She continued as a collaborator/Co-investigator on the project. In this study, we adapted for rural Latinas with breast cancer the Nuevo Amanecer (NA-I) program that we previously found effective for reducing distress and improving quality of life among Spanish-speaking women with breast cancer living in the San Francisco Bay Area. In this fiscal year, our major accomplishments include: a) maintenance of a multi-site research team composed of two rural community-based organizations and a rural public health care system, Circulo de Vida (CDV), and the University of California San Francisco (UCSF); b) exceeding our enrollment target of 140 women, with enrollment and randomization of 153 women into the RCT; c) retention rates of 90% of women at 3-months and 92% of women at 6-months; d) completion of at least 7 of 10 of weekly sessions by 87% of intervention group participants; e) data entry and quality checks of all data collected to date; f) writing SAS code, deriving scores, and analyzing psychometrics of baseline data; g) presentation of the study and program at four scientific conferences; h) completion of debriefing interviews with some of the study sites; and i) drafting of the community guide on program implementation. Baseline characteristics of participants are: mean age of 55 years (range 28-88 years), 80% have high school or less education, 97% are Mexican origin, 66% are married, 75% have public/no health insurance, 18% are employed (full/part time), 49% reported financial hardship in the past year, 47% reported fair or poor health, and most were limited English-speaking (82% spoke English less than very well). Plans for next year are to complete follow-up assessments, finish delivering the program to wait-listed participants, complete debriefing interviews with a subset of participants, conduct quantitative and qualitative data analyses, prepare final reports and manuscripts, and disseminate results and the community guide with program materials. We will develop several manuscripts on the study design and intervention, recruitment results, and results of the randomized trial. We will disseminate our findings to our community and clinical partners, and more broadly. We will pretest and finalize the community guide and build web pages to disseminate program materials and study findings and publicize these resources. A related project consisted of the writing of a manuscript that reports on a new implementation science framework we developed called, The Transcreation Framework for Community-engaged Behavioral Interventions to Reduce Health Disparities. This framework includes the major advantages of other implementation science frameworks while adding important methodological steps critical for reducing health disparities. Perhaps the most novel feature is recognizing that when researchers address social determinants and health disparities with the full engagement of community partners experiencing the disparity, the intervention produced is not an adapted evidence-based intervention (EBI), but a new intervention because of the extensive adaptations required to fit the community context in the presence of these disparities. In the manuscript, we discuss five defining features of our framework: 1) balances fidelity to scientific evidence and fit to develop a new transcreated intervention, (2) tests the transcreated intervention in community settings, 3) engages the community throughout and builds capacity, 4) uses rigorous scientific methods in community settings, and 5) expands the types of evidence used for transcreation of behavioral interventions. We also highlight differences between our framework and the other implementation science models that we reviewed.

Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
National Institute on Min Health & Health Disp
Zip Code
Lee, Jonathan S; Nápoles, Anna; Mutha, Sunita et al. (2018) Hospital discharge preparedness for patients with limited English proficiency: A mixed methods study of bedside interpreter-phones. Patient Educ Couns 101:25-32
Nápoles, Anna María; Stewart, Anita L (2018) Transcreation: an implementation science framework for community-engaged behavioral interventions to reduce health disparities. BMC Health Serv Res 18:710
Johnson, Julene K; Gregorich, Steven E; Acree, Michael et al. (2017) Recruitment and baseline characteristics of the Community of Voices choir study to promote the health and well-being of diverse older adults. Contemp Clin Trials Commun 8:106-113
Echeverri, Margarita; Anderson, David; Nápoles, Anna María (2017) Assessing Cancer Health Literacy among Spanish-Speaking Latinos. J Cancer Educ :