Candidate. I am a driven early career investigator with the long-term goal of becoming an independent scientist in the field of cancer disparities. My major research interests concern identification and incorporation of psychosocial facilitators to breast cancer screening into interventions to reduce disparities in late stage detection. In that light, I have conducted observational, mixed method, community-based participatory research (CBPR) studies and led secondary analyses which indicate social outreach (e.g., conversations with family and friends) and volunteerism are associated with breast cancer screening among Latinas. The next logical step is to develop an intervention that would empower women to engage in social outreach and volunteerism and examine its effects on these women and their networks. I however need training and mentorship to take this next step. My four career objectives are thus to gain expertise in: 1) leading empowerment interventions; 2) implementing CBPR interventions; 3) using social network analysis; and 4) competitive grant writing. My training plan at the University of Illinois at Chicago (UIC) consists of didactic training (coursework, seminars, and workshops), participation in scientific conferences, manuscript development, submission of NIH grant applications, and mentorship from scientists with strong track records in mentorship and expertise in empowerment strategies (Dr. Ferrans), intervention science (Drs. Ferrans, Mermelstein, Geller), social network analysis (Dr. Schneider), and grant writing (all). I will also be trained in the responsible conduct of research. These experiences will position me to be a unique investigator that can compare the potential of different participatory-based interventions to improve individual- and network-level outcomes for the underserved. Environment. UIC is ideally suited for my career progression into independence and implementation of the proposed research. It is one of the top 50 research-funded institutions in the nation and a designated Hispanic- Serving Institution. It has strong partnerships with local Latino communities and is committed to cancer health equity. There are a number of career development opportunities, including, but limited to, seminars, workshops, and other resources through the School of Public Health, Cancer Center (UICC), Center for Research on Women and Gender, and the Institute for Health Research and Policy. Research Plan. Latinas suffer disproportionately from breast cancer relative to non-Latina Whites (NLWs), including late stage detection. While there have been controversies in breast cancer screening, non-adherence to guideline-concordant screening continues to be a major modifiable determinant of breast cancer outcome disparities. Thus, increasing participation in breast cancer screening among Latinas, especially care that corresponds with clinical and academic guidelines, is a public health priority. Participatory approaches are popular methods to improve screening within this group and have included approaches that 1) deliver education to non-adherent Latinas and 2) train community health advocates (community health workers, breast cancer survivors) to engage in breast health promotion. The second approach (empowerment interventions) concerns training participants to engage in social outreach (e.g., having conversations with family and friends about breast health) and volunteering (e.g., helping in health fairs, engaging in civic campaigns about breast cancer programs). Patient activation and volunteerism literature suggest that empowerment interventions may have `added value' for participants themselves over delivering education in terms of preventive health psychosocial factors and practices. Relative to education interventions, empowerment interventions may also affect women's networks, as they may be more likely to disseminate evidence-based breast health promotion among their family and friends. To date, little research has compared interventions' effects on individual-level outcomes or used formal social network analysis to examine network effects. The proposed work adds to the literature through empirically comparing two approaches (education versus empowerment) on three sets of outcomes: 1) women's own screening, 2) women's own self-efficacy, norms, support, knowledge; and 3) women's networks (measured by egocentric analysis). I will lead this work and will benefit from the collective expertise and resources of my mentors (Drs. Ferrans, Mermelstein, Geller) and collaborators (Dr. Schneider, The Resurrection Project, Metropolitan Chicago Breast Cancer Task Force, Sinai Urban Health Institute, University of Illinois Cancer Center).
Aim 1 intervention development will be accomplished through continuous stakeholder engagement and specifically through meetings and focus groups with a bilingual, bicultural community advisory engagement board (CEAB), UICC radiologists and target participants (non-adherent Latinas). We have already begun this process and are obtaining formative data. After we develop intervention materials, a pilot trial will be conducted with an area-level treatment control group design in Chicago. Participants will be 150 Latinas with no history of health volunteerism, residence in one of two targeted areas, and non-adherence to US Preventive Services Task Force screening guidelines.
Aim 1 intervention evaluation will involve an analysis to compare differences in receipt of a medical record-confirmed screening within six months of participating in the study.
Aim 2 will be an analysis to compare interventions' effects on self-efficacy, norms, support, knowledge across three time points ? pre-intervention, immediately post-intervention, and six months post-intervention.
Aim 3 will be a social network analysis, specifically egocentric, to compare interventions' effects on breast health, network size, and network density as well as will number of peers referred to the study.
The participatory-based project will quantify the `added benefit' of an empowerment intervention relative to an education intervention for 150 Latinas on the following outcomes: women's adherence to breast cancer screening guidelines; women's psychosocial facilitators (self-efficacy, norms, support, and knowledge); and women's dissemination of breast health messages throughout their social network. The empowerment intervention will train Latinas in how to discuss breast health with their family and friends and volunteer in local breast health promotion programs. Academic, clinician, and community partners will work together throughout intervention development and evaluation.
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