Despite the presence of five major academic medical centers, a large county hospital, and two NCI designated comprehensive cancer centers, Chicago has some of the worst cancer disparities between income groups in the US. This burden is accentuated with respect to linguistically and culturally isolated immigrants who do not traditionally benefit from nor participate in research. In particular, Chinese women in Chicago, a significantly understudied population, have unacceptably low breast and cervical cancer screening rates which are only half the rates of white women. This application is a direct outgrowth of concerns expressed by leaders of Chicago's Chinatown community about the need to educate and empower low income Chinese women about cancer prevention and control. Patient navigators (PN) have been studied in African American, Latino, and white populations. However, PN research has largely focused on follow-up of patients with cancer or abnormal findings, rarely to improve screening rates. We seek to study the dissemination of PN behavioral health services interventions by implementing a tailored PN intervention with a focus on increasing breast and cervical cancer screening as well as follow-up for the largely immigrant population of low income women in Chinatown. Our proposed research builds on two NIH funded PN studies, our Chinatown RC4 research infrastructure grant activities, including a community data resource center, and our long-standing community based participatory research (CBPR) partnership with Chinatown's major safety net provider, Mercy Medical Center. Using mixed methods within a CBPR approach, we aim to evaluate the effectiveness of PN adaptation and extension to cancer control education and screening under the auspices of our community research partner, the Chinese American Service League. We will study the fundamental mechanisms required to optimally adapt interventions focused on immigrant populations that are culturally and linguistically isolated. The proposed project seeks to expand the role of PNs, to learn more about what determines the effectiveness of PNs as health educators, how to encourage breast and cervical cancer screening, and how PNs can become trusted and respected community health workers and advocates that provide essential links between the community and the health care system for low income women in Chicago's Chinatown. This research will assess how Chinese women interact with health information and resources via a PN team to make health decisions and access the health care system. Women comprise the largest segment of health workers, health consumers, and health decision makers for their families and communities, but are underrepresented accessing appropriate health services among Asian immigrant populations. Once women are empowered, informed health consumers, they become catalysts for social change.
This proposed project aims to adapt the rapidly growing phenomenon of patient navigation into a broader effort to use community health workers for culturally competent cancer control and prevention. Our CBPR approach, grounded in the long-standing prestige of our community organization and safety net provider partners, offers the opportunity to close the loop between community-defined health problems and access to the local health care system. Because many women in Illinois already have public insurance coverage for cancer screening and follow-up but do not take advantage of this resource, this proposal has major relevance for future efforts to increase access for vulnerable populations once broader health reform laws are implemented.
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