? ? Lay health advisor (LHA) intervention models have been increasingly utilized in American Indian and Alaskan Native (AI/AN) communities to address disparities in access to and utilization of recommended breast and cervical cancer early detection exams, including mammograms and Pap exams. While recent studies have documented moderate effectiveness of lay health advisor programs in increasing breast and cervical cancer screening rates in AI/AN communities, no studies have explored the attitudes, beliefs, and norms of tribal lay health advisors themselves, especially in interventions that target a highly stigmatized disease such as cancer. Further, researchers have yet to explore factors external to lay health advisors, such as fragmented health care systems and power imbalances, which may affect the capacity of LHAs to provide breast and cervical cancer-specific services. An investigation of these factors is therefore essential to elucidate future capacity development and intervention strategies for tribal lay health advisor programs to maximize their ability to bolster breast and cervical cancer early detection in their communities. To address this critical gap in scientific knowledge, this research project will conduct in-depth interviews with tribal lay health advisors to explore and analyze the key determinants which impact their ability to integrate cancer control activities into their scope of services. It is hypothesized that a host of determinants, not just cancer-specific knowledge and education alone, explains the variation in behavioral intentions of tribal LHAs to perform this critical health promotion role.
Specific aims of this study are to: (1) develop an interview schedule that incorporates the constructs of the Theory of Planned Behavior, to explore the attitudes, subjective norms, and perceived behavioral control of tribal LHAs, and to elucidate the pathways through which these factors impact their behavioral intentions to provide breast & cervical cancer- specific health education and/or navigational services to community women; (2) conduct open-ended, in- depth interviews with at least 30 tribal LHAs and LHA Directors; (3) utilize Grounded Theory to systematically analyze interview transcripts and identify relevant patterns, themes, and theoretical associations that explain the linkages between attitudes, subjective norms and perceived behavior control and the behavioral intentions of tribal LHAs to incorporate cancer control activities into their scope of services; (4) identify elements of the social, cultural, and political context of tribal communities that can be integrated into pre-intervention capacity development with tribal LHAs to maximize their effectiveness in providing cancer-specific educational and navigational services; and (5) identify community and health care system leverage points for intervention, which can be targeted concurrently with the implementation of LHA interventions, to improve the coordination and delivery of breast and cervical cancer early detection services in tribal communities. This study will explore and analyze the factors that impact the ability of tribal lay health advisors to promote early detection of breast and cervical cancer, two highly stigmatized diseases for which American Indian people experience disproportionately poor survival rates. It will also inform the capacity development needs of tribal lay health advisors to maximize their effectiveness in providing breast and cervical cancer-specific educational and navigational services. Moreover, this investigation will lead to the identification of tribal community and health care system leverage points for intervention, which can be targeted concurrently with the implementation of tribal lay health advisor interventions, to improve the coordination and delivery of breast and cervical cancer early detection services within American Indian communities. ? ? ?
