Comunidades Unidas

Taking Action Summary

Assessment:
In 2008, Utah had the lowest rates of mammography in the country. As efforts to increase screening were established in the following years, the need for culturally-appropriate outreach and education became evident as rates of screening in marginalized communities remain dangerously low. The greatest risk factors for not being screened were determined to be lack of insurance, lack of a primary care provider, and poverty. All of these issues disproportionately affect the Latino community. In 2010, 40% of Latinos of Salt Lake County were uninsured, 38% were without a primary care provider, and 26% could not receive care due to cost. With the help of community leaders and focus groups, the need for a culturally-appropriate intervention was identified and the Latina Breast Cancer Awareness Program was born.

Planning:
The Latina Breast Cancer Awareness Program identified Promotores de salud as an innovative and effective intervention that had seen success in the Latino community. With the help of community members and nursing professors from the University of Utah, Comunidades Unidas created an original Promotores training curriculum entitled ‘Amiga Mia’. This curriculum contains seven sections that address a range of issues including the role of promotores, breast cancer detection and prevention, nutrition and physical activity, navigating the health system, and culturally-appropriate care. The mission of this program is to increase the rates of breast cancer screenings in the Latina community by empowering women to take control of their health and well-being. Our goal is to educate and refer at least 1,000 women per year and provide case management and support for 200. We prioritize strategies that are: culturally appropriate, accessible, non-intrusive, and community-based.

Taking Action:
Our Promotores de salud utilize several strategies that are uniquely crafted to fit the needs and culture of our community. ‘Girls Night Out’ is a special event where women are pampered and given a night away from their children. In this setting, women feel comfortable discussing breast health and receive education and referrals to screenings. Promotores also host ‘charlas’ (informal chats) in strategic community gathering places including parks, churches, schools, and community centers. By basing their activities in the community, Promotores are able to reach those who experience barriers like a lack of transportation or childcare. Women also receive information about breast health and services when attending fitness classes. Promotores collaborate with yoga and Zumba instructors to provide informational sessions before and after their classes. In this way, they reach women in a familiar setting and emphasize the importance of health lifestyles as an important part of breast cancer prevention.

Evaluation:
The impact of the Latina Breast Cancer Awareness Program is evaluated at several levels. Through monthly reports, we are able to track the number of women who have been served by our program and the effectiveness of our activities. Our most important evaluation tool is the feedback of Promotores who continually provide insight and suggestions about successful parts of the program and areas that can be improved. We also employ post-screening evaluations that measure the barriers to care, effectiveness of our program, and risk factors for low screening rates. These evaluations show that 83% of participants began performing self-exams and 62% began consuming healthier diets. Most importantly, 73% of participants said they would not have been able to receive an exam without the help of the program. We discovered that women with low English language proficiency were twice as likely to miss their appointment and began to emphasize our language services.

Sustaining the work:
The Latina Breast Cancer Awareness Program relies heavily on the theory of peer education which adds greatly to the sustainability of this intervention. Because behavior change occurs within a communal body the impact continues as long as the community exists. We also ensure the sustainability of our program by building advocates and encouraging family knowledge sharing so that the behavior change and knowledge effect multiple generations. This is especially true for our Promotores whose generational impact on their children and families will create sustainable behavior change in their communities. This program has received continual funding from the Susan G. Komen Foundation and we work diligently to meet our standards and goals in order to ensure that it continues.