1/30/2012 Nuts and Bolts of CBPR Workshop 1/27/2012 Better Breast - PDF document

1/30/2012 Nuts and Bolts of CBPR Workshop 1/27/2012 Better Breast and Cervical Cancer Control for Korean American Women: A Community Partnership to Address Health Disparities Hae-Ra Han, RN, PhD, FAAN The Johns Hopkins University School of Nursing Baltimore, MD National Cancer Institute (CA129060) Purposes of this presentation To introduce The Healthy Korean Americans 2020, a community-academic partnership to address health disparities faced by the community; and To review the progress of The Healthy Korean Americans 2020 focusing on cancer control 1

1/30/2012 The Healthy Korean Americans 2020 Source: Han HR et al. J Immigr Minor Health. 2007;9(2):137-46. Korean Resource Center (501 c) Executive Council Kim B. Kim CEO/President Hae-Ra Han Chung K. Pak Commissioner, Governor’s Commission Associate Professor on Asian-Pacific American Affairs Johns Hopkins University Young D. Cha Ohoe Kim President (1 st ), National Association of Professor, Towson University Korean American Pharmacists Sang Kyun Shin Yang Kon Kim Franklin Sq. Hospital Professor, Towson University St. Joseph Hospital 2

1/30/2012 Asian Americans Growing fast - 3.8 million in 1980  16 million in 2010 (biggest increase) Korean Americans (KA) are one of the fastest growing subgroups, especially in major metropolitan areas - KA is the second largest minority in the greater Baltimore area Korean Population in the US 1940-2010 1,800,000 Year Population 1,600,000 1940 8,568 1,400,000 1950 10,000 1,200,000 1960 25,000 Population 1,000,000 1970 69,130 800,000 1980 354,593 600,000 1990 798,849 400,000 2000 1,076,872 200,000 2010 1,600,000 0 1940 1950 1960 1970 1980 1990 2000 2010 Year 3

1/30/2012 Major Barriers to Adequate Health Care Individual Adequate  Language  health literacy Health  Fear or being intimidated Care by main health care system Psychological  Feeling of marginalization  Loss of self-confidence  Role conflict r/t dependency on others  “Do not want to be a burden to family”  Depression Environmental/financial  Safety  Cost of medication  Access to health care Language spoken at home  US Census – 11% (23.1 million) of the total population (>= 5 yrs) spoke a language other than English in 1980 to 14% (31.8 million) in 1990 to 18% (47.0 million) in 2000.  American Community Survey – 19.7% (54.9 million) in 2006 % Having English difficulty 80 70 60 50 40 70 30 47.3 48.7 20 33 29.7 10 8.7 0 Source: U.S. Census Bureau. Available from http://factfinder.census.gov/servlet/STTable?-geo_id=01000US&- qr_name=ACS_2006_EST_G00_S1601&-ds_name=ACS_2006_EST_G00_ Health literacy “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions” (U.S. Department of Health and Human Services. Health literacy definition. Washington, DC: U.S. Department of Health and Human Services; 2000) A major determinant of positive health behavior and outcomes 4

1/30/2012 Unequal cancer burden faced by KA women KAs face an unequal cancer burden related to the significant language, health literacy, and cultural barriers. KA women are experiencing rapid increases in breast cancer incidence and have the second highest incidence of cervical cancer nationally. Breast and cervical cancers diagnosed at significantly later stages than those of whites The least likely racial/ethnic group to receive early breast and cervical cancer screening 여성의 건강이 가족 건강으로 직결됩니다 Source: Han HR. Better Breast Health for Korean American Women 2005- 2007 (CA110939) Better Breast and Cervical Cancer Control for KA Women Purpose: To assess the effects of a health literacy-focused cancer control intervention delivered by trained CHWs on 1) obtaining mammogram and Pap tests and 2) health literacy in non- adherent KA women Design: RCT with a delayed intervention Sample: 560 KA women ages 21-64 5

1/30/2012 Study design SAMPLING SITES AND CHW RECRUITMENT/TRAINING Random Sample/Assignment of Churches (n=28) CHW Recruitment/Training (n=40) RECRUITMENT & ENROLLMENT of KA WOMEN TREATMENT GROUP CONTROL GROUP Churches (n=10) Churches (n=10) CHWs (n=10-15) CHWs (n=10-15) Participants (n=280) Participants (n=280) Structured Intervention • In-class health literacy education by • Early detection pamphlet CHWs • Data collection for 6 months • CHW follow-up counseling • CHW navigation assistance for 6 months • Data collection for 6 months Delayed Intervention • In-class health literacy education by CHWs • CHW follow-up counseling • CHW navigation assistance DATA ANALYSIS & DISSEMINATION Study Process Preparation Recruitment Education Reinforcement Study Process Preparation Recruitment Education Reinforcement • Intervention • Churches • CHW material • Community education development & Telephone • Participants Health refinement Counseling Workers • Focus group • Participants Navigational meetings Services 6

1/30/2012 Focus group meetings Aim: To develop and refine Picture Guide Book, health messages 7

1/30/2012 Participants  Health literacy picture guide book & DVD  Computerized tailored health message booklet  Community Resource Book Preparation Recruitment Education Reinforcement • Material • Churches • CHW development & • Community education refinement Telephone • Participants Health • Focus group Counseling Workers meeting • Participants Navigational Services 8

1/30/2012 CHW Participant (N) Holy Korean Kim,Soon 13 25 Martyrs Nam, KS Catholic Church Bethel Presb.Church Korean 31 20 Lee, YH Presb.of Pak,YS Baltimore Yale 15 Presbyterian Jung,EH Church KoAmerican 30 Church of Chin, HK Philippi Kang, Lucia 32 St.Andrew Kim Korean Korean Catholic Church 13 Lim,SS 19 Choi, YM Meth.Church of Love New Covenant Glen Burnie 15 Fellowship Kim,Kay Jang, JM 12 Korean Church Presb.Church Yale 36 Presbyterian Jung,EH 4 Counties in Maryland Church Washington Churches (N=11) Spencerville Yoon, MW 7 Korean SDA CHWs (N=13) Church Participants (N=278) CHW Participant (N) Northern VA. 20 Korean 10 Cho,SH Ko,SH Korean Central Presbyterian Presbyterian church Church Washington 25 Suh, Grace Jang,JM 10 Eden Presb.church The Korean Park, IK 10 Presbyterian. 15 Kim,MS Church of St.Paul chung Catholic Church Washington McDonald, Young Saeng 20 MJ Korean 20 Kim,YM Presbyterian Church Park, IK 10 St.Paul chung Catholic Church McDonald, 20 MJ New Covenant Rhee,JS 26 Fellowship Church The Light 20 Global Mission Kim, JS Church International 23 Chong,CS Calvary Church The Church of Kim,MJ 25 All Nations 2 Counties in Virginia (Loudoun, Fairfax) Church of Chausse,ES 18 Churches (N=12) Disciples CHWs (N=15) Participants (N=282) Demographic characteristics – All females in their late 40s with at least a high school level of education None had formal health education background except one (retired RN) 9

1/30/2012 Reinforcement Preparation Recruitment Education Stage stage Stage • Participants • Material • Churches development & • Community Telephone refinement Counseling Health • Focus group Workers Navigational meeting • Participants Services 10

1/30/2012 No. of education 109 42.5% 20.8% 36.7% Reinforcement Preparation Recruitment Education stage Stage Stage • Material • Churches • CHW Monthly development & • Community education Telephone refinement • Participants Counseling Health • Focus group Workers Navigational meeting • Participants Assistance Number of attempts to Total number Sessions Number of contact of minutes of participants participants counseling 1 st 274 427 4088 2 nd 257 412 4628 3 rd 215 332 3408 4 th 176 282 2227 5 th 167 241 1576 6 th 110 109 1093 Total 1,199 1,803 17,020 11

1/30/2012 65 36 36 6 • 1---------5 4.51 Satisfaction • 1---------5 Helpfulness 4.52 Preliminary findings 12

1/30/2012 56.8 54.1 60 50 40 Intervention 30 Control 20 9.9 9.2 10 0 Mammogram Pap smear E d u c a t i o n E d u c a t i o n 13

1/30/2012 Diff (3mon-base) Diff (6mon-base) F p M (SD) M (SD) Intervention 7.99 (9.77) 11.85 (10.33) Familiarity 23.05 .000 Control 4.65 (8.68) 8.10 (9.89) Intervention 5.48 (6.57) 7.67 (6.76) Comprehension 125.58 .000 Control 1.20 (3.79) 2.28 (4.28) Intervention 1.88 (3.39) 3.16 (3.65) 13.00 .000 REALM 12 Control 1.33 (2.72) 2.00 (2.74) Intervention 0.68 (2.01) 0.59 (2.21) Numeracy 6.91 .009 + Control 0.18 (2.02) 0.25 (1.81) Vital Intervention 8.06 (8.97) 11.50 (9.76) Total 105.83 .000 Health Control 2.71 (5.85) 4.53 (5.75) Literacy Intervention group  8 times Control group  4times 14