Added: Gianina Riccio - Date: 07.02.2022 08:40 - Views: 16676 - Clicks: 4388
Try out PMC Labs and tell us what you think. Learn More.
Native Hawaiians have higher cancer mortality rates and lower cancer screening rates compared with non-Hawaiians in Hawaii. People living in rural areas have particularly limited options for cancer services, especially for services that are culturally attractive and convenient. Recruitment and follow-up for screening and treatment were offered. Principles of community-based participatory research, Hawaiian values, and Kreuter's strategies guided the de of the event. Of the 73 participants, 10 had abnormal screeningand all received follow-up screening, treatment, or both within 3 months.
Six months after the event, the of men current with prostate cancer and colorectal cancer screening and the of women current with clinical breast examination and colorectal cancer screening increased ificantly. In addition, the of participants affiliated with the community's Native Hawaiian health care system and the with health insurance increased ificantly.
studies have noted the barriers to increasing cancer screening among underserved minorities. Culture- and community-based strategies appear to be successful at overcoming these barriers. Compared with whites and Japanese the state's healthiest and most longevous groupHawaiians have the highest cancer mortality rates, in part because they often are diagnosed at a late stage after cancer has spread and treatment options are limited 2. Native Hawaiians also have lower rates of cancer screening than other groups. Hawaiians living in rural areas, especially the islands of Molokai, Lanai, and Niihau, have limited access to cancer screening: none of these islands have capability to provide colonoscopy, and neither Lanai or Niihau have mammography facilities.
Given the low screening rates and late stage of diagnosis, it appears that mainstream cancer screening programs are unsuccessful at recruiting Hawaiians. Other investigators suggest this may be because of the cultural inappropriateness of these programs 4. The sidebar provides a glossary of Hawaiian terms. Culturally appealing health education materials contribute to successful community-based programs.
This paper describes the program, evaluation methods, and lessons learned about the feasibility and effectiveness of this approach. During throughcancer cases were reported on Molokai Kevin Cassel, Cancer Information Services [CIS], oral communication, Januarywhere each new diagnosis of cancer often has a widespread impact on the members of this close-knit community.
This community was selected because of Molokai's high proportion of medically underserved Hawaiians, the lack of medical resources on the island, and its request for help with cancer screening. Molokai General Hospital, the island's only hospital, is a bed facility providing acute and long-term care and low-risk obstetrical inpatient services.
Four family practitioners live on Molokai, an obstetrician—gynecologist is flown in monthly to supervise the midwives and treat patients with complex cases, and other physician specialists visit Housewives looking casual sex Molokai Hawaii. Mammography, sigmoidoscopy, and laboratory services are available on the island; colonoscopy is not available. Principles of CBPR 1011Kreuter's strategies for targeting messages 8and key Hawaiian cultural values guided the de of this event to address team-identified barriers Table 1.
Planning began 6 months before the event, and follow-up activities took an additional 6 months, making this a 1-year project. In this way, Honolulu team members could demonstrate helpfulness and respect for Hawaiian ways and Molokai people, thus gaining credibility.
Throughout a talk-story session, the importance of cancer screening, especially for Hawaiians because of their high cancer incidence and mortality rates, was emphasized. Team members collaboratively devised the registration protocol, and practice sessions were conducted to assure protocol fidelity.
Participants aged 50 years and older were provided an FOBT kit to complete before the event, and men aged 40 years and older were given laboratory requisitions for PSA testing, both of which were recorded as having been distributed in the baseline questionnaire. This allowed the team to track the participants who would need to discuss with a kauka at the event.
We ased a general timeslot in which to see a physician for each registrant so that we could allocate visits evenly during the 1-day event and minimize participant wait time. We anticipated that some of those recruited would not attend. Because we invited preregistrants to bring other family members, we expected new recruits on the day of the event. Participants ed in, and those who had not preregistered spent their first minutes being assisted with the consent form and baseline questionnaire. Participants were then moved through a series of stations, starting with Cancera basic cancer education session developed in collaboration with Hawaii's Cancer Information Service CIS and presented by a kauka who emphasized the importance of early cancer detection and treatment for Hawaiians.
Adults then met one-on-one with a same-sex kauka for 30 minutes for screening and education. They arrived on the island the evening, allowing time to become oriented to the event and to provide a free Housewives looking casual sex Molokai Hawaii medical education workshop on cancer among Native Hawaiians. The project paid for travel and on-island accommodations for the kaukaand the kauka donated their time to the project. During their stay on Molokai, the kauka were seen in casual clothing and in friendly interactions to help participants feel comfortable.
From female kaukawomen received a clinical breast examination, instruction in breast self-examination, and education and screening for oral and skin cancers. From male kaukamen received education and screening for skin, oral, prostate, and testicular cancers. Although the U. Additional health education stations focused on site-specific cancers and lifestyle behaviors and included a station staffed by a CIS member devoted to skin cancer education and at which sunscreen samples were distributed.
An Ask-a- Kauka station allowed participants to ask a kauka any medical questions. Education and screening concluded with a personalized exit interview with a kauka who emphasized kuleana in caring for oneself and others and summarized recommendations for follow up, future screening including mammograms, colonoscopies, and Papanicolaou tests [Pap smears]and lifestyle changes such as smoking cessation, improved diet, and more exercise. Participants were served a healthy Hawaiian lunch, and music was performed by popular local musicians.
Finally, adult participants completed a self-administered survey at the fifth-grade reading level with an item on satisfaction scored on a 5-point Likert-type scale and four open-ended items on what participants learned, liked best, would recommend to improve the event, and wanted to learn about in future programs. As defined in the team-developed protocol for follow up, within a month of the event, participants received letters explaining their screeningreiterating recommendations for follow up on abnormal findings, and recommending screenings not provided at the event.
Assistance with obtaining insurance, scheduling appointments, and transportation also was offered in the letter. The two-tailed exact test version of McNemar's test was used to determine the ificance of changes in measures of health care status from event registration to 6 months after the event. On the day of the event, 73 adults from 41 families were screened, including 63 Native Hawaiians, eight Filipinos, and two whites.
The 73 participants included 42 who had preregistered. Of the 20 who preregistered but did not attend, we later learned that 11 attended funerals of two community members who had recently died and nine attended a community youth baseball game. Of the 31 who registered on event day, five were men who accompanied their wives to the event and were persuaded to participate while waiting for their wives, 14 attended with family members who had preregistered, and 12 had learned of the event through friends and neighbors.
Table 2 compares measures of health care status of participants before and after the event. One year-old man Housewives looking casual sex Molokai Hawaii never having had a physical examination. About one third of women aged 40 and older were not current with breast cancer screening, including 13 women who had never had a clinical breast examination or mammogram.
ificant improvements were found in screening compliance whether received at the event or in the following 6 months and insurance coverage 6 months after the event. All 10 participants with abnormal findings one colorectal, two breast, two prostate, and five skin received follow-up screening, treatment, or both within 3 months of the event. Because insurance enrollment is a time-consuming process, free follow up was obtained for five uninsured participants who needed immediate attention for abnormal findings.
Participants were impressed with the helpfulness and caring of the kauka and the CHWs. One participant commented, "If they care about my health, I should too. As noted in studies, barriers to increasing cancer screening among racial and ethnic minority populations include limited cancer screening knowledge, limited accessibility of health services especially culturally tailored servicesand lack of clinician recommendations 451116 Other elements of success were the time devoted to personalize recruitment, event day, and follow-up and the demonstration of caring by kauka and CHWs.
These elements helped reduce the chance of participants dropping out during the year. The elements also helped establish and enhance relationships among community members and health providers, which proved necessary for changing health care use patterns among the underserved.
The power of trust building also was reflected in the fact that 26 individuals registered for screening on event day, citing the recommendation of a family member or friend. Although not mentioned in the written evaluations by participants, both participants and providers expressed appreciation for brochures with Hawaiian faces. That 16 individuals indicated that they liked "everything" suggests that the relaxed, festival-like atmosphere was also important.
Although each participant was allowed 30 minutes or more with a kauka and some participants had to wait to be seen, only three participants mentioned the waiting time as the thing they liked least. Subsequent focus groups with Native Hawaiian men found that they avoid visiting physicians unless they are in pain Men also communicated that health was traditionally the kuleana of women, and so they depended on wives and daughters to pressure them to seek health care when needed.
Despite intensive follow-up, one man did not have a PSA test within 6 months of the event, 6 women did not have mammograms, and 13 women did not have colorectal cancer screening. Small sample size was a limitation to our study. Although many participants registered on-site, about 20 community members who had preregistered did not attend the event because of other obligations. Also, because a major goal was to test the feasibility of the event, we only recruited participants, and there was no control group against which to measure our effectiveness. Next steps include seeking funds for an experimental test of the program in other underserved Hawaiian communities, using a randomized controlled de, to examine its effectiveness with increasing cancer screening rates and bringing people without insurance, a medical point of contact, or both into the health care system.
Given the participant appreciation of the educational aspects of the intervention, we recommend adding questionnaires to assess knowledge and attitudes to evaluations of future offerings.
Future research also should be performed to identify barriers to cancer screening in Native Hawaiian communities. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U. Use of trade names is for identification only and does not imply endorsement by any of the groups named above. Prev Chronic Dis [serial online] Jul [date cited]. National Center for Biotechnology InformationU.
Journal List Prev Chronic Dis v.
Prev Chronic Dis. Author information Copyright and information Disclaimer. Corresponding author. Copyright notice.Housewives looking casual sex Molokai Hawaii
email: [email protected] - phone:(751) 644-6799 x 2078
The `Ohana Day Project: A Community Approach to Increasing Cancer Screening