cancer awareness network for immiiigrant...
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Center for Immigrant Health (CIH)
NYU School of Medicine
How Effective Are They?
Focus on Three Project Areas Community Cancer Education and
Outreach Materials Development
Technology Access Provider Practices and Education
and Language Access
CANIMP Mission
Builds bridges between immigrant communities and cancer
health service providers and researchers in the areas of lung,
prostate, breast, cervical, oral, and colorectal cancers
Latino, Haitian, English-speaking Caribbean, Chinese,
Korean, South Asian immigrant communities
Eight Intertwined CANIMP
ElementsCommunity Outreach and EducationProvider EducationFormative ResearchJunior Minority Scientist Mentorship ProgramPilot ProjectsCANIMP Internship ProgramTechnology Access ProgramCommunity Training Program: ResearchMethodology
PARTNERS
Community Cancer
Education and Linkages
Eunah Chung, M.P.H.
Community Cancer Education andLinkages
Programs Ever-Changing, Based onOngoing Focus GroupsVariety of Venues
English as Second Language ClassesSoccer ClubsCBO PartnersFaith-based Sites
Korean Community Focus GroupsFocus GroupMost participants visited doctors after they became sick andafter self-medication had failed (home-remedies, traditionalmedicine, over-the-counter medicine)Fear of receiving “bad-news”Language problems inhibited them from seeking medicalattention – even when sick, they forego medical attention ifinterpretation services unavailable or unable to find a friend orrelative to interpretTranslation services were “poor”Breast Cancer - Self breast exams as “hateful” and refused toperform themMammograms – inability to pay, difficulty taking time off, painassociated with mammograms, and fear of results
Focus Groups
Focus Groups Cervical Cancer - Lessknowledgeable about cervical cancer thanbreast cancerBelieved to be caused by frequent sex,abortions, having many children, uncleanhabits and untreated venereal diseaseProstate Cancer – several Korean men didnot know what the prostate was
Tracking Those Educated
825 community members wereeducated over 6 months
732 evaluations were received 80% were women 82% undocumented
Did they go for screening and follow-up?Now being tracked
Those reached
Ethnic Distribution
Other
1%
Haitian
39%
Korean
5%Caribbean
6%Chinese
15%
Latino
34%
Not Enough Men, Therefore…
Lay Health Worker Program for Men
Unique Focus for Lay Health WorkerPrograms
Program Success to be Tracked byUtilization of Screening and Follow-upServices
Health Education Materials:
THE HAITIAN EXAMPLERachel Andre
Printed materials
The Subcommittee for Materials Reviewand Development
Collected over 200 cancereducational materials from local,national, and international sources
Pamphlets, books, posters, showercards
Inadequate Materials
Cancer educational material in Creoleand/or French for the Haitiancommunity was almost entirely lackingExcept….
Cancer facts for men and women Taking Control (Nutrition facts) Breast Self-exam brochure
How Did These
Measure Up?
Cancer Facts for Men Brochure
Results
A literal translation of the EnglishHigh literacy levelOverloaded textThey were culturally inappropriate
Caucasian photos in old versionUnappealing visually
CANIMP Creates Its Own
These brochures were focus grouptested by the community and byproviders and scored well
However…video materials are sorelyneeded and are under development forprostate and colorectal
How Did We Do?
Developing Culturally Appropriate Education
Materials: Determining Effectiveness
Jennifer Lin, M.D.
SCCAN: Screening CTs in ChineseAmerican Newcomers
GoalsTo elucidate barriers and facilitators to Chineseimmigrant participation in cancer screening trialsTo develop strategies to enhance recruitment intothe NYU Early Detection Lung Cancer StudyTo develop recommendations for the facilitation ofrecruitment of Chinese immigrants in to cancerclinical trials
Methods- Part Ifocus groups with community members, keyinformants and physicians
OutlineKnowing your target audience
Partnering early with the community
Transcreating materials
Test marketing
Tracking Effectiveness of Materials
Knowing your audience
Know the languageTraditional Chinese versus Simplified Chinese
Know the level of literacyOnly 3% of newer immigrants from Fuzhou areelementary educates
Know who to include in your target audienceInclude the family
Partnering with the communityEARLY
Help identify target audience and familiarize withtheir cultural issues
Possible source of translators
Serve as advisory group for test marketing
Help disseminate educational materials
Transcreating Materials:Knowing culturally specific preferences
Tone and AttitudePositive reframing• i.e. superstition surrounding cancer, “keeping
healthy” instead of “cancer screening”
Soften tone• do not use “you must” or “you need”
Testimonials
Transcreating Materials continued…Clarity of Content
Transcreation• Literal translation is difficult to understand• “like [a] textbook from [a] doctor’s office…”
Explain difficult or foreign concepts
Be explicit about certain content areas• “FREE”
• “painless”• No medications involved• No documentation necessary
Transcreating Materials continued…
AestheticsColor• red, pink, blue, green
Symbols• no bones / skeleton
Pictures• smiling Asian faces
Text• No big paragraphs
Test MarketingBack translation is NOTsufficient
Use the help of CBOs
Reviewers should besimilar to target audience
Should not be familiar withsubject matter ofeducational material
Tracking Effectiveness
�Controlled Study�2 Senior Centers 1 with specially developed materials
and intervention1 with usual and customary cancer
health education�Measure rates of clinical trials
enrollment
Summary
Chinese immigrants are an extremely diversepopulation
Cultural preferences specific to the Chinesepopulation can be addressed by partnering earlywith CBOs and test marketing translatedmaterials
Disseminate materials with CBOs and use amulti-faceted approach with written educationalmaterial
Technology Access Program
Jyotsna Changrani, M.D.,M.P.H.
Why Consider the Internet?The online population is more and more like the generalpopulation
Women, minorities, and those earning between $30,000and $50,000 are flocking online
62% of Internet users, or 73 million persons, have goneonline to search for health information
6 million persons go online for medical advice on atypical day – more than the number of people whoactually visit health professionals
Importantly,
62% of health seekers researched aspecific illness or condition. Informationon cancer was most popular amongdisease-researching health seekers
61% of health seekers say the Internethas improved the way they take care oftheir health either “a lot” or “some”
However, the Digital Divide Remains
LinguisticLimited non-English and bilingual sitesContent sparse and less accurate
Cultural“One Site Does Not Fit All”
CANIMPRecent Technology Projects
Caribbean CARES
Virtual Community for Immigrants withCancer
CaribbeanCancer Awareness Resources Education Services
To explore strategies that can be employed toimprove penetration and effectiveness of cancercommunication through the Internet inimmigrant communities
Methods included compiling and reviewingexisting online and offline materials; conductingwebsite review sessions with the targetpopulation; and, based on the above,developing a website prototype
The Divide
Of the 31 persons ‘extremely’ or ‘quite’confident in accessing the Internet, only 2 hadused the Internet in the past 6 months toaccess health/medical information
Compares unfavorably with the general U.S.population where 62% of all people on theInternet have used it to access health/medicalinformation
Virtual Community forImmigrants with Cancer(VCIC)
†• Lack of face-to-face support groups for limitedEnglish proficient population
• Where available, face-to-face groups not alwaysconvenient
• feeling too weak or sick to go outside their homes• feeling depressed and ugly• did not want to leave home
• Professionally facilitated online support for non-immigrant English-speaking breast cancerpatients successfully reduced their depression,distress and negative reactions to pain
Spanish Online Support Groups: The Need
VCIC: Project Overview
VCIC provides information, and emotionaland social support to Spanish-speakingimmigrants with breast cancer, through anonline support groupThrough VCIC we will evaluate feasibility,acceptance, and effectiveness of onlinesupport groups within immigrantcommunities
VCIC:Scope of Effectiveness Tracking
The Intervention
Impact on Being a Cancer PatientPsychosocial Adaptation (Pre- and Post-Testing)
Project Implementation and Associated Costs
Whatever the outreach
materials or venue, a poor
reception will ruin the best
efforts
When a patient successfully reaches thehealth care system, what awaitshim/her?
CANIMP Cancer Education and
Services: Response to StatedBarriers
Language
Language
Culture
Finances
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