Comprehensive cancer control plans implementation in appalachian communities program
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Comprehensive Cancer Control Plans Implementation in Appalachian Communities Program. Appalachian Cancer Network Bruce Behringer East Tennessee State University May, 2007. East Tennessee State University Activities in Appalachia.

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Comprehensive cancer control plans implementation in appalachian communities program

Comprehensive Cancer Control Plans Implementationin Appalachian Communities Program

Appalachian Cancer Network

Bruce Behringer

East Tennessee State University

May, 2007


East tennessee state university activities in appalachia

East Tennessee State University Activities in Appalachia

  • Health Sciences Division: Medicine, Nursing, Public Health, Clinical and Rehabilitative Health Sciences, Pharmacy

  • Develop community partnerships programs (1992 – present) to educate health professions students in and with rural and minority communities

  • Community-based participatory research in cancer, diabetes, obesity and substance abuse

  • NCMHHD Appalachian Center for Translational Research in Disparities

ETSU


Rural appalachian cancer demonstration program

Rural Appalachian Cancer Demonstration Program

  • Appropriation through CDC to “…explore, identify, describe, and document cancer disparities in Appalachian TN, VA and KY”

  • ETSU partnered to complete 20 studies in 2001 – 2006

  • Emphasis on qualitative inquiry using community-based participatory research on Appalachian “community as place” and its influence on health

  • Parallel ARC funded quantitative studies

Available at:

http://www.etsu.edu/kellogg/racdphomw.htm


Sample study results

Sample Study Results

  • Nine rural community focus groups …

    • Confused and inaccurate knowledge and awareness, physicians fifth as source of info

  • The Cancer Message Workshop…

    • Find kernels of truth in clearly incorrect statements

  • Primary care provider role in cancer care…

    • Patents seek validation of results and plans

  • Multiple studies…

    • External factors (environment) seen as cause

  • Presentation results: surprise community leaders, confirm health providers sense, acknowledge reality of rural communities


Rural appalachian cancer research review work groups 2006

Rural Appalachian Cancer Research Review Work Groups (2006)

Community perceptions of “What makes the experience with cancer different in Appalachia?”


Contributing factors what makes appalachia different

Contributing factors : what makes Appalachia different?

  • Geographic characteristics

    • Much of population lives in small and isolated communities

    • The mountains shape family lives

    • Strong personal and culture identity with “place”

  • Health system characteristics

    • Availability and access to care difficult

    • Mistrust of “being taken advantage of” by health care system

    • Lower incomes and poor insurance

    • Too few providers demonstrate cultural competence


Contributing factors what makes appalachia different ii

Contributing factors : what makes Appalachia different? II

  • Cultural characteristics

    • Confidence and trust is hard to build

    • General lack of assertiveness about health and health care

    • People are private and proud and don’t want charity

    • There is a strong faith in God with variable dimensions of spirituality and fatalism

    • Minority communities are small and there are too few minority health professionals with whom to create trust


Comprehensive cancer control plans implementation in appalachian communities program1

Comprehensive Cancer Control Plans Implementation in Appalachian Communities Program

  • Interagency Agreement between Appalachian Regional Commission and CDC Division of Cancer Control

  • Proposal funded to ETSU in September 2006, extension in September 2007

    • Bruce Behringer, MPH, Rural and Community Health and Community Partnerships

    • Kelly Dorgan, PhD, Department of Communication

    • Gail Gerding, PhD, Department of Family and Community Nursing

    • Sadie Hutson, PhD, RN, WHNP, Department of Internal Medicine


Purposes of program

Purposes of Program

  • Identify facilitators and barriers to local implementation of CCCCs and state cancer plans in Appalachian region

  • Not a research project but strong evaluation

  • Describe potential strategies for engagement and involvement of rural Appalachian communities and CCCCs

  • CDC intent to share with other distinctive sub-state regions across the country, across CDC programs, and with national partners.

  • “From plan to implementation to partnerships”


Arc cdc program process to date

ARC/CDC Program Process to Date

  • Multi-partner Advisory Board

    • CCCCs

    • National partners: ACS, CIS, ICC

    • Appalachian community members

    • Two planning meetings

  • Community Cancer Control in Appalachian Forum, October 2007

  • Mini-grant RFPs out in March 2008


Findings

Findings

  • Appalachia has special cancer problems, varies by type of cancer

  • This is only partially recognized by states

  • There is a lot of cancer control activity in Appalachia conducted by communities not connected to state plans or coalitions

  • States want to expand activities in Appalachian regions, but some not sure how to engage with communities


Comprehensive cancer control plans implementation in appalachian communities program

All Appy higher

than national;

Appy rates

higher than

state:

NY, MD, OH,

KY, VA,TN

10 of 13 Appy

higher than national;

Appy rates

Higher than

state:

NY,OH, KY

Cancer Outcomes in the Appalachian Region, Joel Halverson, 2007

http://www.etsu.edu/kellogg/Cancer/Forum_Report/Part%202.pdf


Factors influencing participation

Factors Influencing Participation

Available from:

http://www.etsu.edu/kellogg/Cancer/Forum_Report/Part%201.pdf


Framing local and state relationship

Framing local and state relationship

Available from:

http://www.etsu.edu/kellogg/Cancer/Forum_Report/Part%201.pdf


Recommendations from forum and advisory board

Recommendations from Forum and Advisory Board

  • Request for Proposals to promote engagement resulting in awareness and involvement

    • Frame as partnerships to use listening skills

    • Link to state plan goals

    • Use Give-Get Grid to identify mutual expectations and benefits

    • Promote sustained new relationships

  • Data driven with priority to ARC distressed counties

  • Allow regional (multi-state) views of issues

  • Cancer as “health of public issue” with national policy context and implications


Use mini grants to demonstrate different types of engagement

Use mini-grants to demonstrate different types of engagement

  • Proposal 1: Capture and tell your community’s cancer story

    • Cancer is personal

    • Stories part of Appalachian culture

    • Cancer impacts rural as “communities”

    • RFP for assistance to find, collect, produce and tell stories in three communities in bordering states

    • Mountain Empire Older Citizens (Va) selected

    • Will ask CCCCs to help identify communities and participate


Use mini grants to demonstrate different types of engagement1

Use mini-grants to demonstrate different types of engagement

  • Proposal 2: Understand cancer incidence and mortality differences between contiguous counties/regions

    • Data sparks awareness and discussion

    • Maps provide focal point to pose and explore obvious county and regional differences

    • Roundtables are mechanism for CCCCs, partners and communities to ask “why” and and “what can be done?”

    • $2,500 grant: Kentucky development districts


West virginia cancer mortality rates 1999 2004 counties exceed national rate by at least 25

West Virginia Cancer Mortality Rates 1999-2004(Counties exceed national rate by at least 25%)

All-Site Death Rate Ages 35-64

COUNTYRATEExceeds By:

Boone18632%

Braxton18632%

Calhoun19639%

Clay19035%

Fayette18834%

Harrison17826%

Lewis19438%

Lincoln21351%

Logan21956%

McDowell27495%

Mason17927%

Mercer17927%

Mingo20948%

Morgan18733%

Pleasants21956%

Ritchie18632%

Roane19740%

Tucker17927%

Wayne18934%

All-Site Death Rate Ages 65+

COUNTYRATEExceeds By:

Boone148132%

Clay149733%

Logan151535%

Mingo135921%

Wyoming140125%

2008 County Economic Status

Determined by ARC

Map from: http://www.arc.gov/index.do?nodeId=3224

All cancer data from http://www.etsu.edu/kellogg/

Cancer/Forum_Report/Part%202.pdf


Comprehensive cancer control plans implementation in appalachian communities program

West Virginia: Specific Cancer Rates

Lung Death Rates

Ages 35-64

COUNTYRATEExceeds By:

Berkeley5539%

Boone7487%

Brooke5949%

Cabell5334%

Fayette6565%

Harrison5847%

Jackson5539%

Jefferson5642%

Kanawha5744%

Lewis5334%

Lincoln7897%

Logan7385%

McDowell10361%

Marion5027%

Mason6975%

Mercer5847%

Mingo7487%

Morgan6770%

Preston5334%

Raleigh5232%

Ritchie6565%

Roane6975%

Wayne7077%

Wetzel6565%

Ages 65+

COUNTYRATEExceeds By:

Berkeley46047%

Boone58587%

Cabell40128%

Calhoun44342%

Clay52969%

Doddridge44141%

Fayette44643%

Harrison42837%

Jackson43138%

Jefferson39125%

Kanawha41633%

Lincoln48455%

Logan49558%

Marion41432%

Marshall40429%

Mason45756%

Mingo46850%

Ohio42034%

Putnam39025%

Roane42135%

Summers45545%

Tyler41332%

Wayne42335%

Wyoming45756%

Colorectal Death Rates

Ages 35-64

COUNTYRATEExceeds By:

Cabell1631%

Fayette2280%

Harrison1631%

Kanawha1739%

Raleigh1739%

Ages 65+

COUNTYRATEExceeds By:

Hardy18960%

Jefferson18960%

Logan15128%

Mingo23539%

Nicholas18859%

Ohio14825%

Upshur16943%

Wayne15935%

Breast Death Rates

Ages 35-64

COUNTYRATEExceeds By:

Jefferson3934%

McDowell70140%

Mercer4347%

Ages 65+

COUNTYRATEExceeds By:

McDowell16042%

Taylor21894%

Prostate Death Rates

No county rates exceed the national rate by

25% or more within the 35-64 age range.

Ages 65+

COUNTYRATEExceeds By:

Mineral29741%

Preston26928%

Wyoming28736%


Use mini grants to demonstrate different types of engagement2

Use mini-grants to demonstrate different types of engagement

  • Proposal 3: Replicate Community Cancer Control Forum in Appalachian Cancer through state CCC coalitions

    • Mutual lack of awareness/communication between state and local community efforts

    • Forum used to identify and present “best practices” by Appalachian communities

    • Build on Give-Get findings to promote mutual benefits

    • $5,000 grants: Kentucky and Ohio


Logic model and program evaluation

Logic Model and Program Evaluation

Resources

Program

Activities

Outputs

Outcomes

Impact

Mini-grants development

Increase initiation and interaction

Change awareness/attitudes

Program benefits

Methods to engage community

Give-Get Grid

More cancer control action in Appalachia

Process evaluation

Outcome

evaluation


The program mini grant model

The Program Mini-grant Model

The “cancer environment” context

State CCCC

coalitions

and plans

recognize and

engage

Appalachian

region

Stakeholder

engagement

and action by

Appalachian

communities in

cancer control

More

interaction

and

interventions

Generate new processes and outcomes:

target needs, demonstrate effects, describe resources

New mini-grant Logic Models


Timeline 2008

Timeline, 2008

  • Distribute mini-grants February RFP Round 1

  • April review and selection

  • May- November implementation

  • May announce Round 2 RFPs for forum and roundtable

  • November-December

    • Program evaluation

    • Second Forum


Comprehensive cancer control plans implementation in appalachian communities program

Disparities are defined by differences: Race and Place Differences for Appalachian African Americans represents a “Double Disparity”

Gender

differences

Racial

differences

Place

differences

Race and

place

differences


Comprehensive cancer control plans implementation in appalachian communities program

Comparison of Cancer MortalityRates by AgeFor Appalachian County Rates within Thirteen StatesWith United States Rates, 1999-2004


How appalachian program can help ccccs meet cdc guidelines

How Appalachian Program can Help CCCCs meet CDC Guidelines

  • Participation in development, implementation and evaluation of priorities for the comprehensive cancer control plan

  • Recruitment of new members and partners to the decision-making and communication processes

  • Enhancement of the diversity of community support for and commitment

  • Addition of community organized and operated cancer control activities that are currently unaffiliated with CCCCs as an additional represented sector to the coalition

  • Promotion of greater awareness of state Plan and coalition within the Appalachian regions.


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