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3 nd African American Prostate Cancer Disparity Summit Prostate Health Education Network (PHEN). V. Diane Woods, Dr.P.H., M.S.N., R.N. Assistant Research Psychologist/Public Health Department of Psychology, Social Psychology Lab University of California Riverside, California. Capitol Hill

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3 nd african american prostate cancer disparity summit prostate health education network phen

3nd African AmericanProstate Cancer Disparity SummitProstate Health Education Network (PHEN)

V. Diane Woods, Dr.P.H., M.S.N., R.N.

Assistant Research Psychologist/Public Health

Department of Psychology, Social Psychology Lab

University of California

Riverside, California

Capitol Hill

Rayburn House Office Building

Washington, DC

September 27-28, 2007

slide2
Utilizing Community-based Participatory Research (CBPR) to Engage African American Men in Clinical Trials and Prevention

Woods, September 28, 2007

co authors
Co-Authors

Dr. Susanne Montgomery, Ph.D., M.P.H.

Professor and Director, Center for Health Research

Co-Director, Center for Health Disparities and Molecular Medicine

Loma Linda University School of Public Health

Scholastique Nikuze, M.P.H.

Doctoral Student Oregon State University

Woods, September 28, 2007

supported in part by
Supported in part by:
  • Loma Linda University Center for Health Research
  • Loma Linda University Center for Health Disparities and Molecular Medicine
  • NIH National Center on Minority Health and Health Disparities
  • Association of Schools of Public Health (ASPH) and Centers for Disease Control and Prevention (CDC) Division of Cancer Prevention and Control Cooperative Agreement #S1391-20/20
  • African American Health Institute of San Bernardino County
  • The California Endowment
  • The Community Foundation of Riverside and San Bernardino Counties
  • The California Wellness Foundation

Woods, September 28, 2007

presentation objectives
Presentation Objectives
  • To demonstrate how community engagement processes work to increase African American male involvement in prevention and clinical research
  • Discuss the complexity of health disparities
  • Provide a framework for eliminating health disparities in African American men and prostate cancer

Woods, September 28, 2007

community based participatory research cbpr
Community-based Participatory Research (CBPR)

Modified Bibliography

  • Israel BA, Checkoway B, Schulz A, Zimmerman M. Health education and community empowerment: Health Educ Q. 1994; 21(2):149-170
  • Aungst J, Haas A, Ommaya A, Green L. Exploring Challenges, Progress, and New Models for Engaging the Public in the Clinical Research Enterprise: Clinical Research Roundtable Workshop Summary. Washington DC: National Academy of Sciences, 2003
  • Viswanathan M, Ammerman A, Eng E, Gartlehner G, et al. Community-based participatory research: Assessing the evidence. AHRQ Publication 04-E022-2. Rockville, MD: Agency for Healthcare Research and Quality, July 2004.
  • Mickler M. Community-based research partnerships: J Urban Health. 2005; 82(2 Suppl 2): ii3-ii12.

Woods, September 28, 2007

hallmarks of community based participatory research cbpr
Hallmarks of Community-based Participatory Research (CBPR)
  • Community member involvement to investigate their lived experiences
  • Community stakeholders participate as equals
  • Co-learning between community and researchers to generate relevant knowledge, create critical awareness, enhance the quality of the process and products of research
  • Community members to provide descriptions, rich in detail, of the local social context and real-world constraints (i.e., replicability), which will improve conceptual robustness and explanatory utility of a study's findings
  • Community involvement establishes congruence between the study and local reality (i.e., increasing face validity), particularly for defining the problem, adapting methodology to specific ecologies and contexts, and determining the nature of acceptable solutions
  • Community participation to improve adequate response rates and minimizing attrition because the research question and data collection methods are likely to be context sensitive and culturally relevant (i.e., dependability)
  • The group process to move the group through different modes of participation as a process of empowerment

Woods, September 28, 2007

prostate cancer trends
Prostate Cancer Trends

Woods, September 28, 2007

u s prostate cancer incidence and mortality rates by race ethnicity 1997 2001
U. S. Prostate Cancer Incidence and Mortality Rates by Race/Ethnicity, 1997-2001

Woods, September 28, 2007

Source: Cancer Statistics 2005, American Cancer Society

slide10

Prostate Cancer Disparities

Incidence, 1998-2002

Mortality, 1998-2002

271

70

75

200

169

Age-adjusted incidence

per 100,000

Age-adjusted mortality

per 100,000

50

140

29

101

24

100

25

50

18

12

African American

Native American

Asian

Asian

Native American

Latino

White

White

Latino

African American

Advanced PCa

12.3% Blacks

10.5% Latinos

6.3% Whites

“Latinos are more similar to African Americans

on socio-demographic characteristics but more

similar to Non-Latino Whites on clinical presentation,

treatment received, and 5-year disease-free survival”

Latini et al., Differences in Clinical Characteristics and Disease-free Survival for Latino, African American, and Non-Latino White Men with Localized Prostate Cancer: Data from CaPSURE. Cancer 2006;106(4):789-795.

Woods, September 28, 2007

california trends in prostate cancer by race ethnicity 1988 2001
California Trends in Prostate Cancer by Race/Ethnicity, 1988-2001

Source: California Cancer Facts and Figures, 2005. American Cancer Society, California Division and Public Health Institute, California Cancer Registry.

Woods, September 28, 2007

slide12
San Bernardino County, CaliforniaProstate Cancer 1999 Age-Adjusted Death Rates by Race/Ethnicity, per 100,000 Men

Woods, September 28, 2007

county population estimates
County Population Estimates

Source: San Bernardino County Quick Facts, U.S. Census Bureau, 2007 available at http://quickfacts.census.gov

Woods, September 28, 2007

contributing factors regarding black men and prostate cancer
Contributing Factors Regarding Black Men and Prostate Cancer
  • Low participation in prevention
  • Under-utilization of screening
  • Black male health behaviors
  • Low early detection rates

Woods, September 28, 2007

san bernardino county progressive black community involvement in research
San Bernardino County Progressive Black Community Involvement in Research
  • 1997 Needs Assessment
      • HIV
      • Youth Violence
      • Teen Pregnancy
      • Diabetes
  • 2001 Prostate Cancer Project
  • 2003 Countywide Health Planning
  • 2005 Disparities Research
  • 2007 Health Systems & Policy Advocacy

Woods, September 28, 2007

engagement methods qualitative quantitative data
Engagement MethodsQualitative & Quantitative Data
  • Key Informant Interviews
  • Focus Group Interviews
  • Community/Neighborhood Forums
  • African Centered Questionnaires
  • Countywide Public Forums
  • Behavior Questionnaires
  • Healthcare Provider Surveys
  • Healthcare Market Analysis
  • Observational Data

Woods, September 28, 2007

san bernardino county prevention studies with african americans
San Bernardino County Prevention Studies with African Americans
  • 2001 – 2004 Prostate Cancer Prevention N = 277
  • 2003 – 2005 Health Initiative Planning Project N = 1,036
  • 2003 – 2007 AAHI-SBC Community Advisory Council (CBPR) N = 220
  • 2005 - 2007 Breast Cancer Prevention in Women N = 170
  • 2007 Regional Health Initiative – 2 different projects

Cohort of 9 organizations: Project title ?????

Risk Reduction Project (75 churches:20,000 members)

Woods, September 28, 2007

impact
Impact
  • Individual
  • Community
  • Health Systems

Woods, September 28, 2007

black male s qualitative themes
Black Male’s Qualitative Themes
  • Perceived lack of respect
  • No one has engaged them in the past
  • Physicians do not take them seriously
  • Complexity of issues around poor outcomes
  • Contribution of Black men not valued
  • Already empowered, need to be given trusted information for making decisions
  • Supportive of research as long as it is respectful

Woods, September 28, 2007

black male s response
Black Male’s Response
  • 6-Point Strategic Actions
  • Community-driven Peer Navigator Prostate Cancer Prevention Training Manual
  • Community-based Prostate Cancer Prevention Decision-Making Tool

Woods, September 28, 2007

6 point strategic actions
6-Point Strategic Actions
  • Partnerships
  • Public Education
  • Participatory Research
  • Public Health Systems Changes
  • Programs
  • Policy

Woods, September 28, 2007

slide22
Emergent Themes for Development of the Community-driven Peer Navigator Prostate Cancer Prevention Training Manual
  • Disease Process
  • Risk Factors & Health
  • Facts About Prostate Cancer
  • Information Aids
  • Testing
  • Patient’s Feelings & Concerns
  • Interactive Communication Between Physician and Patient about Screening
  • Communication Barriers

Woods, September 28, 2007

community based decision making tool
Community-based Decision-Making Tool
  • Develop Education Curriculum for

Decision-Making Tool

  • Delivery Methods and Settings
  • Physician, Community and Health System Involvement

Woods, September 28, 2007

slide24

Community-driven Engagement Research with African American Men for

Prostate Cancer Prevention

The Missing Link…

A Call for Action

(909) 880-2600

Woods, September 28, 2007