A promising program for cancer intervention in rural communities

From the Health Communication Research Center, Public Health Sciences Division and the Cancer Epidemiology, Prevention and Control Program of the Cancer Consortium

In a new study published in Cancer Causes & Control, researchers from Fred Hutch, the University of Washington, and their collaborators reported preliminary findings that a program to facilitate the implementation of evidence-based interventions for cancer prevention and control was effective for two community-based organizations in rural Washington State. Dr. Linda Ko, a professor in the Public Health Sciences Division and the director of the Health Communication Research Center at Fred Hutch, led the study.

“Rural community-based organizations are vital partners that can help reduce cancer disparities that are exacerbated by poor social determinants of health that are often experienced by immigrants,” the authors wrote. For example, evidence-based interventions are known to improve cancer screening rates, but these interventions are lacking in rural communities. The authors explained that “in addition to promoting health education, community-based organizations are often connected with healthcare systems and can serve as a link between the community and healthcare system by providing community members with screening referrals, home health education, and connections to health and social services.”

To facilitate the implementation of evidence-based interventions in rural community-based organizations, the researchers developed a structured training and consultation program called the Implementation Studio. The Implementation Studio content was developed to be accessible to rural and limited-English-proficient communities. The content was further adapted to be culturally and linguistically appropriate for Hispanic communities in rural Washington State.

The researchers delivered the Implementation Studio program to 14 community health educators at two community-based organizations with services directed to the Hispanic community. One organization was located in rural Yakima Valley, and the second in Seattle. Both organizations had community health educators who lived and worked in rural farming regions of Yakima Valley and Mount Vernon. All community health educators involved in the study were Hispanic and women, with an equal number of bilingual Spanish-dominant, bilingual English-dominant, and Spanish-speaking only participants. One organization had a majority of Spanish language-dominant community health educators, so the researchers delivered the Studio workshop in Spanish. Each community-based organization recruited 25 clients, all Hispanic and mostly women born outside the United States, to participate in the study.

Rattlesnake Mountain beyond the Yakima River in Washington state, with vineyards in the foreground.
The two community-based organizations that participated in the study provide social services to limited-English-proficient community members in rural Eastern Washington State, including the Yakima Valley. Image courtesy of Wikimedia Commons

The Implementation Studio can be delivered in person or via videoconferencing, either as two half-day workshops or as a series of eight one-hour workshops. The first half of the Implementation Studio covers the first three steps of the curriculum: creating an implementation blueprint, adapting evidence-based implementations to a rural context, and collaborating and building partnerships with stakeholders. In this portion of the Studio, both community-based organizations selected a practitioner-delivered colorectal cancer education strategy (ACCCION) from the National Cancer Institute’s Evidence-Based Cancer Control Programs website.

The second half of the Studio focuses on the next two steps: identifying and filling knowledge gaps among the community-based organization staff, and further fine-tuning of the blueprints. Following the completion of the workshops, community health educators had biweekly consultations with Studio team members from the University of Washington.

The researchers evaluated the efficacy of the Implementation Studio in two tiers. First, the researchers used pre- and post-surveys to evaluate the impact of the Implementation Studio on community health educators’ knowledge, ability, and self-efficacy (measured as confidence) to select, use, and implement the evidence-based interventions. In the second tier of the evaluation, the researchers assessed clients’ knowledge of colorectal cancer and screening, as well as their intention to get screened for colorectal cancer.

The survey revealed that participation in the Implementation Studio significantly increased community health educators’ knowledge, ability, and self-efficacy to develop and use the implementation blueprint and evidence-based interventions. Furthermore, clients who participated in the community health educator-delivered ACCION workshop reported increased knowledge of colorectal cancer and screening. They also reported that they will likely talk to their doctor, as well as their family and friends, about colorectal cancer screening, and that they will likely get screened for colorectal cancer.

The researchers are already planning to follow up on the preliminary results of this study. “Future, larger studies are planned to test the Implementation Studio with community-based organizations in order to expand the sample size and observe whether similar findings hold for other community-based organizations,” the authors wrote in the paper. Additionally, they have planned a future study “to conduct in-depth, semi-structured interviews with community-based organizations and their clients on implementation outcomes of acceptability, barriers to implementation, and sustainability.”

The authors stressed the importance of developing and implementing evidence-based interventions that are appropriate for the target community. “Future delivery of the Studio should address the unique needs of community-based organizations, including linguistically appropriate materials and resource constraints,” the authors wrote. “Creating a richer repository of language concordant evidence-based interventions with online navigation options for non-English-speaking community health workers has the potential to increase accessibility and improve use, experience and sustainability of implementing evidence-based interventions.”

This work was supported by the Cancer Prevention and Control Research Network, the National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention, Fred Hutchinson Cancer Center, and the National Center for Advancing Translational Sciences of the National Institutes of Health.

The Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium members Drs. Linda Ko and Rachel Winer contributed to this work.

Ko LK, Vu T, Bishop S, Leeman J, Escoffery C, Winer RL, Duran MC, Masud M, Rait Y. 2023. Implementation studio: implementation support program to build the capacity of rural community health educators serving immigrant communities to implement evidence-based cancer prevention and control interventions. Cancer Causes Control. doi: 10.1007/s10552-023-01743-6. Epub ahead of print.