A new approach to cancer prevention is proving effective with Hispanic farm workers in Washington state's Yakima Valley. Bilingual promotoras—community members trained as health educators—are organizing “home health parties” to talk with the workers about cancer risks and the need for regular screenings.
The parties are designed to increase awareness of—and compliance with—screening guidelines for colorectal, breast, and cervical cancers.
“We're trying to get the Hispanic population in earlier for screening so their cancers can be detected earlier and their chance for a cure will be much greater,” said Beti Thompson, PhD, a member of Fred Hutchinson Cancer Research Center, principal investigator on the project, which is funded through the Community Networks Program of the National Cancer Institute's Center to Reduce Cancer Health Disparities.
“It's like a Tupperware party, only what we're selling is cancer prevention.”
She and her colleagues developed the approach eight years ago as a way to educate farm workers about the health risks they faced from exposure to pesticides. The gatherings are informal, with plenty of time for questions.
“We found it was a wonderful mechanism for reaching the workers,” Dr. Thompson said. “We asked them if they would like us to come to their homes. They would invite a few friends and neighbors over and we would send a promotora over. The workers knew they were being exposed to pesticides, and they knew that was not a good thing.”
The workers were advised to remove their boots and work clothes and take showers as soon as they got home, wash their work clothes separately, mop their floors frequently, and so on.
That project led to the current prevention project. Early data on colorectal cancer screening shows the approach is working, Dr. Thompson said.
Through a series of home health parties, promotoras identified 68 adults who were age-appropriate (age 50 and over) for screenings. Before the promotoras visited with the workers, 30 of the 68 (45%) knew something about fecal occult blood tests and 35 (52%) knew about flexible sigmoidoscopy or colonoscopy. After the home health parties, the percentages who said they were familiar with the tests increased to 68% and 86%, respectively.
The promotoras tell the participants about free and low-cost clinics where they can get screened, and provide transportation for those who need it.
Early data show they are making a significant difference in the number of individuals who are getting screened. In three months, the number of adults who have undergone fecal occult blood testing increased from 12.6% of those who were age-eligible to 32%. Those who had a flexible sigmoidoscopy or colonoscopy increased from 37% before the home health parties to 43% afterward.
The results are “really gratifying,” Dr. Thompson said. “There's nothing like taking a person who has never had any kind of health prevention at all and convincing them that it's important to take care of their health and be screened.”
Also Mammography & Cervical Cancer Screening
Dr. Thompson's group has recently completed the mammography portion of the project and is now getting under way with the cervical cancer arm of the study.
Ilda Islas is a field project supervisor with the project. She lives in the Yakima Valley and has watched her father go through treatment for non-Hodgkin's lymphoma, and then lung cancer.
“I do a lot of staff training, and I work with the promotoras who go to people's homes and do the parties,” Ms. Islas said. Families who agree to host the parties invite relatives, friends, and neighbors.
“Everybody really loves the parties, and it's surprising how many people want us to come into their homes,” she said.
“They make us feel as welcome as possible. Some of these homes are very tiny—many of the families live in one-bedroom homes with not much furniture. It's usually four to 10 people. It allows people to ask the questions they might not be willing to ask in a larger group.”
Roshan Bastani, PhD, of the UCLA School of Public Health and the Jonsson Comprehensive Cancer Center, had high praise for the Fred Hutchinson project. Dr. Thompson and her colleagues “are reaching people in the way that is most comfortable for them. Different people have different levels of comfort talking about their health…. This is a wonderful way to reach people who otherwise might not be accessing the health care system.”
Dr. Bastani also leads a project funded by the National Cancer Institute to increase hepatitis-B testing in Korean adults, who have a higher than average risk of liver cancer. Surveys show that up to 90% of Koreans attend church, so Dr. Bastani's group takes the hepatitis-B prevention program to Korean churches in the Los Angeles area.
“People say these are hard-to-reach populations, but that is mischaracterizing the issue,” Dr. Bastani said. “It's not that they are hard to reach, it's just that we have to learn how to reach them.”
Like Dr. Bastani, Dr. Thompson has several ongoing prevention projects. Dr. Thompson's include a study to increase diabetes detection in Hispanics, funded by the National Center on Minority Health and Health Disparities. The researchers offer blood-glucose tests at health fairs, then urge those who are found to have high fasting-glucose levels to attend a home health party on diabetes.
“It's a population that is really underserved and has a high need,” Dr. Thompson said. “To the extent that we are able to help them, we are very eager to do so.”
© 2008 Lippincott Williams & Wilkins, Inc.