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An Innovative Capacity Building Approach for Preparing Tribal Community Health Representatives (CHRs) to
Deliver Colorectal Health Education, Outreach and Patient Navigation Services
Kevin English, RPh, MPH
Albuquerque Area Indian Health Board, Inc.
Navajo Nation Human Research Review Board Conference
Window Rock, AZ
November 16, 2011
Colorectal Health Data Trends: American Indians
Cancer is leading cause of death among AI/AN women and the 2nd leading cause of death among AI/AN men.
(CDC 2006)
Colorectal cancer is the 3rd most common type of cancer among American Indian & Alaska Native men & women.
(SEER; Wiggins et al Supplement to Cancer 2008).
Colorectal Cancer is the 2nd most common type of cancer for American Indians in the Southwest.
(SEER; Wiggins et al Supplement to Cancer 2008).
Colorectal cancer is the 3rd leading cause of cancer-related death for AI/AN men & women.
(NCHS; Espey et al Cancer 2007)
Colorectal Health Data Trends: American Indians
Nationally, the death rate from colorectal cancer has been dropping for more than 20 years.
Death rates from colorectal cancer are not decreasing among American Indians/Alaska Natives
WHY NOT?
Colorectal Health Data Trends: American Indians
Late detection
AI/AN men and women are more than two times more likely to be diagnosed with late stage CRC than early stage CRC.
(SEER, Perdue et al. Supplement to Cancer 2008)
Insufficient screening
Only 4% of AI/AN men and women age 50-80 who utilize IHS obtained CRC screening in accordance with recommended guidelines.
(Day, Espey, Madden et al Dig Dis Sci 2011)
Delayed treatment
The main goals of the AAIHB Tribal Community Colorectal Health Project are to:
1. Build capacity among CHRs related to colorectal health education, outreach & patient navigation
2. Establish a multidisciplinary colorectal health task force in each participating tribe
3. Implement local colorectal health awareness and patient navigation activities
4. Share successful strategies with other tribal communities throughout the country
AAIHB Tribal Colorectal Health Program
CHR Capacity Development Approach
Three, two-day workshops:
December 9/10, 2009
April 7/8, 2010
August 18/19, 2010
19 unique participants
All 7 AAIHB Tribes
CHR Capacity Development Approach
KEY WORKSHOP TOPICS:
Colorectal Cancer (CRC) 101
Epidemiology of CRC for AI/AN
Screening Guidelines for CRC
CRC Screening Procedures
Bowel Preparation
Colorectal Cancer Risk Factors
CRC Diagnosis and Treatment
Talking about sensitive health issues
Theories of health behavior/communication
CHR Capacity Development Approach
TRAINING TECHNIQUES
PowerPoint
Videos
Anatomical Models
Field visit to colonoscopy facility
Survivor stories
Role playing
Language groups
Interactive games
Health education materials development/dissemination
Health education materials development/dissemination
CHR Capacity Development Evaluation
A 34-item pre-post test was administered to participants at the 3rd workshop measuring:
Knowledge (15 items)
Self-efficacy (11 items)
– I am confident that I can teach my community members about colorectal cancer screening
– It will be easy to add colorectal cancer screening outreach & education to my regular workload.
Norms & intentions (8 items)
– I think colorectal cancer is an important health issue.– I intend to assist my community members in getting
colorectal cancer screenings.
Evaluation Analysis
Paired sample t-tests were utilized to analyze mean differences in pre-post test scores.
Mean differences were also analyzed according to training exposure
To assess the impact of attendance at multiple training sessions upon CHR capacity
Evaluation Findings
CHR Capacity Development Evaluation
Qualitative feedback was also collected related to:
Training benefits
Satisfaction with training materials/approaches
Areas for training improvement
Future capacity development needs
Qualitative Findings
“I am now knowledgeable about the different tests and how screening can prevent the progression to cancer. I understand the procedure from start to finish.”
“I understand more, so people I talk with will benefit from this.”
“I am now able to help self, family and community by having tools and knowledge to share this important information.”
“I’m prepared to discuss colorectal health, I feel confident.”
Qualitative Findings
“My favorite part was the hands-on tour and actually seeing the live instruments and setting.”
“I understand the process of colonoscopy after visiting the facility that performs the colonoscopies.”
“I enjoyed the survivor’s story; it really helped me understand colorectal screening form a personal point of view. That was helpful.”
“We have been given all of the tools, now it is up to us to organize classes and disseminate the information.”
“We can do our job by providing the education, but IHS must provide the needed services.”
Conclusions/Implication for Practice
Significant attention should be placed upon CHR capacity development.
Incorporating experiential learning activities into trainings is a preferred approach.
The use of multiple training sessions appears to confer advantages in retention of knowledge and engendering CHR confidence and motivation to intervene.
The concomitant implementation of system-level initiatives with CHR capacity development may be especially important towards improving local access to colorectal cancer control services.
Next Steps
• Develop tool kit – “Best of” CRC workshops/activities
• Provide CRC workshops for CHR programs in other IHS regions
• Develop brochures, videos, posters, etc. (English & Navajo)
• Evaluation focus groups with CHRs
• Clinic provider detailing
• Continue routine task force meetings in participating tribes
Contact Information
Kevin English – Program Director Tribal Community Colorectal Health Education and
Navigation ProgramAlbuquerque Area Indian Health Board, Inc.
5015 Prospect Ave NEAlbuquerque, NM [email protected]
(917) 962-2603
This project was realized with funding from CDC’s Division of Cancer Prevention and Control in collaboration with the Indian Health Service Division of Epidemiology and
Disease Prevention
