Promoting Population Health

Every Woman Matters is a program through the Nebraska Department of Health which is state run and federally funded. This program focuses on decreasing barriers to preventive breast and cervical cancer screenings in low-income women. They so this by raising public awareness and make these screenings more accessable and affordable to eligible women (Backer, Geske, McIlvain, Dodendorf, & Minier, 2005). Reduced cost or no cost clinical breast exams, mammograms, and Pap smear test are provided through this program.

The EWM program has attempted to provide their services to physician practices to assistin th e development of the program. The practices are expected to follow the GAPS model to implement this change. This includes: “goal setting, assessing existing routines, planning the modification of routines, and providing support for these improvements (Backer et al. , 2005, p402). In order for this to be successful, they need to alter physician and practice behaviors. The practices resources, willingness to change, and the ability of staff to fully cooperate or work as a team should have been evaluated before the attempt to implement EWM program into each practice.

It seems the practices chosen to implement the Every Woman Matters program already had its own issues or barrier for implementation to be fully possible. Some of the problems that were faced were: one practice was only focused on generating income, some were hospital owned which added barriers to approval, enthusiasm was not shared by all staff, staff was disgruntled or overextended, limited resources, resistance from staff, no active leader, prevention not being priority, and the loss of interest or elimination of goals after the first few months POSITIVE HEALTH 3.

(Backer et al. , 2005). Each practice involved had at least one of these issues present resulting in the Every Woman Matters program not being effective in meeting its goals. Prevention Programs Two prevention programs that advocate for early screening are The North Carolina Breast Cancer Screening Program (NC-BCSP) and the Esperanza y vida health education program. Both of these programs are focused on women’s health screenings and treatment and they go about it the same way, influencing and supporting through social networks and offering culturally tailored interventions.

The North Carolina Breast Cancer Screening Program focuses on African American women over 50 years old. They use a social ecological theory which targets several levels of the community from individuals and social networks to institutions and policymakers. They believe that providing “linkages” will develop communities that will endure after the research project ends (Altpeter, Earp, & Schopler, 1998). Social workers and others are used as “coaches or teachers” to develop the community participants’ skills. They help organize local efforts and provide technical assistance or training.

Social workers also identify and integrate the needs of underserved constituents into service planning to aim to improve service delivery. Three interventions are used in developing the program, Outreach, InReach, and Access. Outreach targets individual women and community nerworks to which they belong, building on the capacity of local leadership to advocate and promote breast cancer screening. This includes having agency-based community outreach specialists, county-based community advisory groups and a network of volunteers that span the projects 5-county region. The focus is to enhance

awareness, generate community support, and introduce Lay Health Advisors that run focus groups. InReach enhances service delivery by restructuring clinic policies and procedures to POSITIVE HEALTH 4 increase efficiency of previous services that are delivered, provider education on breast cancer topics, help agencies implement community outreach efforts customized to older African American women. Key players of InReach are health care providers including private practice physicians, radiology centers, county health departments and federally funded rural health centers (Altpeter et al, 1998).

“Program Champions” will advocate with the medical community and agencies for community wide screening, referral, and follow-up plans. Access promotes accessible, equitable care by overcoming institutional barriers (cost, transportation, mammogram quality assurance) that prevent low income African American women from getting screenings. Key players are state and local agencies that are responsible for financing or delivering needed services. Radiology centers improve units or increase the quality of mammograms, the development of linkages, decrease in prices with creative use of federal or state financing with innovative plans such as “free weeks”.

Promotion of ongoing availability in local health agencies of breast cancer screening activities. The NC-BCSP focuses on institutionalizing health promotion programs by establishing relationships with local health departments, rural health clinics, radiology centers, and physicians to ensure the program “meshed” with the current systems already in place in local organizations. This is important in fitting a “niche” within an organization to ensure longevity and uncover existing grassroot linkages that can fimly establish a comprehensive system of accessible, available, and affordable breast cancer screening and treatment options.

Institutionalization depends on infrastructure development, community linkages at multiple levels and monitoring and providing feedback. What I find most importand in the NC-BCSP is the way they use community members to make this program work. Program Champions who have influence at the policy level and Project POSITIVE HEALTH 5 Coordinators who are older black women from the community. Lay Health Advisors who will gain professional knowledge and skills have existing ties within the community and social networks will initiate behavioral change.

Natural helpers from within targeted communities are recruited and trained women who others turned to for advice, support, and assistance in the past. The Esperanza y vida is a peer-led health education program addressing the decreased rate of breast and cervical cancer screening and treatments in the Latina community. Sudarsan (2011 p 194) states “Individuals can not be considered separately from their social environment and background. ”, which they prove by influencing and supporting Latina individuals through social networks and neighborhoods and communities. This programs’ interventions reflect the community’s priorities and culture.

Culturally appropriate information and resources are provided to increase patient knowledge for self care and to decrease obstacles to health care. By offering culturally tailored interventions, they increase the rates of screening. In their program, they use three different locations to account for geographic, ethnic, and community diversity. Along with education regarding breast and cervical cancer screenings and treatment, the Esperanza y Vida program addresses fears, concerns, and perceptions that negatively impact understandings. They also evaluate pre and post-program knowledge, testing attendance to increased screening adherence.

Using ARS, an audience response system which uses Power Point questions and responses are recorded anonymously using a wireless keypad, increasing the probability of participants answering honestly. The program found differences between locations indicating varying familiarity with technology and literacy, resulting in low comfort levels. Esperanza y Vida accommodates Latino perspectives on family, religion, gender roles, and provides navigation into screening. The group settings are community-based locations, faith- based locations, or in womens’private homes.

These “safe” locations are more appealing to POSITIVE HEALTH 6 undocumented Latinas, increasing the rate of participation. Learning by reflecting on access to various local agencies, and community structure variations. Trained peer volunteers are utilized, these are breast or cervical cancer survivors who share their personal stories and stress the importance of early detection and regular screenings. Men are also encoursaged to attend because in Latino families the men tend to have more control over resources and decision making, promoting the health of female family members.

Program sites are obtained by program coordinators who work with Community Advisory Boards, volunteers, and local community and faith-based organizations. Outreach includes providing potential sites with program details including program content, time and space needed to conduct the educational program.

All participants of Esperanza y vida complete questioneers which include demographics, years in the US, current participation in screenings, pre-intervention knowledge surveys (evaluating baseline knowledge and attitudes) and post-intervention survey with the same questions (to measure any changes and success of the program) (Sudarsan, Jandorf, Erwin, 2011).

The staff also tracks site setting, language the program is taught in, the type of program. The language the programs are taught in relate to the host and participants requests which reflects language preference in that specific region. Implementing Esperanza y Vida in diverse locations with geographic considerations and variations and ethnic variables will assist in expanding the program across the US. Adaptation of the same intervention at different geographic sites will provide information to diverse populations. Cultural competence of the program has potential to decrease health disparities in Latinas (and soon other groups) in the US.

The ability to recruit and educate diverse subgroups of the Latino population with success in enhancing knowledge about breast and cervical cancer POSITIVE HEALTH 7 screening and treatments. This program is malleable to different community needs which makes it stand out among others with similar focus. Strategies If I was the nurse leader in charge of developing a follow-up to the Every Woman Matters program, the strategies I would propose for creating a more effective prevention program would include: first, choosing practices that were financially stable, who worked well together, and where all staff was in agreement to promote change.


References Altpeter, M. , Earp, J. , & Schopler, J. (1998). Promoting breast cancer screening in rural, African American communities: the “science and art” of community health promotion. Health & Social Work, 23(2), 104-115.

Retrieved from http://ezp. waldenulibrary. org/login? url=http://search. ebscohost. com/login. aspx? direct=true&db=rzh&AN=1998053486&scope=site Backer, E. L. , Geske, J. A. , McIlvain, H. E. , Dodendorf, D. M. , & Minier, W. C. (2005). Improving female preventive health care delivery through practice change: An Every Woman Matters study.

Journal of the American Board of Family Practice, 18(5), 401–408. Retrieved from the Walden Library databases. Carroll, J. K. , Humiston, S. G. , Meldrum, S. C. , Salamone, C. M. , Jean-Pierre, P. , Epstein, R. M. , and Fiscella, K. (2009). Patients’ experiences with navigation for cancer care. Patient Education and Counseling 80, 241-247. doi:10. 1016/j. pec. 2009. 10. 024 Leeman, J. , Moore, A. , Teal, R. , Barrett, N. , Leighton, A. , & Steckler, A. (2013). Promoting Community Practitioners’ Use of Evidence-Based Approaches to Increase Breast Cancer Screening. Public Health Nursing, 30(4), 323-331. doi:10. 1111/phn.

12021 Retrieved from http://ezp. waldenulibrary. org/login? url=http://search. ebscohost. com/login. aspx? direct=true&db=rzh&AN=2012167333&site=ehost-live Meredith, S. M. (2013). Disparities in Breast Cancer and the Role of Patient Navigator Programs. Clinical Journal of Oncology Nursing, 17(1), 54-59. doi:10. 1188/13. CJON. 54-59 POSITIVE HEALTH 9 Sudarsan, N. , Jandorf, L. , & Erwin, D. (2011).

Multi-Site Implementation of Health Education Programs for Latinas. Journal Of Community Health, 36(2), 193-203. doi:10. 1007/s10900-010-9297-7 Retrieved from http://ezp. waldenulibrary. org/login? url=http://search.ebscohost. com/login. aspx? direct=true&db=rzh&AN=2010969861&scope=site Welch, C. , Miller, C. , & James, N. (2008). Sociodemographic and health-related determinants of breast and cervical cancer screening behavior, 2005.

JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 37(1), 51-57. doi:10. 1111/j. 1552- 6909. 2007. 00190. x Wells, K. , Meade, C. , Calcano, E. , Lee, J. , Rivers, D. , & Roetzheim, R. (2011). Innovative approaches to reducing cancer health disparities: the Moffitt Cancer Center patient navigator research program. Journal of Cancer Education, 26(4), 649-657. doi:10. 1007/s13187-011-0238-7.

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