Enhancing the Effectiveness of Community Health Workers to Reduce Cervical Cancer Disparities in African American Women

PROJECT SUMMARY/ABSTRACTAfrican American women are almost twice as likely to be diagnosed with cervical cancer (CC) as white women. Their initial clinical picture is also more negative, characterized by more severe dysplastic changes and later-stage disease. Given this, it is not surprising that Black women are also more than twice as likely to die from CC as compared to white women. Even worse, these survival disparities persist irrespective of tumor stage at initial diagnosis. It does not have to be this way. CC is completely preventable.Broad uptake of HPV vaccination and adherence to cervical screening guidelines (with proper follow-up) would virtually eliminate all new cases of CC. Unfortunately, only 42% of young adult Black women have received at least one dose of the HPV vaccine compared to 52% of white women. Corrected self-report data show that only 58% of Black women are adherent to screening guidelines compared to 73% of white women.In previous pilot work, we developed and tested a mobile CC navigation intervention for African American women. An integrated web-based risk assessment allowed our SMS software app to select from a library of videos and text-based messages specifically tailored for each user’s particular cervical health prevention challenges. This prototype included 3 types of videos (scripted vignettes, unscripted peer narratives, and educational instruction) and 3 types of text messages (reminder, educational, and supportive). Usability testing strongly supported the feasibility and potential effectiveness of this patient-facing intervention.We are proposing to build on this pilot work by developing a digital dashboard that integrates with our mobile navigation intervention and with electronic health records (EHR). This integrated package will be for community health workers (CHWs) who provide navigation services. This new analytic tool will provide CHWs a unified, graphical view of their navigation data in real-time at the patient-level, case-level, and encounter- level. All navigation data will be presented visually, relying on a diverse array of graphical elements.We will recruit 16 target end-users who provide cancer prevention navigation services in a range of workplace settings to participate in focus groups. Participants will be asked to judge the adequacy of the layout, structure, and functionality of the planned dashboard. In addition, we will recruit executive leaders, directors, implementation/project managers, and end users who have either upstream or downstream touch points with EHR workflows for individual interviews (total N=12). These discussions will focus on the challenges and opportunities of integrating the proposed mHealth tools into EHR workflows. Based on what we learn from these groups and our expert team of consultants, we will then develop a prototype dashboard. When completed, the 16 target end-users will return for usability testing. The usability test will involve completing a series of tasks intended to simulate how a typical end-user would experience the functionality of the fully developed dashboard. Three usability metrics will be assessed: efficiency, accuracy, and subjective satisfaction.PROJECT NARRATIVE The goal of this project is to develop mobile tools that will increase the rates of HPV vaccination and Pap testing among African American women. If successful, this would eliminate virtually all new cases of cervical cancer among Black women.