Adding Health Navigation Assistance to Community Helpline Connected More People to Cancer Control Measures
A partnership that added health navigation services to 2-1-1 call centers helped a significant number of underserved Texans receive cancer control measures such as Papanicolaou (Pap) tests and smoking cessation help, according to a study (PR12, C49) presented at the 9th Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held September 25–28 in Fort Lauderdale, Florida.
“There are many programs available to help low-income people receive health care, but they don’t always know about them,” said the study’s lead author, Maria E. Fernandez, PhD, Professor and Director of the Center for Health Promotion and Prevention Research at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health. “We wondered if we could use the helpline structure to ask people about their health and, if we were able to assess their risk, if we could connect them to programs in their community.”
Dr. Fernandez explained that 2-1-1 helplines constitute a nationwide program that connects low-income and minority callers to community-based services.
Training Staff to Navigate
For this study, UTHealth School of Public Health formed a partnership with 2-1-1 call centers in the Houston area, the El Paso area, and the Lower Rio Grande Valley area of Texas, adding Cancer Control Navigation (CCN) intervention to the helpline’s existing services.
Dr. Fernandez and colleagues trained 2-1-1 staff to assess need and provide cancer control referrals to 2-1-1 callers. They also trained navigators to provide CCN. If the callers needed cancer-related health interventions, some callers were assigned to receive referrals and others were assigned to receive referrals plus more detailed CCN services, which included discussion of the barriers patients faced in receiving health care—for example, negative attitudes about screening, lack of transportation, or difficulty taking time off work—and suggestions for overcoming them.
Navigators continued contact with the callers until the participants had either completed the needed services or chose not to continue to participate. The final sample included 1,736 callers, with follow-up interviews conducted after the initial contact.
Study Findings
The study showed that the CCN intervention increased completion of any needed cancer control behavior by 21% compared with those who received only a referral. Considering individual behaviors, the intervention significantly increased Pap test screening by 53% compared to those who received a referral only.
Several other cancer prevention behaviors were also higher in the CCN group compared with the referral-only group, but Dr. Fernandez cautioned that these findings were not statistically significant, likely due to smaller sample sizes. Nevertheless, the trend of higher completion of cancer control behaviors among participants who received navigation was clear. For example, colorectal cancer screening increased by 40%, mammography increased by 17%, HPV vaccination of daughters increased by 43%, and participation in smoking cessation programs increased by 90%.
Dr. Fernandez said the study results indicate that there is strong potential to reach the poor and the medically underserved with lifesaving cancer control services by partnering with existing programs aimed at helping them such as the 2-1-1 helpline.
Implications and Limitations
“This study was designed and implemented in the real world,” she said. “This type of collaboration has great potential to connect large numbers of medically underserved individuals to cancer control and prevention services and decrease the burden of cancer in underserved populations including the poor, ethnic minorities, and rural residents.”
Dr. Fernandez said the main limitation of this study is that the participants were easily lost to follow-up. Many used short-term cellphones and did not have phone numbers where they could be reached at later dates. Dr. Fernandez said the difficulty in tracking participants resulted in certain sample sizes being smaller than she would have liked.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
