The original project, A Su Salud En Acción, ran between 1985 and 1990 and applied social cognitive theories to reduce chronic disease and improve cancer control among Hispanics in South Texas. This replication project, begun in 1992, was pilot-tested in a Texas-Mexico border site and an urban site in Nevada, and replicated in Reno, Nevada. At each site, personnel were trained to use public communication and peer networking to promote healthy behaviors (i.e., cancer risk reduction and increased screening) among National Breast and Cervical Cancer Early Detection Program participants. Intervention methods included identifying community role models, publicizing them through mass media (TV, radio and newspapers) and promoting interpersonal communication using peer neighborhood networkers. Researchers developed academic and practical learning tools.
Laredo, Texas and Las Vegas and Reno, Nevada
This project increased breast and cervical cancer screening rates among Hispanic women in the intervention areas. It also gave our sponsoring organizations community alliances and networks that they can continue to use and build on as they address other public health issues in Nevada and Texas. The project also generated an educational program manual, available through The University of Texas Health Science Center at San Antonio, and a Web site, http://salud-replication.org/index.html, that presents the program, its effects and recommendations for future applications. Program effectiveness was monitored and evaluated throughout the program using management records, mass media content analysis, cancer screening participation, and historical assessment of the replication process. Laredo site: This site, begun in 1998, lasted until 2000 when the researches did not encourage the Gateway Clinic to continue the program because the NBCCEDP resources allotted to Laredo are exhausted every year with little or no promotion of services. This made the program difficult to fully roll out, as the researchers did not want to bring more people to services than there were federal funds. For instance, from the onset, we reduced our mass media activities (principally TV) and limited our messages to re-screening only, rather than first-time screening for breast and cervical cancer. Still, the clinic had to turn away a number of clients who thought the messages were encouraging general screening. Despite a small budget, this project partnered with an ongoing project sponsored by the Texas Tech University system that trained and employed a team of paid Promotoras to provide community action and clinic navigation services within several colonias where the project operated. To distinguish these two different but complementary community networkers, the peer networkers for this project were called Corazones. Regarding community outreach, the Salud En Acción program recruited over 170 Corazones (peer networkers), with 131 active networkers to date. An additional 20 Promotoras (paid peers who support the program but who are officially employed by Texas Tech, which operates social programs in the colonias) were active at the project’s conclusion. Of the sites that also distributed project small media (bulletins), small business (13), churches (seven) and clinics (five) were the most active. Peer networker refresher sessions combined opportunities for leadership development, increased knowledge about breast and cervical cancer screening and social interaction. Community presentations (used to promote the program and recruit volunteers) were predictably low, as the purpose was to recruit volunteers and expand the network. Due to the constraints mentioned previously, the project’s goals of 100 Corazones and limited mass media were easier to maintain and didn’t require as many presentations. Regarding media production, small media (the project’s newsletter and a very small number of flyers from partner organizations) were produced and distributed monthly. Newsletter distribution averaged about 2,000 per month, with distribution percentages as follows: Corazones 36%, Promotoras 22%, churches 16%, clinics 10%, small businesses 9.5%, with schools and community centers channeling the remaining 7%. Mass media relied on newsprint, with monthly stories featuring role models that discussed how they overcame barriers to breast and cervical cancer re-screening services. TV was avoided, as it tended to be received as a general screening story that, in turn, brought women to the clinic seeking NBCCEDP funded services that were not available.
Las Vegas site: Begun in 1999, this site recruited 144 peer networkers, of 104 were active at project end. More than 150 community sites – small businesses, community centers and neighborhood associations – were distribution sites for newsletters. Due to system challenges, the maximum number of volunteers was 140. Regarding media production, about 1,500 bulletins were distributed each month, with 38,284 distributed to date. Peer networkers distributed almost 34%, small businesses 30% and community centers 19%. Regarding mass media, 173 news segments have been broadcast, the majority produced by Univision, the dominant Spanish language network. Twenty newspaper articles were published, and radio has featured several talk show interviews and a PSA. The program also received a good amount of media coverage. Since June 2000, the project has monitored the number of calls received by the program due to media and community outreach – more than 3,560 calls. TV spurred 2,054 calls, newsletters 593, radio 327, program staff 280 and friends 131. Of those, 1,151 were referred for mammograms, and 3,100 were referred for Pap smears. Despite Las Vegas’ state of underfunded public health, this project successfully increased service demand and expanded the utilization of NBCCEDP resources as designed, especially among women over 50 years of age.
Reno site: The site, originally intended to last until September 2001, maintained stable staffing and community popularity until it ceased March 2002. Reno recruited 76 peer networkers, all of which were active at the project’s conclusion. Newsletters were distributed through 66 community sites, including Saint Mary’s clinics. About 840 bulletins were distributed each month with 24,303 distributed in all. Peer networkers distributed almost 26%, small businesses 38% and community centers 6%. For mass media, 27 evening news segments were broadcast, the majority produced by Univision. Eighteen newspaper articles were published, and radio had 17 programs. Since February 2001, the project has monitored the number of calls received by the program due to media and community outreach – over the project’s 14 months, 716 calls were received. TV spurred 181 calls, newsletters 112, radio 107, program staff 72 and friends 63. Of those callers, 146 were referred for mammograms and 633 were referred for Pap smears. While not all the performance objectives were met (it had fewer than 100 volunteers), the staff of Saint Mary’s Redfield Clinic wrote several grant applications in an attempt to provide continued support for the community outreach model of health promotion used in this project. Also, efforts have been made to continue elements of the project by converting the newsletter to an undated bulletin with other health messages, such as immunization, diabetes and dental care aimed at underinsured Hispanics.