Moffitt Cancer Center, Tampa, FL, USA.
Office of Community Outreach, Engagement, and Equity, Moffitt Cancer Center, Tampa, FL, USA.
Transl Behav Med. 2022 Jan 18;12(1). doi: 10.1093/tbm/ibab093.
Cancer health disparities remain a significant problem in the USA, compounded by lack of access to care, language barriers and systemic biases in health care. These disparities are particularly evident in areas such as genetics/genomics. For example, Latinas at high risk for hereditary breast and ovarian cancer (HBOC) have extremely low rates of genetic counseling/testing. Long-standing barriers and inequities in access to services such as genetic counseling and testing require innovative solutions. One solution can involve training community outreach and education professionals (CORE-Ps) to bridge the gap between underserved communities and genetic specialists. We sought to develop and pilot test a training program for English-Spanish bilingual CORE-Ps to reduce disparities in access to and uptake of genetic services among Latino populations. Guided by Adult Learning Theory and with input from multiple stakeholders, we developed ÁRBOLES Familiares (Family Trees), an in-person and online training program for bilingual CORE-Ps to facilitate identification, referral, and navigation of Latinas to genetic counseling/testing. We conducted a pilot test of 24 CORE-Ps recruited from across the United States and assessed knowledge, genetic literacy, and self-efficacy at baseline and follow-up. At follow-up, participants in the pilot with complete baseline and follow-up data (N = 15) demonstrated significant improvements in HBOC knowledge, genetic literacy, self-efficacy and reports of fewer barriers to identify/navigate Latinas (ps < .05). Qualitative assessment identified ways to improve the training curriculum. Pilot results suggest ÁRBOLES is a promising approach for training CORE-Ps to identify and refer high-risk Latinas to genetic services. Next steps involve further refinement of ÁRBOLES, development of an online toolkit, and adaptation for virtual delivery.
癌症健康差异仍然是美国的一个重大问题,缺乏医疗保健、语言障碍和医疗保健系统中的系统性偏见使这一问题更加严重。这些差异在遗传学/基因组学等领域尤为明显。例如,遗传性乳腺癌和卵巢癌(HBOC)高危的拉丁裔女性接受遗传咨询/检测的比例极低。长期以来,在获得遗传咨询和检测等服务方面存在障碍和不平等,这需要创新的解决方案。一种解决方案可以涉及培训社区外展和教育专业人员(CORE-Ps),以缩小服务不足的社区和遗传专家之间的差距。我们旨在为英语-西班牙语双语 CORE-Ps 开发和试点测试一项培训计划,以减少拉丁裔人群获得和接受遗传服务方面的差异。在成人学习理论的指导下,并在多方利益相关者的参与下,我们开发了 ÁRBOLES Familiares(家族树),这是一个针对双语 CORE-Ps 的面对面和在线培训计划,旨在促进拉丁裔女性的识别、转介和遗传咨询/检测的导航。我们对从美国各地招募的 24 名 CORE-P 进行了试点测试,并在基线和随访时评估了他们的知识、遗传素养和自我效能。在随访时,完成基线和随访数据的试点参与者(N=15)在 HBOC 知识、遗传素养、自我效能以及报告的识别/导航拉丁裔女性障碍较少方面表现出显著改善(p<.05)。定性评估确定了改进培训课程的方法。试点结果表明,ÁRBOLES 是培训 CORE-P 识别和转介高危拉丁裔女性接受遗传服务的一种很有前途的方法。下一步包括进一步完善ÁRBOLES、开发在线工具包以及适应虚拟交付。