Strategies for sustaining programs that address cancer inequities
Cancer has a disproportionate impact on Black women. However, Lay Health Advisor (LHA) programs have shown remarkable promise in addressing health inequities and some of the structural barriers to health experienced by Black women (e.g., stigma, medical mistrust, discrimination). These initiatives involve trained peers from the community who typically deliver and provide health education, navigation, resources, and social support in community and clinical settings.
Rachel Shelton, associate professor of sociomedical sciences, wants to find ways to ensure that these effective, community engaged programs are sustainable for many years to come. She will lead a R01 study funded by The National Cancer Institute, in collaboration with Co-Investigators from Roswell Park Comprehensive Cancer Center and community partners from The National Witness Project. This study seeks to inform understanding of what strategies are effective in promoting the long-term delivery and impact of LHA programs focused on improving racial inequities in cancer and cancer screening among Black women.
Dr. Shelton has collaborated with The National Witness Project for the past 14 years to advance understanding of how to sustain community-led, equity-focused cancer screening programs. National Witness Project is an exemplar for LHA programs, as it is an effective evidence-based program that was co-developed with Black women and has been nationally disseminated, replicated, and implemented nationally over the past 30 years.& Despite it's the success, challenges persist in ensuring its long-term sustainability, especially amidst the COVID-19 pandemic, which has exacerbated existing health inequities. This team is determined to bridge this gap by conducting a comprehensive study to advance understanding of what strategies are feasible and effective in actively promoting the long-term sustainability and impact of community-engaged programs like NWP.
Using a three-pronged approach, the study will first focus on refining sustainability strategies in collaboration with NWP sites across the nation, including refining an innovative entrepreneurship training and curriculum for building the business case for the program and demonstrating its value. Investigators will focus on a range of strategies for building capacity and partnerships to enhance sustainability of NWP (e.g. ongoing training, Community of Practice), with the goal of enhancing capacity for sites to build partnerships with academic/healthcare centers to leverage organizational resources and adapting the program to address local community needs and context. Secondly, the study will examine the impact of this refined package of strategies on multiple sustainability outcomes annually over four years across 16 NWP. Thirdly, using a mixed-methods evaluation approach, Dr. Shelton aims to glean insights into how these strategies influence capacity building and sustainability in community settings.
"Ultimately, the findings hold the potential to enhance the impact of community-led initiatives and contribute significantly to the pursuit of health equity, particularly in cancer screening and outcomes among Black women". This pivotal research is not just about numbers or statistics – it’s about lives; each finding laying foundational stones for reinvigorating and enhancing the impact and continuation of trusted community-led programs that are critical to eliminating cancer inequities.
