Addressing racial disparities in perinatal care for African American/Black individuals in the Chicago community health setting: a qualitative study.

Background: There are persistent disparities in maternal and infant perinatal outcomes experienced by Black birthing persons compared with non-Hispanic white (NHW) individuals in the US. The differences in outcomes arise from not only socioeconomic factors and individual health behaviors but also structural racism. Recent research is beginning to elucidate the benefits of patient navigation to support underserved minoritized individuals who experience this constellation of barriers to equitable care.

An examination of the implementation of a patient navigation program to improve breast and cervical cancer screening rates of Chinese immigrant women: a qualitative study.

Background: Chinese Americans have lower breast and cervical cancer screening rates than the national average and experience multiple barriers to cancer care. Patient navigators have improved screening and follow-up rates for medically underserved populations, yet investigations of cancer navigation programs and their implementation among Chinese Americans are limited. To address this gap, we used the Consolidated Framework for Implementation Research (CFIR) to examine facilitators and barriers to implementing the Chicago-based Chinatown Patient Navigation Program (CPNP) for breast and cervical cancer screening, follow-up, and treatment.

Systematic Patient Navigation Strategies to Scale Breast Cancer Disparity Reduction by Improved Cancer Prevention and Care Delivery Processes.

Purpose: Patient navigation uses trained personnel to eliminate barriers to timely care across all phases of the health care continuum, thereby reducing health disparities. However, patient navigation has yet to be systematized in implementation models to improve processes of care at scale rather than remain a band-aid approach focused solely on improving care for the individual patient. The 4R systems engineering approach (right information and right treatment to the right patient at the right time) uses project management discipline principles to develop care sequence templates that serve as patient-centered project plans guiding patients and their care team.

Refining Trauma-Informed Perinatal Care for Urban Prenatal Care Patients with Multiple Lifetime Traumatic Exposures: A Qualitative Study.

Introduction: Because lifetime trauma exposure has been linked to multiple adverse pregnancy outcomes, there is a need for all perinatal care providers to be versed in trauma-informed care practices. However, there are few data to guide trauma-informed practice during the perinatal period. The objective of this study was to refine ongoing development of a trauma-informed care framework for perinatal care by conducting a qualitative study of all trauma experiences and preferred screening practices of pregnant patients at an urban prenatal clinic.

Leveraging Digital Platforms to Scale Health Care Workforce Development: The Career 911 Massive Open Online Course.

Background: Health care is the fastest growing occupational sector in the United States, but students from low-income and underrepresented minority (URM) backgrounds often lack mentorship and basic information about health care careers and pathways.

Objectives: We developed the Career 911 massive open online course (MOOC) to help students from diverse backgrounds to explore and build career portfolios to enter health-related professions.

Methods: We describe the evolution since 2014 of the Career 911 MOOC and lessons learned.

Using Public Claims Data for Neighborhood Level Epidemiologie Surveillance of Breast Cancer Screening: Findings from Evaluating a Patient Navigation Program in Chicago's Chinatown.

Objectives: This study was designed to evaluate a patient navigation program undertaken with our community partners in Chicago's Chinatown. Inadvertently, the study collected data on two biannual mammography screening cycles that coincided almost exactly with implementation of the Affordable Care Act (ACA) in Illinois.

Methods: The study uses claims data to profile mammography screening rates for residents of an 18 zip code, 398 census tract area on Chicago's near south and southwest side.

The Chinatown Patient Navigation Program: Adaptation and Implementation of Breast and Cervical Cancer Patient Navigation in Chicago's Chinatown.

Background: As health care reform continues within the United States, navigators may play increasingly diverse and vital roles across the health care continuum. The growing interest in patient navigation programs for underserved populations calls for detailed descriptions of intervention components to facilitate implementation and dissemination efforts.

Methods: In Chicago's Chinatown, Chinese immigrant women face language, cultural, and access barriers in obtaining breast and cervical cancer screening and follow-up.

'There's nothing you can do … it's like that in Chinatown': Chinese immigrant women's perceptions of experiences in Chicago Chinatown healthcare settings.

Chinese American women living in linguistically isolated communities are among the least likely to utilize healthcare services. Qualitative research methods can help identify health system vulnerability points to improve local healthcare delivery for this population. We conducted 6 focus groups among 56 Chinese-speaking adult women in Chicago's Chinatown between July and August 2014 to explore their perceptions of experiences receiving medical care and interacting with healthcare providers in Chinatown healthcare settings.

Examining the external validity of the CRUZA study, a randomized trial to promote implementation of evidence-based cancer control programs by faith-based organizations.

The CRUZA trial tested the efficacy of an organizational-level intervention to increase capacity among Catholic parishes to implement evidence-based interventions (EBIs) for cancer control. This paper examines the external generalizability of the CRUZA study findings by comparing characteristics of parishes that agreed to participate in the intervention trial versus those that declined participation. Sixty-five Roman Catholic parishes that offered Spanish-language mass in Massachusetts were invited to complete a four-part survey assessing organization-level characteristics that, based on the Consolidated Framework for Implementation Research (CFIR), may be associated with EBI implementation.

Chinese Immigrant Women's Attitudes and Beliefs About Family Involvement in Women's Health and Healthcare: A Qualitative Study in Chicago's Chinatown.

Healthcare utilization and health-seeking behaviors of Chinese American immigrant women may be influenced by longstanding cultural perspectives of family roles and relationships. An understanding of Chinese immigrant women's perceptions of family social support in health and how these beliefs manifest in healthcare utilization and help-seeking behaviors is critical to the development of culturally appropriate health interventions. Focusing on a sample of Chinese women in Chicago's Chinatown, this qualitative study seeks to describe women's attitudes and beliefs about spouse and adult children's involvement in women's health and healthcare.

Enhancing capacity among faith-based organizations to implement evidence-based cancer control programs: a community-engaged approach.

Evidence-based interventions (EBIs) to promote cancer control among Latinos have proliferated in recent years, though adoption and implementation of these interventions by faith-based organizations (FBOs) is limited. Capacity building may be one strategy to promote implementation. In this qualitative study, 18 community key informants were interviewed to (a) understand existing capacity for health programming among Catholic parishes, (b) characterize parishes' resource gaps and capacity-building needs implementing cancer control EBIs, and (c) elucidate strategies for delivering capacity-building assistance to parishes to facilitate implementation of EBIs.

Knowledge and Beliefs About Biospecimen Research Among Chinese Older Women in Chicago's Chinatown.

Background: Enhancing the participation of Chinese older women in biobanking efforts is important for precision medicine efforts, as underrepresented groups risk benefiting less than others from medical advancements in individualized therapies. Focusing on a sample of Chinese older women in Chicago's Chinatown, this qualitative study seeks to describe attitudes toward, and barriers and facilitators of, participation in biospecimen research.

Method: We conducted six focus groups among Chinese-speaking adult women age 45 and above.

Breast Cancer Screening Beliefs Among Older Chinese Women in Chicago's Chinatown.

Background: Chicago's Chinatown is home to a sizeable community of first-generation Chinese American immigrants. This qualitative study seeks to describe the attitudes toward, and barriers and facilitators of, breast cancer screening among Chinese women in Chicago's Chinatown to inform strategies for future interventions.

Methods: We conducted six focus groups among Chinese-speaking adult women aged 45 and older.

Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care.

Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients' interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus-community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care.

Dissemination of evidence-based cancer control interventions among Catholic faith-based organizations: results from the CRUZA randomized trial.

Background: The CRUZA randomized trial tested the efficacy of an organizational-level intervention to increase the capacity of Catholic faith-based organizations (FBOs) serving Latinos to implement evidence-based strategies (EBS) for cancer control.

Methods: Thirty-one Catholic parishes were enrolled. Twenty were randomized to a "capacity enhancement" (CE) intervention and 11 to a "standard dissemination" (SD) condition.

Providers' Views on a Community-Wide Patient Navigation Program: Implications for Dissemination and Future Implementation.

The DuPage Patient Navigation Collaborative (DPNC) adapted and scaled the Patient Navigation Research Program's intervention model to navigate uninsured suburban DuPage County women with an abnormal breast or cervical cancer screening result. Recent findings reveal the effectiveness of the DPNC in addressing patient risk factors for delayed follow-up, but gaps remain as patient measures may not adequately capture navigator impact. Using semistructured interviews with 19 DPNC providers (representing the county health department, clinics, advocacy organizations, and academic partners), this study explores the critical roles of the DPNC in strengthening community partnerships and enhancing clinical services.

Leveraging the Experiences of Informal Caregivers to Create Future Healthcare Workforce Options.

The objective of this study was gather pilot data from informal caregivers regarding the potential for a training program to assist current or past caregivers in reentering the job market, and thus offering a pathway to economic resilience. In an effort that could foster a sustainable and competent caregiving market to help meet the needs of an aging America, whether training informal caregivers might help them transition into a paid caregiving or other health service role was explored. Caregivers (N=55) of a chronically or terminally ill family member or friend in a suburban county near Chicago were interviewed.

Voices of Informal Caregivers and Community Stakeholders: Whether and How to Develop an Informal Caregiver Training Program.

Our primary objective was to gather pilot data from caregivers and stakeholders to guide the development of a training program to assist informal caregivers in re-entering the job market. The goal of the program would be to help caregivers rebound from their incurred economic burden by transitioning into a paid caregiving or other health-service role. The economic burden they bear often necessitates a return to the workforce following caregiving; yet the act of returning is complicated by an extended absence from the workforce and a lack of experience in other verifiably skilled and paid roles.

Enhancing organizational capacity to provide cancer control programs among Latino churches: design and baseline findings of the CRUZA Study.

Background: Faith-based organizations (FBOs) have been successful in delivering health promotion programs for African Americans, though few studies have been conducted among Latinos. Even fewer have focused on organizational change, which is required to sustain community-based initiatives. We hypothesized that FBOs serving Latinos would be more likely to offer evidence-based strategies (EBS) for cancer control after receiving a capacity enhancement intervention to implement health programs, and designed the CRUZA trial to test this hypothesis.

Recruiting and Surveying Catholic Parishes for Cancer Control Initiatives: Lessons Learned From the CRUZA Implementation Study.

Background: We describe activities undertaken to conduct organizational surveys among faith-based organizations in Massachusetts as part of a larger study designed to promote parish-based cancer control programs for Latinos.

Method: Catholic parishes located in Massachusetts that provided Spanish-language mass were eligible for study participation. Parishes were identified through diocesan records and online directories.

The Development of a Communication Tool to Facilitate the Cancer Trial Recruitment Process and Increase Research Literacy among Underrepresented Populations.

Despite increasing need to boost the recruitment of underrepresented populations into cancer trials and biobanking research, few tools exist for facilitating dialogue between researchers and potential research participants during the recruitment process. In this paper, we describe the initial processes of a user-centered design cycle to develop a standardized research communication tool prototype for enhancing research literacy among individuals from underrepresented populations considering enrollment in cancer research and biobanking studies. We present qualitative feedback and recommendations on the prototype's design and content from potential end users: five clinical trial recruiters and ten potential research participants recruited from an academic medical center.

Evaluating a bilingual patient navigation program for uninsured women with abnormal screening tests for breast and cervical cancer: implications for future navigator research.

Objectives: The DuPage Patient Navigation Collaborative evaluated the Patient Navigation Research Program (PNRP) model for uninsured women receiving free breast or cervical cancer screening through the Illinois Breast and Cervical Cancer Program in DuPage County, Illinois.

Methods: We used medical records review and patient surveys of 477 women to compare median follow-up times with external Illinois Breast and Cervical Cancer Program and Chicago PNRP benchmarks of performance. We examined the extent to which we mitigated community-defined timeliness risk factors for delayed follow-up, with a focus on Spanish-speaking participants.

What women want: patient recommendations for improving access to breast and cervical cancer screening and follow-up.

Background: The patient voice remains underrepresented in clinical and public health interventions. To inform interventions that strive to improve access to breast and cervical cancer screening and follow-up among low-income populations, we explored recommendations from low-income women pursuing health care in the safety net.

Methods: Semi-structured interviews were conducted among women receiving follow-up care for an abnormal breast or cervical cancer screening result or a positive cancer diagnosis in federally qualified health centers, free clinics, or an academic cancer center in the Chicago metropolitan area.

Religion, fatalism, and cancer control: a qualitative study among Hispanic Catholics.

Objectives: To assess cancer perceptions among churchgoers and to examine the potential influence of fatalism and religious beliefs on the use of cancer screening tests.

Methods: Eight semi-structured focus groups were conducted among 67 Hispanic Catholics in Massachusetts.

Results: In this sample, there were few references to fatalistic beliefs about cancer and nearly universal endorsement of the utility of cancer screening for cancer early detection.