Breast and cervical cancer screening in rural and border Texas : a program evaluation of Friend to Friend plus Patient Navigation

This dissertation considers an evaluation of the health education and patient navigation (PN) intervention, Friend to Friend plus Patient Navigation Program (FTF+PN). In 2010, the Texas A & M AgriLife Extension Service was awarded outreach education funding by the Cancer Prevention Research Institute of Texas (CPRIT) to adapt the evidence-based program, Friend to Friend (FTF) in rural and border counties in Texas. FTF consists of “pink parties” intended for an audience of lower income, un-/underinsured women aged 40+ who may be disabled, self-employed, and/or have limited English proficiency (LEP). Increased funding in 2012 supported the addition of four, fulltime equivalent patient navigators to join the team of four, full-time equivalent regional cancer prevention specialists to allow for follow-up and active support for women to obtain the screenings. FTF+PN seeks to build an effective, sustainable infrastructure and overcome barriers to breast and cervical screening and diagnostic services to increase screening rates for underserved, un-/under-insured, and older women in approximately 60 rural and border counties. The goal is to increase the number of women screened according to American Cancer Society (ACS) guidelines for breast and cervical cancer, thereby increasing the probability any cancers detected would be diagnosed in earlier stages. At the time, ACS guidelines recommended annual mammograms for women aged 40-54 and biannual mammograms for those aged 55+ with average risk of breast cancer. For cervical cancer screenings, recommendations included Pap tests every 3 years for women aged 21-29 and every 5 years for women aged 30-65 with no additional screenings needed for women aged 65+ if their previous results were normal. The goal of this evaluation is to demonstrate the efficacy of combining PN, a patient-centered healthcare delivery model that utilizes trained lay navigators to integrate a fragmented system of care in order to reduce barriers to timely care for individuals and subsequently reduce disparities for population groups, with a health education intervention adapted for rural and border Texas. Screening outcomes are also evaluated in light of county-level poverty rates and educational attainment to provide more comprehensive statistical models advancing scientific understanding of screening behavior among varying groups of women.