In spring 1994 students at Baylor University School of Nursing began planning women's health services as part of the comprehensive district nursing care delivered to residents living in a low-income and ethnically diverse (primarily Southeast Asian and Hispanic) area of East Dallas. The first cancer-related services were provided in spring 1995 and included mammograms, individualized breast self-exam teaching, home follow-up on the mammography results and BSE teaching, and, when necessary, assistance obtaining additional screening. Mammograms, teaching, and follow-up were again provided in each semester through spring 1997.
In spring 1996 services were expanded to include fecal occult blood test (FOBT) or stool guiacs and HIV testing. Follow-up care is provided for all suspicious or positive findings. These services are provided in the immediate neighborhood and in participant homes. Other agencies involved include St. Paul Missions, East Dallas Police Storefront, Baylor University Medical Center, UT Southwestern Medical School, and numerous businesses who donated goods and supplies.
Thus far a total of 212 women have been screened. As expected, this was the first mammogram for most of the Asian women; and Cambodians and Laotians had experienced the fewest mammograms. Five of the Cambodian women had undergone a previous mammogram (one of whom was called into the third event for a repeat because of unclear results from second event); two of the Laotian women had undergone a previous mammogram; and eleven of the Vietnamese women had undergone a previous mammogram.
Figure 1. Women Screened in Seven Mammogram Events: Ethnic Breakdown
Of 44 stool guiacs returned for testing there have been two positives, with later testing showing no cancer. HIV test results are not available. All of the HIV tests on Asians were first time tests.
Women living in this community exhibit the major barriers or variables leading to increased cancer morbidity and mortality; and to resistance to screening such as mammography.1-4 Strategies used to overcome these barriers include:
- Reasons for testing are carefully explained to all potential participants.
- Mammograms are provided in the immediate neighborhood in a known and positively-regarded (community policing) facility.
- Participants are greeted at the door, escorted to a seat, and offered refreshments as part of the intake process. Everyone is treated with utmost dignity throughout the process. Gift bags with toiletries and cancer education materials are given to each participant.
- Screening and teaching are individualized using translators - in all cases, females of the same ethnicity; and in most cases, translators of similar age and socio-economic status.
- All participants receive follow-up care, including follow-up visits to explain (mailed) results and reinforce BSE teaching; and, in several cases, to assist participants to receive further testing.
- Door-to-door, face-to-face outreach is the primary means of communicating with participants. Although flyers in the five major languages (Cambodian, English, Laotian, Vietnamese, and English) were distributed, and announcements made on several ethnic radio stations, only 4% of participants resulted from such means.
- After the first event women who had participated previously helped with outreach.
- Standards of modesty are maintained at all times, including while teaching BSE.
Success was also promoted by this cancer screening being a part of a larger program addressing a broad spectrum of health and social needs and problems.
Follow-up and measurement of proficiency and compliance with BSEs are the areas in need of most work. We are in the process of revising follow-up procedures to include increased education. Future plans include Saturday mammograms for women who work on weekdays, increased background cancer teaching, cancer risk assessments, education on the major signs and symptoms of cancer, education on risk reduction and prevention (especially cigarette smoking), and increasing the number of women receiving Pap smears.
These efforts toward early detection and prevention of cancer in an underserved population can be replicated by other schools of nursing and community groups, especially when offered as part of an ongoing and comprehensive program such as district nursing. Certainly there are challenges in providing these services. We have shown, however, that the challenges can be overcome and that students can play a vital role in the health of communities.
Link: http://www.oncolink.upenn.edu/ is a comprehensive, in depth site for information on cancer.
Back to top OR Back to Asian Health
Authors: Stacie Bailey, RN; Polly Bennett, RN; Jody Hicks, RN; Charles Kemp, RN, CRNH; Susan Hawk Warren, RN