Implementation of Community Health Worker Programs to Reduce Health Disparities in Breast and Colorectal Cancer: Results of a National Multi-Site Evaluation

The American Cancer Society (ACS), with support from a Walmart Foundation grant, funded 33 programs throughout the country to address health disparities in breast and colorectal cancer screening from 2011 to 2012. The programs utilized models that incorporated community health workers/lay health workers/community health advisors/Promotoras to conduct facility-based ‘in-reach' and/or community-based outreach and education to increase cancer-related awareness and knowledge, leading to increased mammography and colorectal cancer screening. Programs also implemented changes to electronic medical records systems and internal identification, referral and screening processes to identify and track individuals in need of screening. The ACS Statistics & Evaluation Center (SEC) conducted a process evaluation of the programs through quantitative and qualitative data collection methods. Variation in program models implemented, details about operational successes and challenges, and elucidation of the factors associated with attainment of program goals and objectives will be presented. Across 33 programs, 300 CHWs provided education to 19,862 women and men on breast and/or colorectal cancer. In addition, a total of 2,134 women received breast cancer screening, and 4.685 women and men received colorectal cancer screening. Most programs attained education and outreach output goals, although many programs had challenges in navigating individuals to screening. Some key factors associated with successful implementation include: program history and embeddedness within the community, relationship with local ACS Division staff, staff and volunteer training, and having a relationship with screening facilities. Program challenges included internal program staff communication, changes to electronic medical record systems, internal acceptance of policy changes, and outcomes measurement.