Starting the conversation: Developing events to connect comprehensive cancer control coalitions and programs with underrepresented areas of their states

Appalachia is a federally defined geographic area of (420)in 13 states located in counties from Mississippi to New York. This region where poverty, lower educational levels, and health disparities persist into the 21st century exhibits rates of cancer, especially lung, skin and colorectal cancer that consistently exceed national and state levels. Appalachian culture, as described by participants in project focus groups and supported in literature, is characterized by deep family ties, identification with mountain culture and geography, religiosity, and self-reliance. This foundation for Appalachian cancer health disparities was used to devise strategies to reduce the cancer burden by engaging communities (individuals, state organizations, and health care providers) in locally acceptable engagement modalities in a local and reg settings to create opportunities for further conversation. Forums and roundtables were used to develop a Cancer Communication Toolkit for communities to use to model the implementation of locally-generated workshops to facilitate discussion using storytelling, case scenarios, breakout sessions with guided discussions, and targeted evaluative techniques that could lead communities to greater understanding about cancer prevalence and local strategies for fostering ongoing dialog with state agencies and organizations that would lead to greater representation of rural areas in state cancer control plans. This is a description of the development of the Toolkit and its publication and dissemination. A description of the lessons learned proved valuable in the assessment of the effectiveness of this strategy for developing greater communication in these 13 states.