Cancer Disparities Reduction Collaborative: Implementing a Community-based Screening Intervention in Appalachia

BACKGROUND: The Cancer Disparities Reduction Collaborative (CHA Collaborative) is an early detection and cancer screening intervention of the American Cancer Society (ACS) using Community Health Advisors (CHAs) and local community coalitions called Community Network Partnerships (CNPs) to help navigate underserved populations to cancer screenings.  As cancer incidence and mortality rates are much greater in the Appalachian region than in other regions of the U.S. (Paskett et al., 2011), the CHA Collaborative included projects in West Virginia, Kentucky, and Western North Carolina.   Data from the pilot evaluation reveal that Appalachia communities had unique struggles with project implementation and increasing early detection efforts. 

METHODS: A mixed-method evaluation included qualitative data from field visits (representing a total of 13 counties in three Appalachian states), in-depth interviews with Appalachia program staff, focus groups with CNPs and CHAs (n=20), and a survey of Appalachia-based CNP members (n=40). 

RESULTS: Findings indicate that Appalachian intervention sites had unique struggles when compared to African American community sites.  In particular, volunteer recruitment and retention, the “decentralized” nature of services, and individual level factors were all cited as barriers to implementation.  Individual level factors included a culture of “privacy,” and low literacy and educational levels.

CONCLUSION: While Community Health Worker interventions can play a significant part of addressing health disparities, community context must be fully understood for programs to be successfully implemented.  The Appalachia region encompasses many distinct communities and program structures must be tailored to each community’s specific cultural and geographical needs.