Adaptation of a Community Health Advisor Program to Reduce Cancer Screening Disparities: Findings from a 3-Year Pilot Study

From 2011 to 2014, the American Cancer Society (ACS) implemented the Community Health Advisor (CHA) Collaborative, a pilot project adapted from an evidence-based CHA program created by the Deep South Network for Cancer Control, to reduce cancer disparities in underserved communities in the South.

The CHA program was implemented in 28 communities, including African-American, Appalachian, and American Indian communities. A mixed methods process and outcome evaluation was completed in June 2014. The qualitative evaluation included 16 focus groups with 52 CHA volunteers and 43 partner organization representatives along with 13 semi-structured interviews with CHA staff. CHA volunteers collected data on number of individuals educated, type of education provided, and demographic and screening information for individuals navigated.

Program start-up averaged about 8 months, but varied by geographic location. Three hundred and eighty-three CHA volunteers were recruited. CHAs conducted cancer outreach and education with a total of 31,439 individuals. CHAs navigated a total of 4,270 women to mammography screening, with a median of 29 days to screening completion. 75% were noncompliant for mammography. Program implementation varied due to differing program start dates, external funding, and staff transitions during the pilot. Respondents identified successes and challenges unique to each type of community (Appalachia, American Indian, and African American communities).  A lack of resources for screening was a commonly reported barrier across sties.

Discussion of key strategies for program adaptation, implementation, CHA recruitment, and regional variations will help other CHW programs translating evidence-based interventions in diverse community contexts.