Removing Barriers To Health Care By Solving Issues Related To Disparities
For Americans, access to health care historically has been — and often remains — unequal. Many minorities encounter numerous barriers that contribute to racial and ethnic disparities in seeking cancer treatment. These barriers can include inadequate health insurance, low personal income, poor geographic access, lack of transportation to health care providers, culture factors and language barriers.
Some forms of cancer strike minorities disproportionately. For example, African-American men — regardless of their socioeconomic status — develop prostate cancer at a higher rate and die at a rate that is more than twice the rate at which white men develop and die of the same disease. Hispanic women in the United States have higher rates of cervical cancer than non-Hispanic white women. Breast cancer is the leading cause of cancer death among Hispanic women. And African-American women diagnosed with breast cancer are less likely than white women to survive five years past diagnosis. Colorectal cancer rates are higher in native Alaskans than in any other group in the United States.
Understanding The Causes Of Disparities Is Key Step In Closing The Gaps
Moffitt is committed to reducing disparities and working toward closing gaps in health care outcomes. “At Moffitt Cancer Center we work as teams to identify the root causes of disparities, whether they are socioeconomic or based on genetics and biology or poor health behaviors,” says B. Lee Green, Ph.D.
, vice president of Moffitt Diversity
and senior member of Moffitt’s Health Outcomes and Behavior Program
Several Moffitt research initiatives this past year have yielded data that may help solve some of the issues related to health disparities.
HPV Vaccination Disparities Among Girls From Low-Income Families
In the February 2013 issue of Cancer
, Moffitt and University of Florida researchers published findings of a study designed to analyze factors associated with disparities in human papillomavirus (HPV) vaccination among girls ages 9 to 17 from low-income families. The study findings suggest HPV vaccination disparities among low-income females require targeted intervention to increase vaccination rates among the underserved.
“The HPV vaccine has made cervical cancer preventable,” says Susan Thomas Vadaparampil, Ph.D.
“However, low-income and minority women still experience a higher number of deaths from the disease. Since all patients of all physicians surveyed were eligible for free vaccination due to their participation in the Florida Medicaid program, our findings suggest that cost may not be the only barrier to vaccination.” Dr. Vadaparampil is the lead author on the HPV vaccination disparities study, described above. She has a long-standing interest in health disparities, and she leads and collaborates on several projects to reduce disparities across the cancer prevention and control continuum. Her responsibilities include leading a National Institutes of Health-funded study to examine physician, systems and policy level factors influencing recommendation of HPV vaccination for females among a national sample of physicians from three primary care specialties. She was also recently funded by the state of Florida’s Bankhead Coley Research Program to examine provider recommendation of HPV vaccination for adolescent males.
Minority Beliefs Regarding The Risk Of Getting Cancer
Blacks, Asians and Hispanics were more likely to believe they had a lower chance of getting cancer than did whites, Moffitt researchers and colleagues found after analyzing national data. And Hispanics were less likely than whites and blacks to believe that they could lower their chances of getting cancer. The findings highlight the need for consistent cancer prevention messages and screening recommendations. The study researchers stressed the need for research on best ways to communicate cancer risk information to various racial and ethnic groups. Their study appears online in the American Journal of Health Promotion
“We found that blacks, Asians and Hispanics were all more likely to believe that they had a lower chance of getting cancer than did whites,” says Dr. Green, the study’s senior author. “These findings are important because we already knew that racial and ethnic minorities, especially blacks, have higher cancer mortality, incidence and prevalence rates than whites have. Additionally, there are differences in how preventative health behaviors are addressed based on race and ethnicity.” Read more.
Hispanics Are Nearly Twice As Likely To Lack Trust In Health Care Professionals
Racial, ethnic and educational discrepancies exist concerning fears and mistrust related to the patient-health care provider relationship that may contribute to unwillingness to participate in cancer screenings. Compared to whites, Hispanics were nearly twice as likely to report a lack of trust in medical professionals, according to a study by Moffitt researchers and colleagues, reported in the November 2013 issue of the Journal of Health Care for the Poor and Underserved.
Health care providers need to do a better job of inspiring trust and eradicating certain fears, especially among Hispanics, to improve cancer screening rates for lower-income minorities, the researchers concluded.
Relating To Hispanics Is Essential To Their Participating In Clinical Trials
“Hispanic cancer patients rarely participate in clinical trials, and Moffitt researchers used feedback from focus groups to help develop a DVD and accompanying booklet in Spanish to educate and empower patients to participate in treatment decisions,” says Gwendolyn P. Quinn, Ph.D.
, scientific director of Moffitt’s Survey Methods Core Facility and senior member in the Health Outcomes and Behavior Program
. The study was published online in May 2013 by the Journal of Health Communication: International Perspectives
. The researchers found examples of culturally based beliefs that may have kept patients from considering a clinical trial. “For example, Hispanic patients typically believe that the doctor will tell them what to do, causing confusion among these patients about why a doctor would ask them to make a treatment decision, such as participating in a clinical trial,” says Dr. Quinn. The researchers developed these decision support materials in Spanish to help improve confidence in decision making.
A pilot study reported in Clinical Trials
and first published in August 2013 was conducted among Spanish-speaking patients diagnosed with cancer. All patients took a pretest on knowledge, attitudes and intentions (KAI) and then either watched the DVD in clinic or received printed information from the NCI explaining clinical trials. All patients completed a post-assessment to identify any changes in KAI. Patients who had watched the DVD reported feeling more confident in their ability to make a decision about a clinical trial if one were offered to them in the future. Dr. Quinn, the study’s lead author, also is the former director of the National Training Collaborative for Social Marketing, a cooperative venture of the U.S. Centers for Disease Control and Prevention (CDC) and the American Association of Medical Colleges (AAMC) that trains health care professionals in the field of social marketing.
“Health care disparities have an impact on the health care system, on the economy and on people’s lives,” concludes Dr. Green. “Our goal is to establish a center that screens for cancer, assists with issues that may hinder the delivery of care and engages in studies in health disparities research.”
Spanish-Speaking Events Serve Tampa Bay’s Hispanic Community
The Moffitt Program for Outreach Wellness Education and Resources (M-POWER
) provides the community with health education in the areas of prevention, early detection and screening.
To improve services specifically to members of the Hispanic community in the Tampa area, Moffitt Cancer Center conducts educational symposiums in Spanish and also provides simultaneous interpretations of certain educational events into Spanish.
The Moffitt Diversity Department’s Yo Me Cuido®
program, a Latina breast health education project, educates Hispanic women about the importance of screening.
“…there is still a need for information among the Hispanic community, because of different factors,” says Myriam Escobar, community outreach worker with Moffitt Diversity Department’s Yo Me Cuido® program. Escobar was recently honored at the White House as a “Champion of Change” and was recognized by the president for her work inspiring healthy changes among Hispanic women. Meet Myriam Escobar and read her entire interview in Spanish. Lea la entrevista íntegra de Myriam Escobar en español