Need: The breast cancer education, screening, and navigation program (BEST) 4 in West and South Texas is designed to comprehensively address essential barriers to breast cancer screening in 33 counties in Texas Public Health Regions (PHRs) 1, 2, 8, 9, and 10. Our target area has a population of over 3 million people and comprises 28 rural and 12 border counties. Individuals in these counties have high rates of poverty (23% of individuals in the Texas-Mexico border counties are below the federal poverty line), low educational attainment (28 counties high school graduation rates are lower than the national average), and high rates of being uninsured (32 counties have higher uninsured rates com...
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Need: The breast cancer education, screening, and navigation program (BEST) 4 in West and South Texas is designed to comprehensively address essential barriers to breast cancer screening in 33 counties in Texas Public Health Regions (PHRs) 1, 2, 8, 9, and 10. Our target area has a population of over 3 million people and comprises 28 rural and 12 border counties. Individuals in these counties have high rates of poverty (23% of individuals in the Texas-Mexico border counties are below the federal poverty line), low educational attainment (28 counties high school graduation rates are lower than the national average), and high rates of being uninsured (32 counties have higher uninsured rates compared to the national average). Furthermore, the Hispanic population is significant and exceeds state and national averages for the proportion of Hispanics. This area is also significantly medically underserved: All 33 counties are designated as whole or partial area MUAs, and all have physician-to-population ratios below the national average. As a result of being medically underserved, predominantly rural, having low SES, and significant minority population proportions, women in this area suffer breast cancer health disparities due to low screening rates and late-stage breast cancer diagnosis. Overall Project Strategy: The BEST program is a comprehensive, culturally tailored, multilevel, and multicomponent intervention that uses a socioecological approach to address known barriers to breast cancer screening, diagnosis, and treatment in the region. The program serves the CPRIT priority populations of the underserved, rural, and cultural/ethnic minority populations. The program addresses several levels of the socioecological model. It includes research-tested, evidence-based outreach, education, clinical service delivery, patient navigation, dissemination, and implementation, and it promotes the uptake of sustainable system changes. Service delivery will be facilitated through our ongoing collaborations with community organizations, faith groups, schools, and healthcare providers and through new partners who will facilitate recruitment education, navigation, and reduction of SDOH barriers. In this new application, we will a) build upon successful components of the current program, strengthening and developing new partnerships in the current service area; b) enhance collaborations with service providers to ensure timely and appropriate navigation to diagnostics and treatment; and c) Adpat and implement the PRAPARETM SDOH screening tools to evaluate individual SDOH barriers; d) expand navigation by equipping staff with training on SDOH screenings, sensitive response to patient answers, and referral procedures based on screening results; e) build strong connections with local social service organizations, food banks, housing authorities, and transportation services to create a referral network. Specific Goals: Our program goals are: 1) Maintain our comprehensive breast cancer services while enhancing partnerships to expand the implementation of evidence-based interventions with Clinical partners; 2) Implement comprehensive screening for social determinants of health (SDOH) to enhance patient navigation and maximize the program's impact and 3) Ensure 100% of patients with abnormal screening results will be given the opportunity to receive diagnostic testing, and 100% of patients diagnosed with cancer who require treatment will be guided into treatment. We propose to serve over 200,000 individuals, providing over 53,000 educational services, 30,000 navigation services, and almost 5,000 clinical services. Significance and Impact: In line with CPRIT's prevention program goals to reduce overall cancer incidence, our program aims to prevent and reduce the burden of breast cancer among the underserved. We will expand a multilevel, culturally appropriate breast cancer prevention program comprised of innovative components that enhance sustainability by building community partnerships and capacity. This intervention will positively impact cancer prevention among predominantly Hispanic and rural populations along the Texas-Mexico border.
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