Empowering Latinas to Obtain Guideline-Concordant Breast Cancer Screenings

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ABSTRACT Latinas suffer disproportionately from late stage breast cancer (BC) diagnoses and worse post-diagnosis quality of life relative to non-Latina Whites (NLWs), in part due to lower guideline-concordant screening. Education+navigation (educate) approaches have offered Latinas community education to address psychosocial barriers (e.g., fear) and navigated Latinas to free/low-cost breast cancer care. Our transdisciplinary team has developed a promising empowerment+navigation (empower) approach that may lead to greater BC screening among Latino networks. In the empower approach, Latinas who are non-adherent to US Preventive Services Task Force (USPSTF) guidelines learn about BC; are navigated to free/low cost breast cancer care; and gain communication skills to promote BC screening throughout their networks. Our premise is that empowering non-adherent Latinas as breast health agents may lead to greater BC screening among non-adherent Latinas and their networks than treating non-adherent Latinas as passive recipients of education. The current proposal tests our premise and identifies “active ingredients” of the empower approach. In Aim 1, we will conduct an individual randomized controlled trial (RCT) in a federally qualified health center (FQHC). This trial will build on our team’s current service projects to provide free/low-cost BC screening in the FQHC, including leveraging its relationship with a community organization committed to leadership development among Latinas. Among non-adherent Latinas, we will compare the effects of empower and educate approaches on initial and repeat BC screening, in line with USPSTF guidelines. In Aim 2, we conduct an observational social network study. We will recruit network members through non- adherent Latinas enrolled in our RCT. Among network members, we will compare the effects of empower and educate approaches on initial and repeat BC screening across four years. In Aim 3, we will explore theoretical mechanisms of change that could contribute to intervention differences in BC screening. For non-adherent Latinas’ BC screening, we will examine the mediating roles of greater BC knowledge and motivation to be healthy role model. For network members’ BC screening, we will examine the mediating role of non-adherent Latinas’ enhanced capacity to promote BC screening. Specifically, we will test the independent effects of volunteerism in community BC initiatives, potential to “bridge” network members with formal change agents (e.g., community health workers, navigators), acceptability to promote BC, feasibility to promote BC, and BC promotion to network members. Our innovative, robust approach has direct implications for expediting the translation of promising community interventions into practice.