A Process Evaluation of the Alaska Native Colorectal Cancer Family Outreach Program

Abstract

This article presents the results of a process evaluation of the Alaska Native (AN) Colorectal Cancer (CRC) Family Outreach Program, which encourages CRC screening among AN first-degree relatives (i.e., parents, siblings, adult children; hereafter referred to as relatives) of CRC patients. Among AN people incidence and death rates from CRC are the highest of any ethnic/racial group in the United States. Relatives of CRC patients are at increased risk; however, CRC can be prevented and detected early through screening. The evaluation included key informant interviews (August to November 2012) with AN and non-AN stakeholders and program document review. Five key process evaluation components were identified: program formation, evolution, outreach responses, strengths, and barriers and challenges. Key themes included an incremental approach that led to a fully formed program and the need for dedicated, culturally competent patient navigation. Challenges included differing relatives’ responses to screening outreach, health system data access and coordination, and the program impact of reliance on grant funding. This program evaluation indicated a need for more research into motivating patient screening behaviors, electronic medical records systems quality improvement projects, improved data-sharing protocols, and program sustainability planning to continue the dedicated efforts to promote screening in this increased risk population.

Culturally competent healthcare – A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision

“…All mixed methods studies used congruent triangulation [72–85], except for one that chose a sequential transformative design [86]. Qualitative studies included four case studies [87–90], and the methods of data collection used were interviews [90–92], focus groups [89, 93] or open-ended questions [88]. The number of participants ranged from 6 [41] to 5963 [43] participants.…”

“…The number of participants ranged from 6 [41] to 5963 [43] participants. Twenty-nine studies focused on one ethnic group [27, 30–36, 39, 41, 42, 47–49, 51, 57, 69, 75, 77–80, 82–85, 87, 89, 92] while thirty-three included more than one ethnic group [28, 29, 37, 38, 40, 43–46, 50, 52–56, 58–68, 70–73, 86, 91, 93] and five studies did not report the ethnicity of their participants [74, 76, 81, 88, 90].…”

Stakeholder perspectives on the implementation and impact of Indigenous health interventions: A systematic review of qualitative studies

“…‘I've seen this many, many times in the Indian Health Service and now in the Alaska Native Health System is that when the grant for a program starts to shrink, the program also begins to shrink. And when the grant goes away, the program goes away and it has nothing to do with how important that program is to the health of the population or how successful the program is,’ (key informant for an Alaskan Native cancer outreach programme) 34 …”

Effectiveness of Interventions to Increase Colorectal Cancer Screening Among American Indians and Alaska Natives

“…In a similar study by Jean-Jacques et al (14), 23% of participants had incorrect or nonfunctional telephone numbers. Lasser et al (15) reported that of those eligible for patient navigation, 25% could not be contacted after 8 to 11 telephone call attempts. When a tribal facility or health system chooses to use CHRs to assist with cancer screening, CHRs need to have designated time to focus on this task.…”

“…When a tribal facility or health system chooses to use CHRs to assist with cancer screening, CHRs need to have designated time to focus on this task. Patient navigators hired in 1 facility in Alaska specifically to assist with CRC screening efforts dramatically increased the number of CRC patients’ first-degree relatives who completed screening ( 16 ). Future studies could seek to determine how much outreach is appropriate before reaching saturation.…”