Colorectal Cancer Screening at the Nexus of HIV, Minority Statuses, and Cultural Safety

Abstract

Background The incidence of non-AIDS-defining cancers has increased significantly among persons living with HIV (PLHIV). Screening education is recommended. Purpose Social learning, minority stress, and cultural safety theories informed this pilot to assess the feasibility of a colorectal cancer screening intervention targeted to PLHIV, with additional tailoring for relevance to Native Hawaiians, a group with low participation in cancer screening. Method The targeted education included behavioral modeling and barriers counseling in a culturally safe environment. Using a 2-group, pre/posttest design, AIDS service organizations were randomized to culturally responsive or standard education. AIDS service organizations consumers recruited through venue-based promotions were the unit of analysis. Knowledge–attitudes–practices, fecal occult blood test screening completion, and intervention feasibility were measured. Results Treatment arm participants, regardless of ethnicity, adhered to fecal occult blood test instructions and achieved increases in screening knowledge, attitudes, and practices. Relevance and acceptability of the educational intervention were endorsed. Discussion The culturally responsive intervention was successful in this group of PLHIV. Additional tailoring may be needed to reach PLHIV who do not participate in organizational activities. Conclusion/Translation to Health Education Practice This culturally responsive intervention shows promise for efficacy testing in a broader PLHIV population. Constituent-involving strategies were central to its development and delivery.

Advancing patient‐centered care for structurally vulnerable drug‐using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction interventions into hospitals

“…While there remains no consensus on the definition of PCC, most PCC models include the following dimensions [1,8,9]: (i) recognition of bio-psychosocial influences on health; (ii) acknowledgement of subjective health needs and experiences; (iii) shared power and decision-making between patients and health-care providers; and (iv) promotion of patientprovider communication and relationships based on mutual trust. While first advanced as a means to address power relationships between health-care providers and indigenous populations, 'cultural safety' has been advanced more recently as a core dimension of PCC [10] and best practice in the care of vulnerable populations [11][12][13]. 'Cultural safety' seeks to ensure that care is responsive to power imbalances and institutional policies and practices that produce health inequities on the basis of race, gender identity, sexuality and socio-economic status, among other characteristics [14].…”

Listening to the Voices of Native Hawaiian Elders and ‘Ohana Caregivers: Discussions on Aging, Health, and Care Preferences

“…A number of culturally-based and culturally tailored programs have been developed and successfully tested to address the needs of Native Hawaiians with breast and colectoral cancer, diabetes, and heart disease (Braun et al 2005; Ka’opua et al 2011b, 2013; Look et al 2012; Mokuau et al 2012; Moy et al 2010). Nonetheless, attention to the health needs and care preferences specific to nā kūpuna and family caregivers is at a nascent stage.…”

Addressing Risk and Reluctance at the Nexus of HIV and Anal Cancer Screening

“…Disclosure of highly sensitive obstacles may be difficult for persons marginalized by minority statuses. Culturally competent, culturally safe barriers counseling (discussion of obstacles and solutions in specific cultural context, with honoring of cultural preferences) is used to positive effect in screening for other malignancies and should be considered in AIN screening promotion/education (Gierisch et al, 2010; Holden et al, 2010; Ka‘opua et al, 2014). Integration of strategies that address perceptions of risk and reluctance to screening may advantage translation of biomedical screening innovations to community settings and, ultimately, potentiate public health benefits for all.…”

“…Although there was no significant ethnic variation in AIN prevalence, researchers noted that NH results may underestimate abnormalities due to this group’s low/no participation in clinical studies. Culturally competent communications are recommended to address current disparities, with sociocultural relevance established through constituent dialogic processes (Airhihenbuwa, 1995; Ka‘opua, 2008; Ka‘opua et al, 2014; Shiramizu et al, 2012). …”