Implementing Women’s Cancer Screening Programs in American Indian and Alaska Native Populations

Abstract

The National Breast and Cervical Cancer Early Detection Program provides funding to tribes and tribal organizations to implement comprehensive cancer screening programs using a program model developed for state health departments. We conducted a multiple-site case study using a participatory research process to describe how 5 tribal programs implemented screening services, and to identify strategies used to address challenges in delivering services to American Indian and Alaska Native women. We analyzed data from semistructured interviews with 141 key informants, 16 focus groups with 132 program-eligible women, and program documents. Several challenges regarding the delivery of services were revealed, including implementing screening programs in busy acute-care environments, access to mammography, providing culturally sensitive care, and providing diagnostic/treatment services in rural and remote locations. Strategies perceived as successful in meeting program challenges included identifying a "champion" or main supporter of the program in each clinical setting, using mobile mammography, using female providers, and increasing the capacity to provide diagnostic services at screening sites. The results should be of interest to an international audience, including those who work with health-related programs targeting indigenous women or groups that are marginalized because of culture, geographic isolation, and/or socioeconomic position.

Traditionality and Cancer Screening Practices Among American Indian Women in Vermont

“…Although the sample was predominately rural (83%), which has been identified as a screening barrier in previous research with AI/AN women (Foxall et al, 2001;Lantz et al, 2003), the women's high level of education, insurance coverage, and income provided access to screening and health care services often not available to poor and uninsured populations of AI/AN women. These high screening rates also may be related to the fact that because AI tribes in Vermont are not federally recognized, women are not limited to IHS sites for screening services.…”

“…These high screening rates also may be related to the fact that because AI tribes in Vermont are not federally recognized, women are not limited to IHS sites for screening services. The lack of mammography equipment and screening programs within the IHS has been identified as Downloaded by [Temple University Libraries] at 10:09 19 November 2014 a barrier to screening for AI/AN women living on-reservation and in urban areas served by IHS (DHHS, 2003;Giuliano et al, 1998;Lantz et al, 2003;Risendal et al, 1999).…”

‘Organised’ cervical screening 45 years on: How consistent are organised screening practices?

“…Populations also have different access to organised programmes based on factors other than geography. The United States, for example, has organised and funded cervical screening programmes in most states for eligible underserved women [75][76][77]. Conversely, some organised screening programmes may not be available to women who cannot pay to attend.…”

Development and Implementation of a Culturally Sensitive Cervical Health Survey: A Community-Based Participatory Approach

“…A true CBPR project will have communities determining their own research needs and being involved in all stages of research (Barton 1998;Berardi and Donnelly 1999;Crazy Bull 1997;Christopher 2003;Deloria 1991). This practice has been encouraged by Native researchers (Burhansstipanov 1999;Weaver 1997Weaver , 1999 and has been consistently encouraged as a part of standardized community assessment in public health (Sprott 1988;Lantz et al 2003). Community participation is indispensable in order to ensure that researchers are responsible to the community, that the research is relevant to the community and that the consequences of the research will be positive for the participants and the community overall (Banner et al 1995;Israel et al 1998).…”