Building Mixtec Community Capacity to Address Breast Health

Institution: University of California, Los Angeles
Investigator(s): Annette  Maxwell , DrPH - Sandra  Young ,  -
Award Cycle: 2012 (Cycle 18) Grant #: 18AB-1400 Award: $168,750
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Disparities: eliminating the unequal burden of breast cancer



Initial Award Abstract (2012)

Introduction: Mixtec have immigrated from one of the poorest areas of Mexico and have become one of the largest indigenous groups of farm workers in California, estimated at 82,000 to 125,000. An estimated 20,000 Mixtecs live in Ventura County. Many are unable to read and write even at a basic level in any language and speak neither Spanish nor English, but only their native non-written Mixteco language. They face exploitation and discrimination in labor, housing and everyday life and most live in extreme poverty. Mixteco/Indigena Community Organizing Project (MICOP), a 501(c)(3) nonprofit corporation, was founded in 2001 and provides referrals to health and social services, case management, trainings and educational workshops, language interpretation services, along with cultural pride and awareness events to about 5,000 individuals annually. The UCLA Center for Cancer Prevention and Control Research has assisted MICOP with training Mixtec-Spanish bilingual promotoras and during that training, MICOP staff and promotores identified breast health as a community priority.

Question(s) or hypotheses: The pilot CRC represents one of the first research projects in the Mixtec community with a focus on breast health. We will need information on community demographics and breast cancer screening utilization and a method for recruiting Mixtec women before we can launch a trial in this population. Research questions center around how to best reach out to Mixtec farmworkers, what types of programs can be successfully implemented, and what are scientifically rigorous study methodologies that are acceptable to this community.

General methodology: MICOP promotores will conduct a door-to-door needs assessment with at least 1,000 households to obtain information on household composition, needs, and service utilization, including breast cancer screening among age-eligible women, as well as eliciting community concerns and current access to service agencies. This directory will be a tool for recruiting community members for breast cancer research and other studies and will assist MICOP in planning and delivering community services. We will conduct focus groups and one-on-one interviews with women and men, as well as one-on-one interviews with staff from 3 community clinics to learn about barriers and facilitators of breast cancer screening and to explore how we can adapt evidence-based strategies to promote breast health for the Mixtec population. By working together, we hope to strengthen our partnership, and we will conduct a partnership evaluation to determine strengths of our partnerships and aspects that need to be improved.

Innovative elements: Innovative aspects of this proposal are (1) the focus on an overlooked population that does not have a written language, (2) the inclusion of men in an attempt to modify strong community norms against breast cancer screening, (3) the involvement of promotoras in assessing the needs of the population and in developing intervention strategies to promote breast health, and (4) a strong focus on Mixtec community capacity building .

Community involvement: Breast health was identified as a health priority in focus groups with both Mixtec promotores and women in the Mixtec community. The proposal was jointly developed by MICOP and UCLA. The Mixtec Advisory Committee (13 women and 8 men) as well as a group of 12 promotores voted to support the proposed study and provided letters of support. The community will stay involved and informed about the project through updates at the monthly community meetings that are often attended by several hundred members of the Mixtec community. The Mixtec Advisory Committee has agreed to review all study protocols and assessment forms, advise on all activities throughout the study, and assist in interpretation and dissemination of the findings. While we will conduct focus groups with a small number of women and men to gain a better understanding of the community norms regarding breast cancer screening and what it will take to modify these norms, the community needs assessment (AIM 1) will involve 1,000 households and therefore allow for broader community involvement. In addition, MICOP is planning to use the needs assessment form developed in the proposed study in other ongoing projects and outreach efforts to build a large data base for service planning and delivery.

Future Plans: At the end of the 18 months pilot study, we expect to have the tools, strategies and products developed to promote breast health in this population. We plan to apply for a Full CRC award to test these strategies. However, this effort can only be successful if community norms regarding breast cancer screening can be modified. Long-term goals are to build the Mixtec community capacity to address breast cancer disparities and to promote breast health.




Final Report (2015)

This pilot study represents one of the first research projects among indigenous people from Mexico who have settled in the U.S. Specific aims were to conduct a needs assessment survey in the Mixtec community in Ventura County; and to conduct focus groups with men and women to obtain community perspectives on mammography screening.

Indigenous promotoras conducted 989 household surveys in Spanish and 2 indigenous, non-written languages (Mixteco and Zapoteco) in Oxnard, Port Hueneme and El Rio between May and September 2013. Respondents were predominantly female (84%), married or living together (87%) and all were born in Mexico. Languages spoken at home included Spanish and Mixteco (54%), Mixteco only (23%), Spanish and Zapoteco (8%), Spanish only (8%) and English and at least one other language (7%). Respondents reported insufficient employment opportunities (74%), food for the family (59%) or housing (48%), lack of transportation (59%), and discrimination or bullying (34%). Most reported access to medical care for children (90%), but only 57% of respondents were able to get health care for themselves. Most women reported breast feeding (94%), and receipt of a pelvic exam (85%) and a breast exam (72%), but only 39% of women knew where to obtain a free or low cost pelvic or breast exam. Of women 40 years and older (N=122), only 48% had ever heard of and 33% had ever had a mammogram. Among women 50 years and older (n=43), 43% had ever heard of and 36% had ever had a mammogram. Only 11% of women 50 years and older had a mammogram within the past 2 years and 30% knew where to obtain a free mammogram. Members of 4 focus groups expressed that they lacked knowledge on cancer and screening tests. Women were fearful about going to the doctor, not knowing what to expect and because some had heard negative experiences from other women. Barriers to obtain a mammogram included cost, lack of knowledge, lack of time and transportation, fear and lack of trust in the medical system and lack of interpreters. Recommendations to increase cancer screening included holding a screening event in a local community setting or van on Sunday afternoon, having female providers for breast exams and mammograms, having interpreters available, conducting door-to-door outreach and advertising screening through the radio, and to provide small incentives to women who complete screening

Through a community-based participatory research process that included an established and trusted community organization, we were able to conduct almost 1,000 surveys in two indigenous languages and in Spanish in an immigrant community that is largely undocumented and has low levels of income and education. Our survey documents that the Mixtec and Zapotec community in Ventura County experiences major problems in many basic needs. Breast cancer screening rates are extremely low. We have submitted a proposal for a study that will develop a community-wide and an individually-directed intervention to promote breast health.



Training Mixtec Promotores to Assess Health Concerns in their Community: A CBPR Pilot Study. Journal of Immigrant and Minority Health
Periodical:Journal of Immigrant and Minority Health
Index Medicus: J Immigr Minor Health
Authors: Maxwell AE, Young S, Rabelo Vega R, Herrmann AK, See C, Glenn BA, Mistry R, Bastani R.
Yr: 2012 Vol: Sept. Nbr: Abs: Pg:

Social determinants of health in the Mixtec and Zapotec community in Ventura County, California.
Periodical:International Journal for Equity in Health
Index Medicus:
Authors: Maxwell AE, Young S, Crespi CM, Rabelo Vega R, Cayetano RT, Bastani R
Yr: 2015 Vol: 14 Nbr: 1 Abs: Pg:16

Building Capacity to Address Women's Health Issues in the Mixtec and Zapotec Community
Periodical:Women's Health Issues
Index Medicus:
Authors: Maxwell AE, Young S, Crespi CM, Rabelo Vega R, Cayetano RT, Bastani R
Yr: 2015 Vol: 25 Nbr: 4 Abs: Pg:403-9